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

基于艾滋病毒临床的艾滋病毒感染者老年综合症筛查

• 批准号: 10761940
• 负责人: Mary Clare Masters
• 金额: $ 16.3万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10761940
• 关键词: Academic achievement; Address; Adopted; Adoption; Age; Aging; Brain; Caring; Clinic; Clinical; Clinical Investigator; Clinical Research; Cognition; Communicable Diseases; Comprehensive Health Care; Continuity of Patient Care; Data; Dedications; Development Plans; Diagnosis; Early Diagnosis; Elderly; Evaluation; Exhibits; Frequencies; Future; General Population; Geriatric Assessment; Geriatrics; Goals; HIV; Health; Home; Impaired cognition; Impairment; Individual; Intervention; Investigation; Leadership; Literature; Logic; Medical; Medicine; Memory Loss; Mentorship; Methodology; Methods; Modeling; Outcome; Pathway interactions; Patient Preferences; Patient Selection; Patient-Focused Outcomes; Patients; Penetration; Persons; Physical Function; Physical Performance; Population; Premature aging syndrome; Process; Proctor framework; Protocols documentation; Provider; Quality of life; Recommendation; Reporting; Research; Research Infrastructure; Research Methodology; Research Personnel; Risk; Screening procedure; Site; Standardization; Structure; Syndrome; Training; Universities; Vulnerable Populations; Work; aged; antiretroviral therapy; barrier to care; care systems; career; career development; clinical care; cognitive function; cohort; comorbidity; contextual factors; design; disability; evidence base; experience; follow-up; functional disability; healthy aging; implementation evaluation; implementation measures; implementation outcomes; implementation research; implementation science; implementation strategy; improved outcome; medical schools; medical specialties; meetings; mortality; peer; programs; promote resilience; response; satisfaction; scale up; screening; skills; social; social health determinants; user centered design

PROJECT SUMMARY AND ABSTRACT Older persons 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 Northwestern Medicine Infectious Disease Center (NM-IDC) provides care annually to over 1,500 PWH, approximately half of whom are aged 50 years old or older. NM-IDC 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 the Northwestern University Feinberg School of Medicine 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.

项目摘要和摘要 老年艾滋病毒携带者(PWH)有更多的合并症，并有更高的老年综合征风险 与没有感染艾滋病毒的同龄人相比，他们的年龄相对更小。然而，老年人的识别和管理 威斯康星综合征仍然是艾滋病毒护理中的一个临床挑战。作为老年医学评估一部分的老年医学评估 老年威尔斯亲王医院的常规艾滋病毒护理尚未报告。此外，到目前为止，还没有一项研究得到严格的评估 将这种评估纳入专门护理威斯康星医院的诊所(艾滋病毒诊所)。致信地址 我们将利用实施研究和以用户为中心的设计来实施和 对这一人群中两种关键老年综合征的HIV临床筛查干预进行评估，认知 和身体功能受损。西北医学传染病中心(NM-IDC) 每年护理1,500多名威尔斯亲王医院，其中约一半人年龄在50岁或以上。NM-IDC诊所 工作人员将接受培训，对认知和身体功能进行循证筛查评估，并 将对所有接受连续性治疗的50岁或以上的威尔斯亲王医院进行适当的后续护理教育 在诊所里进行护理。具体来说，我们的目标是：1)利用以用户为中心的设计来选择以下实施策略 与关键利益攸关方的筛选干预和过程；2)评估 老年PWH患者身体功能损害和记忆丧失的筛查和护理路径方案，以及 3)确定与患者、提供者、 和其他诊所工作人员。在一个跨学科研究团队的共同指导下，玛丽·克莱尔·马斯特斯 MD/MSCI，寻求在艾滋病毒和老龄化的交叉点建立她以前的临床研究经验。 马斯特斯博士将接受实施科学、定性和混合研究方法、参与性研究等方面的培训 侧重于纳入弱势群体的研究(特别是有认知或 身体功能障碍)，解决健康的社会决定因素，以及高级领导技能。她 长期研究目标是成为一家独立的调查者，专注于实现可扩展和 可持续的干预措施，以减少老年人的功能和认知障碍并提高复原力 威尔斯亲王医院。西北大学范伯格医学院的综合研究基础设施将 促进她的学业目标的实现。未来的研究方向包括评估这种干预的 对临床结果的影响和在适当护理中的保留及其扩大到更多的地点。这些数据是 至关重要的是提供最适当的战略，以维持和扩大艾滋病毒老年方案 未来。