{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:51:05Z","timestamp":1791622265610,"version":"4.3.4"},"reference-count":53,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"amfAR, The Foundation for AIDS Research","award":["D43TW011302"],"award-info":[{"award-number":["D43TW011302"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["AIDS Patient Care and STDs"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:p>\n                    In the antiretroviral therapy era, as people living with HIV (PWH) age, the decline of HIV-associated dementia has been accompanied by a growing burden of earlier Alzheimer-type pathology and other milder, heterogeneous cognitive impairments, underscoring the need for proactive detection and multidisciplinary management within routine HIV care. Yet, cognitive care remains largely absent, particularly in low- and middle-income countries (LMIC). We evaluated readiness to integrate a multidomain cognitive-rehabilitation program into tertiary HIV clinic in Malaysia and identified implementation determinants. We used a sequential mixed-methods design. An online Knowledge\u2013Attitude\u2013Practice survey was distributed to all infectious-disease physicians nationwide (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    = 94). Qualitative data were generated through focus-group discussions with health care providers (HCPs) and in-depth interviews with PWH aged &gt;40 years. Transcripts were analyzed thematically using the Consolidated Framework for Implementation Research (CFIR 2.0). Forty-nine physicians responded (52.4% response), median age was 44 years (inter-quartile range (IQR) 38\u201351), and 71.4% were female. While 71\u201382% demonstrated satisfactory knowledge and attitudes toward cognitive health, 88% reported poor practice; only 20.5% routinely screened older PWH. Thirty-three HCPs from multidisciplinary backgrounds participated in five focus groups, alongside 19 in-depth interviews with PWH. Three interlinked domains emerged: (1) knowledge\u2013practice gap related to uncertainty around screening tools, referral pathways, and evidence applicability; (2) systemic barriers including time constraints, high caseloads, lack of guidelines, and workforce limitations; and (3) stigma affecting acceptability. Facilitators included strong patient motivation for brain health, allied health upskilling, physician-initiated referrals, and dedicated care coordination. Integration of multidisciplinary cognitive rehabilitation is hindered by modifiable structural deficits in knowledge translation, workforce organization, and guideline support. HIV-adapted screening algorithms, formalized referral processes, and task-shared coordinator roles could enable earlier cognitive interventions for older adults living with HIV in Malaysia and similar LMIC settings.\n                  <\/jats:p>","DOI":"10.1177\/10872914261423775","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T06:39:37Z","timestamp":1772260777000},"page":"161-173","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Cognitive Care the Next Blind Spot in HIV Clinical Practice? Exploring the Facilitators and Barriers to Integrating Cognitive Care into Routine HIV Care in Malaysia: A Mixed Method Study"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6279-3999","authenticated-orcid":false,"given":"Kejal","family":"Hasmukharay","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Geriatric Unit, Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho","family":"Ming Hui","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazlin A.","family":"Mahyudin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anisa","family":"Salleh","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Research for AIDS (CERIA), Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjanna","family":"Kukreja","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Infectious Diseases Unit, Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pui Li","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Infectious Diseases Unit, Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Meng Li","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Infectious Diseases Unit, Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor J.","family":"Ong","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan","family":"Xin Woen","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Research for AIDS (CERIA), Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syaza","family":"Hisham","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Research for AIDS (CERIA), Universiti Malaya, Kuala Lumpur, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh Kumar","family":"Verma","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Management Science University, Shah Alam, Malaysia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn L.","family":"Lovero","sequence":"additional","affiliation":[{"name":"Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Ross","sequence":"additional","affiliation":[{"name":"Therapeutics Research, Education and AIDS Training in Asia (TREAT Asia), amfAR \u2013 The Foundation for AIDS Research, Bangkok, Thailand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena","family":"Rajasuriar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 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