Addressing health and social care needs of older people with HIV suffering from mental health disorders in Georgia

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The evidence generated from the current Georgian study (NIH/FIC grant 3D43TW011532-03S1, Vascular contributions to cognitive impairments and dementia (VCID) among people living with HIV in the country of Georgia), demonstrates a high prevalence of depression (50%), anxiety (45%), as well as substance use disorders (SUD; 26%) and alcohol use disorders (AUD; 21%) among OPWH who are >40 years in Georgia. However, significant challenge remains how to provide appropriate person-centered health and social care services to such OPWH in Georgia, which has a post-Soviet health system with services organized within silos. Currently, OPWH receive HIV/AIDS care in a highly centralized and vertical model, but with poorly integrated mental health and virtually non-existent social care services. On the other hand, mental health services are mainly delivered through specialized psychiatric clinics and mental hospitals. It is unclear how these existing service silos can be bridged in order to serve the mental health needs of OPWH who need both mental health as well as HIV care, and need such services in the community, not within institutions. Because Georgia lacks community-based health and social care services and interventions for OPWH; novel person- and community- centered approaches, at both community and health system levels, will need to be developed if OPWH are to receive comprehensive care for their needs. This application is a supplement to Fogarty HIV Research Training Grant (D43TW011532; Strategic Training Partnership to End AIDS in Georgia). We propose to address the negative impact of brain health outcomes on HIV care continuum among OPWH in Georgia. Georgian MPH graduate training will be operationalized via: Aim 1. Advanced didactic training in HIV-aging (focus on mental health disorders, and the related health and social care needs) and mixed methods research (focus on health and social care services), as well as health and social care services survey methods; and Aim 2. Hands-on training in health and social care services survey and data analysis, the goals of which are to: Aim 2.a. Develop an inventory of health and social care services via conducting mental health and social care services survey in relevant public and private healthcare facilities, as well as the respective service provider CBOs/NGOs; Aim 2b. Explore health and social care service needs, barriers to services (e.g., barriers to care at the individual level, the social or interpersonal level, and structural level, including HIV-associated stigma, as well as other social determinants of health affecting access to services), and attitudes and expectations for health and social care services (e.g., acceptability of current services, including setting, location, content, etc.) among OPWH via conducting qualitative research among 28 OPWH (seven in-depth interviews per group of OPWH with (1) depression, (2) anxiety, (3) SUD, (4) AUD). Our results will inform development of interventions to reduce the negative impact of mental health disorders among this target group and improve HIV care continuum in the long term. This project's successful completion will catalyze new research that can focus on designing and testing relevant, innovative interventions using a more rigorous study design (e.g., RCT). These future deliverables will be achieved through HIV-aging-mental health research capacity building of one Georgian trainee, doctoral student with previous experience in HIV research, who will receive advanced didactic and hands-on training in the development of a strategic skillset.