Informal Caregiving in Patients With Atrial Fibrillation and Multimorbidity: A Cross-European Study of Caregiver Burden, Health-Related Quality of Life, and Caregiver Engagement.

The HIV epidemic continues to have a significant impact on sub-Saharan Africa, where nearly two-thirds of all people with HIV (PWH) reside (). Brain health disorders, including cognitive impairment and mental health disorders, remain common despite effective antiretroviral therapy (). The burden of these complications is particularly high in resource-limited settings such as Uganda (; ), underscoring the need for region-specific data to identify modifiable factors and inform interventions to preserve brain health. Facial emotion processing (FEP), the ability to rapidly and accurately interpret others’ emotions, is a core aspect of social cognition and has been identified by the National Institute of Mental Health’s Research Domain Criteria (RDoC) framework as a fundamental process underlying brain health. FEP engages multiple cognitive operations, with strongest links to attention and memory (; ; ; ; ) and more mixed evidence for executive function (; ). Deficits in FEP are well-documented in psychiatric and neurological disorders and are strongly linked to impaired social functioning (; ; ; ; ; ; ). In HIV, fewer studies have examined FEP, but evidence suggests that PWH show lower accuracy and slower reaction times than people without HIV (PWoH)(; ; ; ; ), particularly for negative emotions such as fear, sadness, and anger (; ; ; ). Beyond accuracy, FEP bias, the tendency to misinterpret or misattribute emotions, is an important but understudied dimension of social cognition. In PWoH, heightened negativity bias has been consistently linked to conditions such as depression, posttraumatic stress disorder, and borderline personality disorder (; ; ; ; ; ), implicating overlap with the RDoC-defined negative valence system. To date, FEP bias has not been studied in PWH, and nearly all prior work has been conducted in high-income countries, leaving substantial gaps in regions most affected by the epidemic. To address these gaps, we examined both FEP accuracy and bias among PWH and PWoH in the Rakai Neurology Cohort Study (RNCS) in Uganda. We hypothesized that PWH would demonstrate lower accuracy for negative emotions and greater negativity bias compared to PWoH. Using the RDoC framework, we also evaluated cognitive, mental health, and demographic correlates of FEP to identify pathways that may inform targeted intervention strategies.