Due in large part to the successful development of antiretroviral therapy, adults with HIV infection are living longer; in the United States, 47% of all people living with HIV are age 50 and older. This aging population increasingly experiences multimorbidity, polypharmacy, and significant mental health and psychosocial challenges. Older HIV-positive adults also experience a high frequency of geriatric conditions including falls, frailty, and functional impairment. Geriatric assessment and management could help address this medical and social complexity. Supporting a role for geriatric assessment, studies show that assessments can predict hospitalization and mortality among older HIV-positive adults and geriatric conditions are associated with poorer quality of life. Yet little is known on how to best integrate geriatric assessment and management in HIV care settings. Strategies developed need to be efficient, able to be administered by non-geriatrics trained clinicians, and also tailored to the unique aging issues that are influenced by HIV infection. Our proposal addresses this knowledge gap by developing and testing a tailored Geriatric Assessment and Initial Management guide focused on the needs of older HIV-positive adults, also referred to as G-AIM HIV. Specifically, the objectives of this proposal are to 1) develop G-AIM HIV by incorporating patient and expert perspectives on the most important geriatric assessment domains and initial management steps; 2) examine HIV providers? and staff attitudes towards G-AIM HIV and identify facilitators and barriers to its use; and 3) pilot G-AIM HIV in two HIV outpatient settings to evaluate feasibility, acceptability and preliminary patient reported outcomes such as quality of life. The objectives of this proposal support the career development activities of the PI Dr. Meredith Greene focused on 1) Delphi methodology and stakeholder engagement, 2) qualitative research methods, 3) intervention and clinical trial research with vulnerable populations, and 4) ongoing leadership development. Dr. Greene will conduct all work at the University of California, San Francisco with an exceptional mentoring team, led by Dr. Kenneth Covinsky. This K76 Beeson proposal will advance our knowledge of how to integrate geriatric principles into HIV care to improve quality of life for older HIV-positive adults. It will also provide advanced research skills and valuable data to launch Dr. Greene?s career as an independent investigator and leader at the intersection of HIV and geriatric medicine.
The number of older adults living with HIV is dramatically increasing in the United States and they are facing unique health concerns which need to be better addressed. The objective of this proposal is to develop and test a tailored geriatric assessment and initial management strategy for older HIV-positive adults that can be used in HIV outpatient settings. Ultimately, the information learned from this proposal will lead to the development of clinical interventions to improve quality of life for the aging HIV population.
