Prevalence and correlates of frailty and neurocognitive impairment among older adults living with HIV at Kenyatta National Hospital.

肯雅塔国立医院艾滋病毒感染者老年人虚弱和神经认知障碍的患病率及其相关性。

• 批准号: 10881834
• 负责人: CAREY FARQUHAR
• 金额: $ 9.97万
• 依托单位: KENYATTA NATIONAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10881834
• 关键词: Acceleration; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adult; Africa South of the Sahara; Age; Aging; Award; Caring; Child; Childhood; Chronic Disease; Clinical; Complement; Country; Cross-Sectional Studies; Data; Development; Disease; Doctor of Philosophy; Educational workshop; Elderly; Epidemiology; Equipment and supply inventories; Exposure to; Face; Fellowship; HIV; HIV-associated neurocognitive disorder; HIV-infected adolescents; High Prevalence; Hospitals; Individual; Kenya; Life Expectancy; Longterm Follow-up; Measures; Mentors; Neurocognitive; Neurocognitive Deficit; Outcome; Patient Outcomes Assessments; Patients; Perinatal; Persons; Phenotype; Physicians; Play; Policy Maker; Population; Postdoctoral Fellow; Prevalence; Prevention; Process; Quality of life; Research; Research Methodology; Research Personnel; Research Project Grants; Research Training; Risk; Stress; Training; Universities; Viral; Washington; age effect; age related; antiretroviral therapy; care systems; clinical practice; co-infection; comorbidity; early onset; epidemiology study; experience; frailty; health care delivery; health related quality of life; high risk; implementation science; implementation strategy; indexing; marginalization; mortality; online course; pediatrician; perinatal HIV; programs; research study; screening; success; tool; treatment program

PROJECT SUMMARY/ABSTRACT Increased availability of highly efficacious antiretroviral therapy (ART) and the success of global treatment programs has resulted in marked reduction in HIV-associated mortality. Consequently, there is an increase in the life expectancy of adults and children living with HIV and a marked reduction in AIDS-defining illnesses. However, people living with HIV (PLWH) experience higher prevalence and earlier onset of chronic illnesses and age-related conditions. Perinatally HIV-infected adolescents may be at higher risk of earlier onset of age- related conditions due to prolonged exposure to HIV and ART, and prolonged exposure to other viral co- infections that may enhance the aging. The accelerated aging process is associated with decreased ability to face stress, increased frailty, and increased prevalence of age-related comorbidities including neurocognitive impairment. Frailty and neurocognitive impairment seen with advancing age puts individuals at increased risk of adverse clinical outcomes and are particularly important contributors to low health-related quality of life (HRQOL) for older PLWH highlighting the need for timely identification and strategies to mitigate their effects. Unfortunately, older adults (> 50 years) living with HIV continue to be underserved and marginalized in research and clinical practice. As the number of older PLWH increase in high HIV prevalence regions especially in sub-Saharan Africa, it is critical that healthcare delivery programs identify frailty and neurocognitive impairment, and address patient needs to optimize their HRQOL. To our knowledge, there are no data on the prevalence or effects of aging-related conditions such as frailty and neurocognitive impairment on HRQOL among older PLWH and perinatally HIV-infected adolescents in Kenya, a high HIV burden country in sub-Saharan Africa. There is also a lack of culturally adapted and age-appropriate tools to measure frailty and quality of life among perinatally HIV infected adolescents in the region. This supplement application aims to support Drs. Jacqueline Kagima, a physician with over 10 years of experience managing PLWH, and Emily Wangui, a pediatrician with 9 years’ experience managing children living with HIV conduct a mentored research study to determine prevalence, correlates and effects of frailty and neurocognitive impairment among older PLWH while building capacity to conduct HIV and aging research at Kenyatta National Hospital (KNH) through in-person and online courses on research methodology. Additionally, the mentored research project will provide preliminary data for Drs Kagima and Wangui as they develop their K43 applications. 1. In Aim 1, we will conduct a cross-sectional survey using the Frailty Index and Frailty Phenotype criteria and the HIV-associated neurocognitive disorders criteria to determine the prevalence and correlates of frailty and neurocognitive impairment among older adults (> 50 years old) living with HIV who seek HIV care at KNH. In Aim 2, we will use the Patient Reported Outcomes Quality of Life-HIV scale to assess the effect of frailty and neurocognitive impairment on the quality of life of older adults living with HIV. In Aim 3, we will convene a stakeholder workshop with HCW, representatives of PLWH, policymakers, HIV care implementation partners and researchers to develop an implementation strategy to integrate frailty and neurocognitive assessment into HIV care. In Aim 4, we will adapt and pilot the Frailty Index and Pediatric Quality of Life Inventory (PedsQL)™ 4.0 tools among perinatally HIV infected adolescents to assess their utility in this population and in our settings. This mentored research project will address the emerging need to understand the impact of aging among older adults and perinatally infected adolescents living with HIV and aid in the development of strategies to promote the integration of frailty and neurocognitive screening in this population. This will play a key role in informing HIV care services on the long-term follow-up of PLWH to optimize their health-related quality of life. This application will complement the training and capacity-building activities currently underway as part of the D43 award “Integrating prevention and treatment of non-communicable diseases and HIV care through research training in Kenya-INTEGRATE (TW009580) led by Drs. John Kinuthia (KNH) and Carey Farquhar (University of Washington). The INTEGRATE program seeks to address the critical gaps in implementation science and epidemiology research in the prevention and care of non-communicable diseases among PLWH by offering long-term training through an MPH/PhD program in implementation science and epidemiology: PhD training at University of Nairobi (UoN) (3 years) and MPH training in Seattle (1 year); 1-year mentored post-doctoral fellowship in Kenya and short-term in-person and online training on research methodology in Kenya.

项目总结/摘要 增加高效抗逆转录病毒疗法（ART）的可用性和全球治疗的成功 这些方案显著降低了艾滋病毒相关死亡率。因此， 感染艾滋病毒的成人和儿童的预期寿命延长，艾滋病定义疾病显著减少。 然而，艾滋病毒感染者（PLWH）的患病率较高，慢性病发病较早 与年龄有关的问题。围产期感染艾滋病毒的青少年可能有更早发病年龄的风险- 由于长期暴露于艾滋病毒和抗逆转录病毒疗法，以及长期暴露于其他病毒的共同作用， 可能会加速衰老的感染。加速老化过程与能力下降有关 面对压力，虚弱增加，年龄相关合并症的患病率增加，包括 神经认知障碍 随着年龄的增长而出现的虚弱和神经认知障碍使个体的不良反应风险增加 临床结局，并且是导致低健康相关生活质量（HRQOL）的特别重要因素， 老年艾滋病毒/艾滋病感染者，强调需要及时识别和战略，以减轻其影响。 不幸的是，感染艾滋病毒的老年人（> 50岁）在艾滋病毒/艾滋病领域仍然得不到充分的服务，并被边缘化。 研究和临床实践。随着艾滋病毒高流行地区老年艾滋病毒携带者人数的增加， 特别是在撒哈拉以南非洲地区，医疗保健提供计划识别脆弱性至关重要， 神经认知障碍，并解决患者的需求，以优化其HRQOL。据我们所知， 没有关于衰老相关疾病（如虚弱和神经认知）的患病率或影响的数据 在肯尼亚，老年艾滋病毒携带者和围产期艾滋病毒感染青少年的HRQOL受损， 撒哈拉以南非洲的负担。还缺乏适应文化和适合年龄的工具， 衡量该区域感染艾滋病毒的围产期青少年的脆弱程度和生活质量。 此补充申请旨在支持Jacqueline Kagima博士，一位拥有超过10年经验的医生， 和艾米丽Wangui，一位有9年管理经验的儿科医生 感染艾滋病毒的儿童进行一项有指导的研究，以确定流行率、相关因素和 老年PLWH在建立行为能力时对虚弱和神经认知障碍的影响 肯雅塔国立医院（KNH）通过面对面和在线课程进行艾滋病毒和老龄化研究， 研究方法此外，指导研究项目将为博士提供初步数据， Kagima和Wangui开发K43应用程序。 1.在目标1中，我们将使用虚弱指数和虚弱表型标准进行横断面调查 和HIV相关的神经认知障碍标准，以确定患病率和相关因素 在寻求艾滋病毒感染的老年人（> 50岁）中， 关注KNH在目标2中，我们将使用患者报告结局生活质量-HIV量表评估 虚弱和神经认知障碍对老年艾滋病毒感染者生活质量的影响。在 目标3，我们将与HCW、艾滋病毒携带者和艾滋病患者代表、政策制定者、艾滋病毒 护理实施伙伴和研究人员制定实施战略， 以及对艾滋病毒护理的神经认知评估。在目标4中，我们将调整和试行脆弱指数， 儿科生活质量量表（PedsQL）™ 4.0工具在围产期HIV感染青少年中的应用， 评估它们在这个人群和我们的环境中的效用。 这个指导研究项目将解决新出现的需要，了解老龄化的影响， 艾滋病毒感染的老年人和围产期感染的青少年，并协助制定战略， 促进这一人群的虚弱和神经认知筛查的整合。这将发挥关键作用， 向艾滋病毒护理服务机构通报艾滋病毒携带者和艾滋病患者的长期跟踪情况，以优化他们与健康有关的生活质量。 这一应用将补充目前正在开展的培训和能力建设活动， D43奖“通过以下措施将非传染性疾病的预防和治疗与艾滋病毒护理结合起来， 肯尼亚研究培训-INTEGRATE（TW 009580），由John Kinuthia博士（KNH）和Carey Farquhar博士领导 （华盛顿大学）。INTEGRATE计划旨在解决执行中的关键差距 艾滋病毒携带者非传染性疾病预防和护理的科学和流行病学研究 通过在实施科学和流行病学方面的MPH/PhD计划提供长期培训： 内罗毕大学博士培训（3年）和西雅图公共卫生硕士培训（1年）; 1年辅导 肯尼亚博士后研究金，以及关于肯尼亚研究方法的短期面对面和在线培训。 肯尼亚.