Investigating an Executive Function Intervention Using Goal Management Training in HIV+ Adolescents in South Africa

Master Thesis


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Advances in pharmacological treatment and medical management of HIV have resulted in decreases in HIV-associated mortality and morbidity for people living with HIV worldwide. However, many HIV+ individuals continue to experience some degree of neurocognitive impairment, particularly in the domain of executive functioning. HIV-related executive deficits are particularly pertinent in the adolescent population as individuals transition into adulthood and assume greater responsibility for their daily functioning. Despite the high prevalence of HIV in South African adolescents, neuropsychological rehabilitation interventions are largely absent. Currently, metacognitive approaches such as Goal Management Training (GMT) demonstrate the best evidence base for improving executive functions. The main aim of this study was to evaluate the effectiveness of a pGMT intervention for HIV+ adolescents in South Africa. A secondary objective was to provide commentary on the feasibility of conducting cognitive rehabilitation interventions in low resourced settings such as those commonly found in South Africa. This quantitative study used a pre-test post-test quasi experimental research design to investigate the effectiveness of a 7-week pGMT intervention in HIV+ adolescents in South Africa. Participants included 18 HIV+ adolescent (aged 14-17) first language Xhosa speakers from low socio-economic backgrounds. Participants formed two groups: a pGMT intervention (n = 10), and a Control (n = 8) group. A neuropsychological test battery was administered pre- and post- intervention to assess executive functions. Neuropsychological test scores were sorted into four executive function composite domains. To assess the efficacy of the pGMT intervention, these executive function domains were analysed using a mixed-design ANOVA and Mann-Whitney U analysis of difference scores. No significant effects were detected, suggesting that the pGMT intervention demonstrated limited efficacy in the study sample. However, the successful implementation of the intervention supports the use of the GMT protocol in low-resourced settings such as those commonly found in LMICs like South Africa. Findings of the current study contribute valuable insights into the limitations and opportunities relevant not only to research in this field, but also more broadly to the implementation of cognitive rehabilitation interventions in LMICs such as South Africa.