KNUST Aging and HIV Outcomes

KNUST 老龄化和艾滋病毒结果

• 批准号: 10751613
• 负责人: Nana Kwame Ayisi-Boateng
• 金额: $ 14.28万
• 依托单位: KWAME NKRUMAH UNIVERSITY/SCIENCE/TECH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10751613
• 关键词: Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; African; Aging; Boston; Cardiometabolic Disease; Caring; Categories; Cessation of life; Chronic Disease; Clinical; Communicable Diseases; Complex; Comprehensive Health Care; Country; Data; Dependence; Diagnosis; Disease; Disease Management; Dyslipidemias; Elderly; Enrollment; Epidemic; Epidemiology; Exposure to; Family Practice; Female; Foundations; Frequencies; Future; Geriatric Assessment; Geriatrics; Ghana; Goals; Guidelines; HIV; HIV therapy; Health Personnel; Health Services; Healthcare; Hypertension; Impaired cognition; Incidence; Informed Consent; Intervention Studies; Interview; Life; Life Expectancy; Longitudinal, observational study; Measures; Medical Records; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Organ; Outcome; Outcome Study; Participant; Patient Self-Report; Patients; Perception; Persons; Phenotype; Physical assessment; Physiological; Policies; Polypharmacy; Prevalence; Principal Investigator; Psychosocial Assessment and Care; Quality of life; Research; Research Assistant; Research Training; Science; Screening Result; Structure; Surveys; Syndrome; Technology; Testing; Universities; University Hospitals; Update; Work; aged; aging and technology; antiretroviral therapy; care systems; clinical practice; community organizations; diabetes management; effective therapy; effectiveness testing; experience; follow-up; frailty; healthy aging; high risk; human old age (65+); improved; indexing; kidney dysfunction; mortality; mortality risk; multiple chronic conditions; patient oriented; peer; physical conditioning; policy implication; pragmatic trial; preservation; programs; satisfaction; screening; sex; social vulnerability

Abstract Thanks to life-extending HIV therapy, there are an estimated 7 million people with HIV (PWH) aged over 50 years worldwide; 5 million of them live in sub-Saharan Africa, the epicenter of the HIV epidemic. Of the ~312,000 PWH in Ghana in 2019, almost 1 in 6 is aged over 50 years. Geriatric syndromes (e.g., frailty, multimorbidity) and discrete diseases of aging (e.g., hypertension) threaten these gains in healthier life expectancy for aging PWH. These threats are particularly troubling in Ghana and sub-Saharan African countries where access to geriatric care and chronic disease management is limited. Efforts underway in the region leverage HIV care systems to diagnose and manage chronic diseases of aging. A gap in these efforts is a focus on geriatric syndromes – multi-factorial clinical conditions, common in older PWH, that do not fit discrete disease categories. Filling this gap, particularly in the sub-Saharan Africa region, is the next barrier to extending quantity of life and preserving quality of life for aging PWH. To help fill this gap, our long-term goal is to provide comprehensive care for geriatric syndromes and diseases of aging without over-diagnosing or over- treating older PWH. The objectives of the current proposal are to 1) characterize frailty, multimorbidity, and discrete diseases of aging in older PWH; and 2) identify barriers and facilitators to providing effective patient- centered healthcare for older PWH. Frailty is associated with HIV, dependency and mortality. It is characterized by diminished strength, endurance, and functioning. Multimorbidity – multiple, interacting physical and mental health conditions – is associated with HIV, polypharmacy, morbidity and mortality. We hypothesize that 1) frailty and multimorbidity are under-recognized and discrete cardiometabolic diseases are under-diagnosed in older PWH in Ghana; and 2) Infectious Disease Unit referrals for discrete cardiometabolic diseases are not effective for their management in Ghana. To test these hypotheses, we propose a longitudinal observational study at the University Hospital Infectious Disease Unit, Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana. The study will enroll 151 PWH who are 50 years and older to address three specific aims: 1) Characterize frailty and multimorbidity in older PWH in care at the University Hospital, KNUST; 2) Assess under-diagnosis and management of discrete cardiometabolic diseases in older PWH; and 3) Identify barriers and facilitators to providing effective, patient centered healthcare to aging PWH. KNUST Aging & HIV Outcomes (KAHO) study will help identify priorities and opportunities for building an effective integrated model of HIV and geriatric healthcare in Ghana. This integrated model will extend the gains in quality life expectancy for Ghanaians and other Africans in similar settings who are aging with HIV.

摘要 多亏了延长生命的艾滋病毒治疗，估计有700万50岁以上的艾滋病毒(PWH)患者 其中500万人生活在撒哈拉以南非洲，那里是艾滋病毒流行的中心。中的 2019年加纳的PWH为312,000人，几乎每6人中就有1人超过50岁。老年综合征(例如，虚弱， 多发病)和离散的老龄化疾病(如高血压)威胁着更健康生活中的这些成果 预计威尔斯亲王医院将会老化。这些威胁在加纳和撒哈拉以南非洲地区尤其令人不安。 获得老年护理和慢性病管理的机会有限的国家。目前正在进行的努力 该区域利用艾滋病毒护理系统来诊断和管理老龄化的慢性疾病。这些努力中的一个差距是 对老年综合征的关注--多因素临床症状，在老年PWH中常见，不适合 离散的疾病类别。填补这一空白，特别是在撒哈拉以南非洲区域，是下一个障碍 延长老年威尔斯亲王医院的生命数量并保持其生活质量。为了帮助填补这一空白，我们的长期目标是 为老年综合症和老年病提供全面的护理，而不会过度诊断或过度- 治疗较年长的威尔斯亲王。当前提案的目标是：1)描述虚弱、多发病和 2)确定障碍和促进者，以提供有效的患者- 以老年威尔斯亲王医院为中心的医疗保健。虚弱与艾滋病毒、依赖性和死亡率有关。它是 衰弱的以力量、耐力和机能减弱为特征的多发病--多种疾病，相互作用 身心健康状况--与艾滋病毒、多药联用、发病率和死亡率有关。我们 假设1)虚弱和多发病未被充分认识，离散的心脏代谢性疾病 加纳老年PWH诊断不足；和2)传染病科转诊离散心脏代谢 在加纳，疾病的管理并不有效。为了检验这些假设，我们提出了一个纵向的 夸梅·恩克鲁马科技大学大学医院传染病科的观察性研究 和技术(Knust)，加纳库马西。这项研究将招募151名50岁及以上的威尔斯亲王医院患者参加 解决三个具体目标：1)描述在大学护理中的老年PWH的虚弱和多发病特征 医院，Knust；2)评估老年人离散心脏代谢性疾病的诊断不足和处理 以及3)确定为老年威斯康星医院提供有效的、以患者为中心的医疗保健的障碍和促进者。 Knust老龄化与艾滋病毒结果(Kaho)研究将有助于确定优先事项和机会，以建立 加纳艾滋病毒和老年医疗保健的有效综合模式。这一集成模式将扩大收益 加纳人和其他类似环境中艾滋病毒携带者的预期寿命。