The Impact of Hearing Loss Treatment Scale-Up in Persons Aging with HIV on Dementia Risk, Quality of Life, and Healthcare Costs

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PROJECT SUMMARY When treated with antiretroviral therapy (ART), persons with HIV (PWH) are living life expectancies similar to persons without HIV but remain at increased risk for multimorbidity due to chronic inflammation among other causes. PWH experience a two-fold increase in dementia incidence compared with persons without HIV. Given the absence of treatments to substantially alter the course of dementia, dementia prevention is of critical importance. Recent evidence suggests that hearing loss is a leading preventable cause of dementia and that up to 8% of all dementia worldwide may be due to hearing loss. Hearing loss is common among PWH and occurs up to five years earlier than among persons without HIV. Further, emerging data have shown that hearing aids could substantially mitigate the increased risk of dementia due to hearing loss. Despite the potential for improvements in quality of life and dementia risk, hearing loss treatment uptake among PWH remains low. Only 20% of persons with hearing loss use hearing aids, and PWH may face increased difficulties accessing hearing aid technology given disadvantageous social determinants of health, underinsurance, and other structural barriers to care. Given the high burden of hearing loss and dementia among people aging with HIV, hearing loss screening and treatment may be especially important in this population. In the parent R01 (R01AG069575), Dr. Emily Hyle and her research team detailed methods for developing and populating a simulation model of dementia and multimorbidity for the aging HIV population, the CHARMED (Cognitive impairment, HIV, Aging, heaRt, MEntal health, and Dementia) model. In this administrative supplement, the research team will integrate an existing, validated model of hearing loss natural history and treatment, the Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL), with the CHARMED to expand the capacity for multimorbidity modeling. The team will then use the updated CHARMED model to project the effectiveness and cost-effectiveness of hearing loss screening and treatment scale-up among aging PWH. The model will project the potential reduction in dementia risk among aging PWH due to hearing loss screening and treatment. The results of this project will inform future clinical trials, clinical practice, and health policy guidelines for the care of persons aging with HIV.