HIV Clinic-based Screening for Geriatric Syndromes in Older Adults with HIV

PROJECT SUMMARY AND ABSTRACT Older people with HIV (PWH) experience more comorbidities and are at increased risk for geriatric syndromes at relatively younger ages than their peers without HIV. However, identification and management of geriatric syndromes in PWH remains a clinical challenge in HIV care. The frequency of geriatrics assessment as part of routine HIV care for older PWH has not been reported. Furthermore, no studies to date have rigorously evaluated implementation of such assessments integrated in clinics dedicated to the care of PWH (HIV clinics). To address this gap in clinical care, we will use implementation research and user-centered design to implement and evaluate an HIV clinic-based screening intervention for 2 key geriatric syndromes in this population, cognitive and physical function impairment. The Montefiore Center for Positive Living (CPL) provides care to over 2,800 PWH per year, approximately half of whom are aged 50 years old or older. CPL clinic staff will be trained to administer evidence-based screening assessments of cognitive and physical function and will be educated on appropriate follow-up care for all PWH aged 50 years old or older who receive continuity care in the clinic. Specifically, we aim to: 1) utilize user-centered design to select implementation strategies for the screening intervention and process with key stakeholders, 2) evaluate the implementation outcomes of the screening and care pathway protocol for physical function impairment and memory loss among older PWH, and 3) identify contextual factors associated with variability in implementation outcomes among patients, providers, and other clinic staff. With co-mentorship from an interdisciplinary team of researchers, Mary Clare Masters, MD/MSCI, seeks to build upon her previous clinical research experience at the intersection of HIV and aging. Dr. Masters will receive training in implementation science, qualitative and mixed research methods, participatory research with a focus on inclusion of vulnerable populations (particularly older adults who have cognitive or physical function impairment) and addressing social determinants of health, and advanced leadership skills. Her long- term research goal is to become an independent investigator focused on implementing scalable and sustainable interventions to reduce functional and cognitive impairment and promote resilience among older PWH. The integrated research infrastructure at Albert Einstein College of Medicine and Montefiore Medical Center will facilitate achievement of her academic goals. Future research directions include evaluating this intervention’s impact on clinical outcomes and retention in appropriate care and its scale-up to additional sites. These data are essential to inform the most appropriate strategies for sustaining and expanding HIV geriatric programs in the future.