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      Focus groups inform a mobile health intervention to promote adherence to a Mediterranean diet and engagement in physical activity among people living with HIV

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          Abstract

          Background

          A personalized mobile health intervention (iSTEP) aims to promote a Mediterranean diet and increase physical activity, thereby improving neurocognitive functioning among persons living with HIV (PLWH). This article describes a qualitative study conducted to develop iSTEP for PLWH, including assessment of diet habits and preferences for tracking physical activity.

          Method

          Two focus groups, with seven and 13 PLWH respectively, discussed barriers and facilitators of a healthy diet and provided feedback to refine iSTEP components, including the feasibility of using a Fitbit and the content of text messages designed to encourage improved diet and physical activity.

          Results

          Focus group discussions revealed several healthy diet barriers, including housing instability, time required for food preparation, cost of healthy food, depression, gastrointestinal issues, physical disability, and changes in appetite since HIV diagnosis. Participant-identified healthy diet facilitators included affordable price options for healthy food, a structured food plan, desire to modify appearance or weight, access to medical professionals, motivation for disease prevention, and social support. Participants endorsed wearing a Fitbit on the wrist and receiving text messages as useful methods to monitor and encourage a better diet and greater physical activity.

          Conclusions

          These findings assisted the expansion of a mobile health intervention that promotes health behaviors in order to improve neurocognitive outcomes among PLWH.

          Trial registration

          NCT03123731, prospectively registered on ClinicalTrials.gov, April 21, 2017.

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          Most cited references39

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          mHealth Technologies to Influence Physical Activity and Sedentary Behaviors: Behavior Change Techniques, Systematic Review and Meta-Analysis of Randomized Controlled Trials.

          mHealth programs offer potential for practical and cost-effective delivery of interventions capable of reaching many individuals.
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            Mediterranean diet and brain structure in a multiethnic elderly cohort.

            To determine whether higher adherence to a Mediterranean-type diet (MeDi) is related with larger MRI-measured brain volume or cortical thickness.
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              Current understanding of HIV-associated neurocognitive disorders pathogenesis.

              The present review discusses current concepts of HIV-associated neurocognitive disorders (HAND) in the era of antiretroviral therapy (ART). As the HIV epidemic enters its fourth decade (the second decade of ART), research must address evolving factors in HAND pathogenesis. These include persistent systemic and central nervous system (CNS) inflammation, aging in the HIV-infected brain, HIV subtype (clade) distribution, concomitant use of drugs of abuse, and potential neurotoxicity of ART drugs. Although the severest form of HAND, HIV-associated dementia (HAD), is now rare due to ART, the persistence of milder, functionally important HAND forms persist in up to half of HIV-infected individuals. HAND prevalence may be higher in areas of Africa where different HIV subtypes predominate, and ART regimens that are more effective in suppressing CNS HIV replication can improve neurological outcomes. HAND are correlated with persistent systemic and CNS inflammation, and enhanced neuronal injury due to stimulant abuse (cocaine and methamphetamine), aging, and possibly ART drugs themselves. Prevention and treatment of HAND requires strategies aimed at suppressing CNS HIV replication and effects of systemic and CNS inflammation in aging and substance-abusing HIV populations. Use of improved CNS-penetrating ART must be accompanied by evaluation of potential ART neurotoxicity.
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                Author and article information

                Contributors
                619-543-4737 , blhenry@ucsd.edu
                elquintana@ucsd.edu
                djmoore@ucsd.edu
                johngarciamed@ucsd.edu
                jlmontoya@ucsd.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                22 January 2019
                22 January 2019
                2019
                : 19
                : 101
                Affiliations
                [1 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, School of Medicine, Department of Psychiatry, , University of California, San Diego, ; La Jolla, CA USA
                [2 ]Cancer Center, University of California, San Diego, La Jolla, CA USA
                Article
                6386
                10.1186/s12889-018-6386-5
                6343351
                30606151
                8ce738c2-5cff-4812-bdfd-da34131008b6
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 16 September 2018
                : 28 December 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000056, National Institute of Nursing Research;
                Award ID: R01 NR016912
                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R21 MH100968
                Award ID: P30 MH062512
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Public health
                focus groups,mediterranean diet,hiv,mhealth,neurocognition
                Public health
                focus groups, mediterranean diet, hiv, mhealth, neurocognition

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