Unmet basic needs negatively affect health-related quality of life in people aging with HIV: results from the Positive Spaces, Healthy Places study

Systematic Review: HIV, Aging, and Housing-A North American Perspective, 2012-2023

Advances in anti-retroviral therapy (ART) have decreased mortality rates and subsequently led to a rise in the number of HIV-positive people living longer. The housing experiences of this new population of interest-older adults (50 years and older) living with HIV-are under-researched. Understanding the housing experiences and unmet needs of older people with HIV can better provide comprehensive care services for them. This study's systematic review evaluated the peer-reviewed literature reporting housing access/insecurity/assistance/options, housing impact, and unmet needs of older individuals living with HIV in North America from 2012 to 2023. Furthermore, Latent Semantic Analysis (LSA), a text-mining technique, and Singular Value Decomposition (SVD) for text clustering were utilized to examine unstructured data from the abstracts selected from the review. The goal was to allow for a better understanding of the relationships between terms in the articles and the identification of emerging public health key themes affecting older adults living with HIV. The results of text clustering yielded two clusters focusing on (1) improvements to housing and healthcare services access and policies and (2) unmet needs-social support, mental health, finance, food, and sexuality insecurities. Topic modeling demonstrated four topics, which we themed to represent (1) a holistic care approach; (2) insecurities-food, financial, sexuality, and other basic needs; (3) access to housing and treatment/care; and (4) homelessness and HIV-related health outcomes. Stable housing, food, and healthcare services access and availability are critical elements to incorporating comprehensive, holistic healthcare for older adults living with HIV. The aging population requires high-priority policies for accessible and equitable healthcare. Clinicians and policymakers should address individual barriers, adopt a patient-centered approach, increase doctor visits, provide competency training, ensure long-term follow-up, involve families, and improve patient education in care management, contributing to HIV/AIDS geriatric care models.

Sex differences in health-related quality of life and poverty risk among older people living with HIV in Spain: A cross-sectional study

BACKGROUND

Current antiretroviral therapies have increased the life expectancy of people living with HIV (PLHIV). There is, however, limited evidence regarding the health-related quality of life (HRQoL) and living conditions of older people living with HIV (OPLHIV) in Spain.

METHODS

We implemented a self-administered online questionnaire to identify sex differences in HRQoL and poverty risk among Spanish OPLHIV (PLHIV ≥50 years). Participants were contacted through non-governmental organisations. We used the standardised WHOQoL-HIV BREF questionnaire and the Europe 2020 guidelines to estimate HRQoL and poverty risk respectively. The statistical analysis included multivariable generalised linear models with potential confounding variables and robust estimates.

RESULTS

The study included 247 OPLHIV (192 men and 55 women). On the WHOQoL-HIV BREF questionnaire, men scored higher on 84% of items and in all six domains. Women had significantly lower HRQoL in five domains: physical health (β: -1.5; 95% CI: -2.5, -0.5; p: 0.002), psychological health (β: -1.0; 95% CI: -1.9, -0.1; p: 0.036), level of independence (β: -1.1; 95% CI: -1.9, -0.2; p: 0.019), environmental health (β: -1.1; 95% CI: -1.8, -0.3; p: 0.008), and spirituality/personal beliefs (β: -1.4; 95% CI: -2.5, -0.3; p: 0.012). No statistical differences were found in the domain of social relations. Poverty risk was considerable for both men (30%) and women (53%), but women were significantly more likely to experience it (OR: 2.9; 95% CI: 1.3, 6.5; p: 0.009).

CONCLUSION

The aging of PLHIV is a public health concern. Our findings indicate that HRQoL and poverty risk among Spanish OPLHIV differ significantly by sex. Spain should, therefore, implement specific policies and interventions to address OPLHIV needs. The strategies must place a high priority on the reduction of sex inequalities in HRQoL and the enhancement of the structural conditions in which OPLHIV live.

Human Immunodeficiency Virus in Older Adults

As people with HIV live longer, they can experience increased incidence and earlier onset of chronic conditions and geriatric syndromes. Older people are also at substantially increased risk of delayed diagnosis and treatment for HIV. Increasing provider awareness of this is pivotal in ensuring adequate consideration of HIV testing and earlier screening for chronic conditions. In addition, evaluating patients for common geriatric syndromes such as polypharmacy, frailty, falls, and cognitive impairment should be contextualized based on how they present.

Predictors of poor health-related quality of life among people living with HIV aged ≥60 years in the PISCIS cohort: Findings from the Vive+ project

INTRODUCTION

Advancements in and accessibility to effective antiretroviral therapy has improved the life expectancy of people living with HIV, increasing the proportion of people living with HIV reaching older age (≥60 years), making this population's health-related quality of life (HRQoL) more relevant. Our aim was to identify the determinants of poor HRQoL in people living with HIV aged ≥60 years and compare them with those of their younger counterparts.

METHODS

We used data from the 'Vive+' study, a cross-sectional survey conducted between October 2019 and March 2020, nested within the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands, Spain. We used the 12-item short-form survey (SF-12), divided into a physical component summary (PCS) and a mental component summary (MCS), to evaluate HRQoL. We used the least absolute shrinkage and selection operator for variable selection and used multivariable regression models to identify predictors.

RESULTS

Of the 1060 people living with HIV (78.6% males) who participated in the study, 209 (19.7%) were aged ≥60 years. When comparing older people living with HIV (≥60 years) and their younger counterparts, older people exhibited a worse PCS (median 51.3 [interquartile range {IQR} 46.0-58.1] vs. 46.43 [IQR 42.5-52.7], p < 0.001) but a similar MCS (median 56.0 [IQR 49.34-64.7] vs. 57.0 [IQR 48.9-66.3], p = 0.476). In the multivariable analysis, cognitive function correlated with a PCS (β correlation factor [β] -0.18, p = 0.014), and depressive symptoms and satisfaction with social role correlated with an MCS (β 0.61 and β -0.97, respectively, p < 0.001) in people living with HIV aged ≥60 years.

CONCLUSION

Depressive symptoms, poor cognitive function, and lower satisfaction with social roles predict poorer HRQoL in older people living with HIV. These factors need to be considered when designing targeted interventions.

Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing

OBJECTIVES

Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health-related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions.

METHODS

In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1-5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV-related stigma, isolation from the HIV community, and difficulties accessing non-HIV health services.

RESULTS

Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20-3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (β -0.49; 95% CI -0.74 to -0.24), stigma (β -0.53; 95% CI -0.73 to -0.33), isolation from the HIV community (β -0.49; 95% CI -0.70 to -0.29), and difficulties accessing non-HIV health services (β -0.50; 95% CI -0.71 to -0.30).

CONCLUSIONS

Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services.

HIV and an Ageing Population-What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions

The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug-drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review.

The mediation role of self-esteem and hope on the relationship of quality of life and unmet needs of elderly with psychiatric disorders

BACKGROUND

Self-esteem is one of the factors affecting the quality of life. On the other hand, quality of life decreases in people with psychiatric disorders. The aim of the present study was to evaluate the mediating role of self-esteem and hope on the relationship between unmet needs and quality of life of the elderly with psychiatric disorders.

MATERIALS AND METHODS

This descriptive-analytical study was performed on 112 chronic psychiatric patients hospitalized in the geriatric ward of (blinded) 2020. Based on the inclusion criteria, a total of 100 samples were entered into the study by census. The World Health Organization (WHO) quality of life questionnaire, Rosenberg Self-Esteem Scale, Snyder Hope Scale, and Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) were used to collect data. The research model was tested using the path analysis technique. Data was analyzed using Statistical Package for the Social Sciences (SPSS) Ver. 26 and LISREL Ver. 2/9.

RESULTS

Unmet needs were negatively related to the other three variables of the study, namely, self-esteem, hope, and quality of life. There was a significant relationship between unmet needs and quality of life with a mediating role of self-esteem and hope (P < 0.05). Quality of life was also negatively related to unmet needs and directly related to self-esteem and hope.

CONCLUSION

Based on the findings of this study, it is essential that health-care providers consider planning to provide programs to improve self-esteem and hope in order to reduce unmet needs and increase the quality of life.

Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop

People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.

Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough?

With improved access to antiretroviral therapy throughout the world, people are aging with HIV, and a large portion of the global population of people with HIV (PWH) is now age 50 or older. Older PWH experience more comorbidities, aging-related syndromes, mental health challenges, and difficulties accessing fundamental needs than the population of older adults without HIV. As a result, ensuring that older PWH are receiving comprehensive healthcare can often be overwhelming for both PWH and the providers. Although there is a growing literature addressing the needs of this population, gaps remain in care delivery and research. In this paper, we suggest seven key components to any healthcare program designed to address the needs of older people with HIV: management of HIV, comorbidity screening and treatment, primary care coordination and planning, attention to aging related-syndromes, optimization of functional status, support of behavioral health, and improved access to basic needs and services. We review many of the difficulties and controversies related to the implementation of these components, which include the absence of screening guidelines for this population and the challenges of care integration, and we suggest key next steps.

"We can hardly even do it nowadays. So, what's going to happen in 5 years from now, 10 years from now?" The health and community care and support needs and preferences of older people living with HIV in Ontario, Canada: a qualitative study

Introduction

The population of people living with HIV (PLWH) is ageing consequent to effective treatment and a steady stream of new diagnoses among older adults. PLWH experience a greater burden of age‐related comorbidities and poorer social determinants of health compared to their HIV‐negative peers, yet comprehensive requisites for care and support as PLWH age remain poorly understood. Preferences And Needs for Ageing Care among HIV‐positive Elderly people in Ontario, Canada (PANACHE ON), explored the health and community care and social support needs and preferences of a diverse group of older PLWH (age 60+) and described life course experiences among older PLWH that shape these needs and preferences and whether they are met.

Methods

PANACHE ON was a qualitative community‐based participatory research study. In‐person focus groups using a semi‐structured interview guide were co‐facilitated by pairs of trained older PLWH from July to October 2019. Purposive sampling bolstered the inclusion of communities disproportionately affected by HIV in Ontario. Descriptive analysis was used to summarize demographic data; participatory data analysis was conducted by a subset of the research team, with transcripts double‐coded and analysed using NVIVO 12 Plus.

Results

A total of 73 PLWH participated, 66% identified as men. The mean age was 64 years (range 55–77) and median time living with HIV was 23 years (range 2–37). The current and anticipated needs of older PLWH, many of which were only partially met, included necessities such as food and housing, mobility and sensory aids, in‐home support, social and emotional support, transportation and information. Three experiences—trauma, stigma and uncertainty—intersected in the lives of many of our participants, shaping their needs for care and support, and impacting the ease with which these needs were met.

Conclusions

Unmet health and social needs and limited control over the availability and accessibility of ageing‐related care and support due to resource constraints or reduced capacity for self‐advocacy results in anxiety about the future among older PLWH, despite their well‐developed coping strategies and experience navigating systems of care. These study findings will inform the development of the first national needs assessment of older PLWH in Canada.

The Association Between Leisure Activity Engagement and Health-Related Quality of Life in Middle-Aged and Older People With HIV

BACKGROUND AND OBJECTIVES

Middle-aged and older adults with human immunodeficiency virus (HIV) are at risk for decreased health-related quality of life (HRQoL), which may be improved by engaging in leisure activities. We examined associations between HRQoL and participation in cognitive, physical, social, and passive leisure activities, and whether depressive symptoms mediated these relationships. Wilson and Cleary's conceptual model of HRQoL guided this study.

RESEARCH DESIGN AND METHODS

In this cross-sectional observational study, we enrolled 174 adults living with HIV aged 40 and older (M = 51.3, SD = 7.03). Participants completed assessments of leisure activities, depressive symptoms, and HRQoL. Data were analyzed using Spearman's rho correlations, hierarchal multiple regression, and mediation analyses.

RESULTS

Greater engagement in physical activities was associated with higher physical HRQoL (b = 2.02, p < .05). Greater engagement in social activities was associated with both higher physical (b = 1.44, p < .05) and mental HRQoL (b = 1.95, p < .01). However, all associations between leisure activities and HRQoL were fully attenuated by depressive symptoms. Cognitive and passive leisure activities were not significantly correlated with HRQoL. Mediation analyses confirmed that depressive symptoms were the mediator mechanism by which social activities affected mental and physical HRQoL.

DISCUSSION AND IMPLICATIONS

More frequent engagement in physical and social leisure activities is associated with better HRQoL, and social leisure activities improve HRQoL via their impact on mood. Interventions to increase leisure activities, especially among people living with HIV who have poorer affective functioning, may be the most effective approach to improving HRQoL.

Problems undermining the health-related quality of life of people living with HIV in Spain: a qualitative study to inform the development of a novel clinic screening tool

Background

In settings with high antiretroviral therapy coverage, numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). As part of a larger study to develop and validate a new patient-reported outcome measure for use in HIV clinical care in Spain, we sought to identify the most burdensome health-related issues experienced by PLHIV in order to determine which issues should be addressed in the new instrument.

Methods

We conducted a literature review and a qualitative study based on four focus group discussions (FGDs) with key informants in Spain. Participants were selected via purposive sampling. Two FGDs convened 16 expert HIV service providers, and two convened 15 PLHIV with diverse epidemiological profiles. FGDs followed semi-structured interview scripts and incorporated an exercise to prioritise the most critical health-related issues among those named in the discussions. Content analysis was conducted using MAXQDA 12.

Results

The analysis of FGD data identified several broad categories of issues that were perceived to negatively affect PLHIV. The most frequently named issues fell within the categories of social problems; physical symptoms; psychological problems; and sexuality-related problems. Regarding social problems, stigma/discrimination was by far the issue raised the most frequently. In the prioritisation exercise, stigma/discrimination was also ranked as the most burdensome issue by both service providers and PLHIV. Within the physical symptoms category, the issues named most frequently were sleep-related problems, fatigue, physical pain and body fat changes. Regarding psychological problems, FGD participants most commonly spoke of emotional distress in general terms, and also called attention to depression and anxiety. In the prioritisation exercise, both service providers and PLHIV ranked psychological well-being as the second-most important issue following stigma. Sexuality-related problems that were reported included sexually transmitted infections, hormonal problems, lack of libido, and general sexual dissatisfaction.

Conclusions

PLHIV are negatively affected by a wide range of health-related issues. HIV-related stigma and psychological well-being remain major challenges. Identifying and addressing these and other issues in routine clinical care supports healthy aging and may ultimately contribute to better health and HRQoL outcomes in this population.

Food and medicinal uses of Annona senegalensis Pers.: a country-wide assessment of traditional theoretical knowledge and actual uses in Benin, West Africa

BACKGROUND

The growing interest for more natural products in food and health industries has led to increasing research on traditional knowledge related to plants. While theoretical knowledge (TK) on the uses of a species informs on the wide spectrum of potential uses of that species, actual uses (AU) highlight their potential being actually used. Distinguishing between the two is important when reporting ethnobotanical studies. However, studies often equated AU and TK, sometimes misleading conclusions, and decision-making. This study assessed TK, AU, and difference between TK and AU of Annona senegalensis and how each is related to factors such as age, sex, sociolinguistic group, and main activity in Benin republic.

METHODS

Data were collected through semi-structured individual interviews (n = 755) and analyzed using among others, relative frequency of citation (RFC), and use-value (UV).

RESULTS

A total of 168 theoretical uses were recorded but only 92 were "actually" practiced, of which four were food and 88 medicinal uses. TK and AU were positively correlated. As expected, TK was also significantly higher than AU, indicating that some potential uses of the species are still not valued. Sociolinguistic group and main activity, not age and sex, were the main factors influencing TK, AU, and difference between TK and AU. The highest TK was found with Bariba sociolinguistic group and the highest AU with Otamari. Fruits (100%) and flowers (10%) were the most used organs for food, while leaves (40%) and roots (7%) were mostly used for medicinal purposes. The most common food uses were consumption of the ripe fruits (100%), and food seasoning with flowers (10%). The most cited diseases were malaria (28%) and intestinal worms (8%).

CONCLUSIONS

The study illustrated the importance of differentiating between TK and AU. It documented  the wide range of the uses of A. senegalensis, while highlighting its most common uses, and the need to better valorize and sustainably manage the species.

From surviving to thriving: the current status of the behavioral, social, and psychological issues of aging with HIV

PURPOSE OF REVIEW

Despite significant advances in knowledge regarding the biological and clinical issues related to aging with HIV, significantly less research has centered on related psychological, behavioral, and social issues, which are increasingly recognized as important for successfully aging with HIV.

RECENT FINDINGS

Barriers to successful aging include physical challenges from a sociobehavioral perspective, psychosocial challenges, and system-level challenges. In contrast, several resiliencies and interventions that help facilitate healthy aging with HIV are also emerging. Comprehensive interventions to address the physical, mental, and psychosocial needs of older people living with HIV (OPLWH) are necessary.

CONCLUSION

To promote healthy aging with HIV, we must utilize both clinical and biopsychosocial interventions. The lack of data on the needs of OPLWH is an important barrier to healthy aging in this population.

Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places

Despite significant advances in antiretroviral therapy, unmet basic needs can negatively impact health-related quality of life (HRQoL) in people living with HIV, especially as they age. We aimed to examine the effect of unmet basic needs across age groups on changes in HRQoL over a 4-year period in persons with HIV. Physical and mental HRQoL scores from the Positive Spaces, Healthy Spaces cohort interviewed in 2006 (n = 538), 2007 (n = 506), and 2009 (n = 406) were examined across three age groups according to their unmet needs for food, clothing, and housing. Individual growth curve model analyses were used to investigate changes over time, adjusting for demographics, employment, living conditions, social supports, HIV status, and health behavior risks. Low scores on physical and mental HRQoL were positively associated with higher number of unmet basic needs (β = −6.40, standard error (SE) = 0.87, p < 0.001 and β = −7.39, SE = 1.00, p < 0.001, respectively). There was a slight improvement in physical and mental HRQoL over 4 years in this HIV cohort, but the burden of unmet basic needs took its toll on those over 50 years of age. Regularly assessing unmet basic needs is recommended given the impact these can have on HRQOL for people living with HIV. Recognition of unmet needs is vital, as is the development of timely interventions.

Serving the Co-Morbid Mental Health and Substance Use Needs of People with HIV

People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location.

Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain

BACKGROUND

Numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). We developed a clinic screening tool (CST-HIV) for the purpose of identifying these issues in routine specialist clinical care in Spain.

METHODS

We used the following established instrument development procedures: (1) a literature review; (2) four focus group discussions (FGDs), two that convened 16 expert HIV care providers, and two that convened 15 PLHIV; (3) prioritisation, selection and definition of constructs (health-related issues) to include in the CST-HIV and drafting of initial item pool; and (4) a pilot study to analyse psychometric properties and validity of items and to determine which to retain in the final CST-HIV. The FGD interview scripts incorporated an exercise to prioritise the health-related issues perceived to have the greatest negative effect on HRQoL. The online questionnaire used for the pilot study included the pool of CST-HIV items and validated measures of each construct.

RESULTS

We identified 68 articles that reported on factors associated with the HRQoL of PLHIV. The most burdensome health-related issues identified in the FGDs related to stigma, socioeconomic vulnerability, sleep/fatigue, pain, body changes, emotional distress, and sexuality. Based on the literature review and FGD findings, we selected and defined the following constructs to include in the initial CST-HIV: anticipated stigma, emotional distress, sexuality, social support, material deprivation, sleep/fatigue, cognitive problems, and physical symptoms. Two researchers wrote six to eight items for each construct. Next, 18 experts rated 47 items based on their clarity, relevance, and representativeness. Pilot testing was carried out with 226 PLHIV in Spain. We retained 24 items based on empirical criteria that showed adequate psychometric properties. Confirmatory factor analysis confirmed the eight-factor structure with a good fit to the data (RMSEA = 0.035, AGFI = 0.97, CFI = 0.99). We found strong positive correlations between the instrument's eight dimensions and validated measures of the same constructs. Likewise, we found negative associations between the dimensions of the CST-HIV and HRQoL.

CONCLUSION

The CST-HIV is a promising tool for use in routine clinical care to efficiently identify and address health-related issues undermining the HRQoL of PLHIV.

Association between Food Insecurity and Health-Related Quality of Life: a Nationally Representative Survey

BACKGROUND

Food insecurity, limited or uncertain access to enough food for an active, healthy life, affected over 37 million Americans in 2018. Food insecurity is likely to be associated with worse health-related quality of life (HRQoL), but this association has not been measured with validated instruments in nationally representative samples. Given growing interest understanding food insecurity's role in health outcomes, it would be useful to learn what HRQoL measures best capture the experience of those with food insecurity.

OBJECTIVE

To determine the association between food insecurity and several validated HRQoL instruments in US adults.

DESIGN

Cross-sectional.

PARTICIPANTS

US adults (age ≥ 18), weighted to be nationally representative.

MAIN MEASURES

Food insecurity was assessed with three items derived from the USDA Household Food Security Survey Module. HRQoL was assessed using PROMIS-Preference (PROPr), which contains 7 PROMIS domains, self-rated health (SRH), Euroqol-5D-5L (EQ-5D), Health Utilities Index (HUI), and Short Form-6D (SF-6D).

KEY RESULTS

In December 2017, 4142 individuals completed at least part of the survey (31% response rate), of whom 4060 (98.0%) reported food security information. Of survey respondents, 51.7% were women, 12.5% self-identified as black, 15.8% were Hispanic, and 11.0% did not have a high school diploma. 14.1% of respondents reported food insecurity. In adjusted analyses, food insecurity was associated with worse HRQoL across all instruments and PROMIS domains (p < .0001 for all). The magnitude of the difference between food-insecure and food-secure participants was largest with the SF-6D, EQ-5D, and PROPr; among individual PROMIS domain scores, the largest difference was for ability to participate in social roles.

CONCLUSIONS

Food insecurity is strongly associated with worse HRQoL, with differences between food-secure and food-insecure individuals best measured using the SF-6D, EQ-5D, and PROPr. Future work should develop a specific instrument to measure changes in HRQoL in food insecurity interventions.

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

PURPOSE

People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient's needs.

PATIENTS AND METHODS

We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score.

RESULTS

A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen.

CONCLUSION

Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.

Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health

There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health.

Physical, Emotional, and Psychosocial Challenges Associated with Daily Dosing of HIV Medications and Their Impact on Indicators of Quality of Life: Findings from the Positive Perspectives Study

To assess challenges with daily oral antiretroviral therapy (ART), we analyzed data for 2389 participants in the 2019 Positive Perspectives survey of people living with HIV in 25 countries. ART-related challenges reported included difficulty swallowing pills (33.1% [790/2389]); stress from daily dosing routine (33.3% [795/2389]); bad memories from daily intake of HIV medication (35.1%[839/2389]), and concern “that having to take pills every day means a greater chance of revealing my HIV status to others” (37.9% [906/2389]). Individuals who felt empowered by daily oral dosing [“taking my pill(s) every day reassures me that my HIV is being kept under control”] had 69% higher odds of optimal overall health (AOR 1.69, 95% CI 1.40–2.04). Conversely, odds of optimal overall health were lower among those who felt daily pill intake “limits my day-to-day life” (AOR 0.53, 95% CI 0.44–0.64). These findings show that there is need for increased flexibility of ART delivery to meet diverse patient needs.

Unmet needs across Europe: Disclosing knowledge beyond the ordinary measure

Unmet healthcare needs (or foregone healthcare) is a widely used intermediate indicator to evaluate healthcare systems attainment since it relates to health outcomes, financial risk protection, improved efficiency and responsiveness to the individuals' legitimate expectations. This paper discusses the ordinary measure of this indicator used so far, prevalence of unmet needs in the whole population, based on the level of healthcare needs among the population. The prevalence of needs and the prevalence of unmet needs among those in need are key aspects that have not yet been fully explored when it comes to foregone healthcare. We break down the ordinary measure into prevalence of needs and prevalence of unmet needs among those in need based on data taken from the European Social Survey 2014. Afterwards, we analyse these different measures in a cross-country perspective. We also discuss the link between them and the implicit relative assessment of healthcare systems considering the whole population and the sub-group of the population aged 65 or more. Comparisons across countries show different attainment levels unveiling varying challenges across European countries, depending on the combination of levels of need and levels of unmet needs for those in need.

Frailty: a new vulnerability indicator in people aging with HIV

PURPOSE

To review the concept of frailty and its measurement, describe the existing data on frailty in people living with HIV, examine the limits of frailty as a marker of vulnerability in people living with HIV, and explore how frailty measurement could be incorporated into HIV care.

METHODS

Narrative literature review.

RESULTS

Frailty is an emerging marker of vulnerability that is increasingly being assessed among people aging with HIV. Which frailty measurement tool is best for people with HIV has not yet been established, and likely depends on clinical context. Evaluation of vulnerability should take into account social and structural factors. Frailty assessment can be incorporated into clinical care as a part of comprehensive geriatric assessment. Models of HIV-geriatric care are being established.

CONCLUSIONS

As a group, people with HIV are aging and increasingly face multiple interacting age-related medical and social problems. It requires remarkable resilience to age successfully with HIV. The clinical care of people aging with HIV could benefit from a focus on frailty and related social vulnerability to better understand patients' needs and develop appropriate goals and care plans.