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Despite effective antiretroviral treatment, neurocognitive impairment (NCI) and functional disability remain concerningly prevalent among people living with HIV (PLWH). Despite this, there are currently no adequate evidence-based treatments targeting NCI in PLWH who reside in low- and middle -income countries. This is a major public health concern given that most the global population of PLWH is concentrated in those countries. Studies emerging from high-income countries of the global north suggest that different forms of cognitive remediation therapy (e.g., compensatory cognitive training [CCT] and restorative computer-based cognitive remediation training [CCRT]) may be helpful in treating NCI in PLWH. This developmental pilot study is the first to culturally adapt and pilot test a CCT approach (CogSMART) and a CCRT approach (BrainHQ©) for use in African PLWH. Forty-three participants (mean age = 41.1 ± 5.4 years) were randomized into either an intervention group (n = 27) or a matched-contact control group (n = 16). All participants completed a neuropsychological test battery and self-report measures of mental health and everyday functional competencies at baseline and at study exit. Participants assigned to the intervention group completed 10 CogSMART and 20 BrainHQ© sessions over the 5 weeks between baseline and exit testing. A significantly smaller proportion of intervention-group participants met criteria for neurocognitive impairment at study exit (30%) than at baseline (70%). Mixed-model analyses detected a significant and a noteworthy time x group interaction effect for the two cognitive outcomes, Global Deficit Score (p < 0.001) and delayed verbal memory (p = 0.050). In both cases, intervention-group participants made greater cognitive gains than controls participants over the 5-week trial period. Culturally adapted cognitive remediation therapy shows good potential to reduce symptoms of NCI among South African PLWH. Reduction of such symptoms could, in turn, lead to better quality of life and other functional and health improvements. However, the current results must be replicated using larger-scale randomized controlled trials in the same setting. Future research should also seek to better understand the barriers to, and facilitators of successful implementation of neurorehabilitation interventions for NCI among PLWH in low- and middle-income countries. ClinicalTrials.gov NCT06466642.