Building capacity for patient-centered outcomes research to improve the quality and impact of HIV care in Tanzania

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Project Summary/Abstract As a result of widespread access to effective antiretroviral treatments (ART), globally, life expectancy for people living with HIV (PLWH) has increased substantially, nearing that of the general population. In Tanzania, 1.7 million people are reported to be currently living with HIV. About a third are >50 years of age, with estimations that this population will grow by 25% by 2040. The aging process is associated with molecular and cellular damage which subsequently increase the risk for non-AIDs related comorbidities such as cardiovascular disease (CVD), chronic kidney disease, diabetes, and cancer among aging PLWH. Persistent chronic immune activation and inflammation that persists despite effective ART also increases the risk for these NCDs. Age-related comorbidities including frailty, impairment in ADL, and cognitive dysfunction are also prevalent among older PLWH and together with NCDs, which are increasingly diagnosed at a younger age in PLWH, can significantly impact QOL. In Tanzania, the ageing PLWH population is presenting considerable challenges for how to address prevention, and treatment needs in these vulnerable group. Data on the current burden of geriatric and medical co-morbidities among older PLWH and their impact on QOL in Tanzania is sparse. Identification of these conditions is further complicated by infrequent use of screening tools adapted for Tanzania for monitoring ageing-related co-morbidities such as frailty and cognitive functioning. In this project, we will assess the burden of medical and geriatric comorbidities such as frailty and cognitive dysfunction and their association with quality of life (QOL) in a cohort of PLWH age>50 in urban Tanzania using a number of tools already validated in Tanzania and similar settings. These data will inform subsequent qualitative interviews that will be conducted with older PLWH reporting higher and lower QoL, to better understand and inform interventions needed to reduce the burden of age-related co-morbidities and improve QoL. The project will leverage resources and participants from an existing research cohort of ALHIV that was established by Dr. Ottaru (Trainee Project Lead) to examine ideal health and CVD in 2020, and is supported by the parent training grant. The establishment of a cohort of older PLWH will be important for longitudinal research to understand the progression of comorbidities and effectiveness of strategies and interventions to reduce burden, improve QoL and inform the care needed for older PLWH in Tanzania and the region. The supplement meets the goals of the parent D43 grant (1D43TWO10946-01A1, “Building capacity for patient-centered outcomes research to improve the quality and impact of HIV care in Tanzania”) which is designed to build capacity for patient-centered outcomes research in Tanzania. It will also provide the opportunity for Dr. Ottaru to acquire news skills in the measurement of aging comorbidities, longitudinal cohort management, mixed methods and PCOR and support her plans for pursuing funding to become an independent researcher in HIV and aging in Tanzania.