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

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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.