Characterizing opioid agonist therapy uptake and factors associated with treatment retention among people with HIV in British Columbia, Canada.

Accidental overdoses are now the leading cause of death among people with HIV (PWH) in British Columbia (BC). We examined the utilization and retention of opioid agonist therapy (OAT). Adult PWH (≥19 years) with ≥ 1 OAT dispensation in BC between 2008 and 2020 were included (n = 1,515). OAT treatment episodes were formed based on specific criteria for slow-release oral morphine (SROM), methadone, injectable OAT (iOAT), and buprenorphine/naloxone. Retention in treatment was defined as any episode lasting ≥ 12 months. Logistic regression with generalized estimating equations modeled retention-associated factors. There was a 56.6% decline in OAT retention over time. Buprenorphine treatment exhibited significantly lower odds of retention (OR: 0.58; 95% CI: 0.36-0.92) compared to methadone. Conversely, no significant change in retention odds was observed for SROM (0.72; 0.33-1.54) and iOAT (0.81; 0.31-2.12). Factors associated with increased odds of retention included a 10-year increase in age (1.69; 1.46-1.95), previous retention history (1.96; 1.40-2.73), achieving OAT therapeutic dose (8.22; 6.67-10.14), and suppressed HIV viral load (1.35; 1.10-1.67). Individuals with a lifetime HCV diagnosis receiving iOAT were more likely to retain (3.61; 1.20-10.83). Each additional year on OAT during the study period was associated with a 4% increase in the odds of retention. A significant proportion of PWH had a history of OAT prescribing but experienced low retention rates. Retention outcomes were more positive for SROM and iOAT. The association between OAT medication type and retention odds may be particularly influenced by HCV diagnosis. Optimal management of opioid use disorder among PWH, with an emphasis on attaining the therapeutic dose is crucial.

Comparing virtual reality, desktop-based 3D, and 2D versions of a category learning experiment.

Virtual reality (VR) has seen increasing application in cognitive psychology in recent years. There is some debate about the impact of VR on both learning outcomes and on patterns of information access behaviors. In this study we compare performance on a category learning task between three groups: one presented with three-dimensional (3D) stimuli while immersed in the HTC Vive VR system (n = 26), another presented with the same 3D stimuli while using a flat-screen desktop computer (n = 26), and a third presented with a two-dimensional projection of the stimuli on a desktop computer while their eye movements were tracked (n = 8). In the VR and 3D conditions, features of the object to be categorized had to be revealed by rotating the object. In the eye tracking control condition (2D), all object features were visible, and participants' gaze was tracked as they examined each feature. Over 240 trials we measured accuracy, reaction times, attentional optimization, time spent on feedback, fixation durations, and fixation counts for each participant as they learned to correctly categorize the stimuli. In the VR condition, participants had increased fixation counts compared to the 3D and 2D conditions. Reaction times for the 2D condition were significantly faster and fixation durations were lower compared to the VR and 3D conditions. We found no significant differences in learning accuracy between the VR, 3D, and 2D conditions. We discuss implications for both researchers interested in using VR to study cognition, and VR developers hoping to use non-VR research to guide their designs and applications.

A 20-year population-based study of all-cause and cause-specific mortality among people with concurrent HIV and psychotic disorders.

OBJECTIVE: We aimed to characterize mortality among people with HIV (PWH) and psychotic disorders (PWH/psychosis+) vs. PWH alone (PWH/psychosis-). METHOD: A population-based analysis of mortality in PWH (age ≥19) in British Columbia (BC) from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) study. Deaths were identified from the Vital Statistics Data (classified as HIV vs. non-HIV causes). Mortality trends across all fiscal years were examined. Cox models assessed the hazard of psychotic disorders on mortality; possible differences between schizophrenia and nonschizophrenia types of psychotic disorders were also evaluated. RESULTS: Among 13 410 PWH included in the analysis, 1572 (11.7%) met the case definition for at least one psychotic disorder. Over the study period, 3274 deaths (PWH/psychosis-: n  = 2785, PWH/psychosis+: n  = 489) occurred. A decline over time in all-cause mortality and HIV-related mortality was observed in both PWH/psychosis+ and PWH/psychosis- ( P value <0.0001). A decline in non-HIV mortality was observed among PWH/psychosis- ( P value = 0.003), but not PWH/psychosis+ ( P value = 0.3). Nonschizophrenia psychotic disorders were associated with increased risk of mortality; adjusted hazard ratios with (95% confidence intervals): all-cause 1.75 (1.46-2.09), HIV-related 2.08 (1.60-2.69), non-HIV-related 1.45 (1.11-1.90). Similar associations between schizophrenia and mortality were not observed. CONCLUSION: People with co-occurring HIV and nonschizophrenia psychotic disorders experienced a significantly higher risk of mortality vs. PWH without any psychotic disorder. Implementing care according to syndemic models considering interactions between HIV and particularly episodic psychotic disorders could help manage mortality risk more effectively among PWH/psychosis+.

Knowledge of hepatitis C and awareness of reinfection risk among people who successfully completed direct acting antiviral therapy.

BACKGROUND: Hepatitis C virus (HCV) education may be changing following the simplification of HCV treatment and emergence of direct acting antiviral (DAA). We aimed to characterize HCV knowledge among people who recently completed DAA therapy. METHODS: The Per-SVR (Preservation of Sustained Virologic Response) is a prospective cohort of patients who achieved a sustained virologic response upon successful completion of DAA therapy. The per-SVR study provided the sampling frame of participants who completed a psychometrically validated 19-item HCV knowledge scale at cohort entry (n = 227). To score the questionnaire, for each correct response one point was awarded, with no point for incorrect response. We assessed mean HCV knowledge score in the overall sample and mutually exclusive populations: people who inject drug (PWID) (n = 71); people with co-occurring HIV (n = 23); PWID and co-occurring HIV (n = 29), and others (n = 104) Using a latent class analysis based on distal outcome, we identified unobserved subgroups and assessed HCV knowledge amongst them. RESULTS: Total mean (SD) percent of correct responses were 83 (11) in the overall sample; 83 (10) in PWID; 79 (12) in people with co-occurring HIV; 81 (10) in PWID and co-occurring HIV, and 84 (11) in rest of the sample Three latent groups were identified: baby boomers who ever experienced homelessness (n = 126); women sex workers who ever experienced homelessness (n = 68); men who inject drug, ever experienced homelessness and had ever diagnosis of mental health disorders (n = 18). Mean percent of correct responses were 85 (8), 82 (11), 85 (10), in latent class 1, 2, and 3, respectively. CONCLUSION: Patients successfully treated with DAAs had a high HCV knowledge. High knowledge and awareness of reinfection among complex patient groups often facing barriers to HCV care is encouraging and emphasizes the positive outcomes of universal access to treatment.

The ubiquity of selective attention in the processing of feedback during category learning.

Feedback is essential for many kinds of learning, but the cognitive processes involved in learning from feedback are unclear. Models of category learning incorporate selective attention to stimulus features while generating a response, but during the feedback phase of an experiment, it is assumed that participants receive complete information about stimulus features as well as the correct category. The present work looks at eye tracking data from six category learning datasets covering a variety of category complexities and types. We find that selective attention to task-relevant information is pervasive throughout feedback processing, suggesting a role for selective attention in memory encoding of category exemplars. We also find that error trials elicit additional stimulus processing during the feedback phase. Finally, our data reveal that participants increasingly skip the processing of feedback altogether. At the broadest level, these three findings reveal that selective attention is ubiquitous throughout the entire category learning task, functioning to emphasize the importance of certain stimulus features, the helpfulness of extra stimulus encoding during times of uncertainty, and the superfluousness of feedback once one has learned the task. We discuss the implications of our findings for modelling efforts in category learning from the perspective of researchers trying to capture the full dynamic interaction of selective attention and learning, as well as for researchers focused on other issues, such as category representation, whose work only requires simplifications that do a reasonable job of capturing learning.

Digit eyes: Learning-related changes in information access in a computer game parallel those of oculomotor attention in laboratory studies.

Active sensing theory is founded upon the dynamic relationship between information sampling and an observer's evolving goals. Oculomotor activity is a well studied method of sampling; a mouse or a keyboard can also be used to access information past the current screen. We examine information access patterns of StarCraft 2 players at multiple skill levels. The first measures are analogous to existing eye-movement studies: fixation frequency, fixation targets, and fixation duration all change as a function of skill, and are commensurate with known properties of eye movements in learning. Actions that require visual attention at moderate skill levels are eventually performed with little visual attention at all. This (a) confirms the generalizability of laboratory studies of attention and learning using eye movements to digital interface use, and (b) suggests that a wide variety of information access behaviors may be considered as a unified set of phenomena.