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

项目摘要/摘要 高效抗逆转录病毒疗法(ART)的可获得性增加和全球治疗的成功 这些方案显著降低了与艾滋病毒相关的死亡率。因此，这一数字增加了 艾滋病毒携带者的成人和儿童的预期寿命和艾滋病定义疾病的显著减少。 然而，艾滋病毒携带者(PLWH)的患病率更高，慢性病发病更早 以及与年龄相关的疾病。围产期感染艾滋病毒的青少年可能有更高的年龄早发风险- 由于长期接触艾滋病毒和抗逆转录病毒药物以及长期接触其他病毒共同作用而导致的相关疾病 可能会加速衰老的感染。加速的衰老过程与能力下降有关 面对压力，虚弱程度增加，与年龄相关的合并症患病率增加，包括 神经认知障碍。 随着年龄的增长而出现的虚弱和神经认知障碍使个人面临更大的不良风险 临床结果，尤其是低健康相关生活质量(HRQOL)的重要因素 较老的公共卫生部门强调需要及时确定减轻其影响的战略。 不幸的是，感染艾滋病毒的老年人(&gt；50岁)在#年继续得不到充分的服务和边缘化。 研究和临床实践。随着艾滋病毒高发地区老年PLWH人数的增加 特别是在撒哈拉以南非洲，至关重要的是，医疗保健提供方案必须识别脆弱性和 神经认知障碍，并解决患者的需求，优化他们的HRQOL。据我们所知，在那里 没有关于衰老相关疾病(如虚弱和神经认知)的患病率或影响的数据 高HIV感染的肯尼亚PLWH和围产期感染HIV的青少年对HRQOL的损害 撒哈拉以南非洲的负担国家。也缺乏适应文化和适合年龄的工具来 衡量该地区围产期感染艾滋病毒的青少年的脆弱程度和生活质量。 本补充申请旨在支持Jacqueline Kagima博士，一位拥有10年以上经验的内科医生 管理PLWH的经验，以及拥有9年管理经验的儿科医生Emily Wgui 艾滋病毒携带者儿童进行一项有指导的研究，以确定流行率、相关性和 老年PLWH在建立指挥能力时的脆弱和神经认知障碍的影响 肯雅塔国立医院(KNH)通过面对面和在线课程进行艾滋病毒和老龄化研究 研究方法。此外，指导研究项目将为DRS提供初步数据 神岛和万吉正在开发他们的K43应用程序。 1.在目标1中，我们将使用脆弱指数和脆弱表型标准进行横断面调查 以及判定HIV相关神经认知障碍患病率的标准及其相关性 寻求HIV感染的老年HIV携带者(50岁)的虚弱和神经认知障碍 在肯塔基医院接受治疗。在目标2中，我们将使用患者报告的结果生活质量-HIV量表来评估 虚弱和神经认知障碍对艾滋病毒携带者老年人生活质量的影响。在……里面 目标3，我们将召开一次利益攸关方研讨会，由妇女人权委员会、公共卫生组织的代表、政策制定者、艾滋病毒 关怀实施合作伙伴和研究人员，制定整合脆弱性的实施战略 并将神经认知评估纳入艾滋病毒护理。在目标4中，我们将调整和试点脆弱指数和 围产期感染™的青少年的儿科生活质量调查 评估它们在这一人群和我们的环境中的效用。 这一有指导的研究项目将解决了解老龄化对老年人影响的新需求 感染艾滋病毒的老年人和围产期感染青少年，并协助制定战略 促进脆弱和神经认知筛查在这一人群中的整合。这将在以下方面发挥关键作用 告知爱滋病护理服务机构对公共卫生院的长期跟进，以优化他们与健康有关的生活质素。 这一应用程序将补充目前正在进行的培训和能力建设活动，作为 D43奖：将非传染性疾病的预防和治疗与艾滋病毒护理相结合 在肯尼亚的研究培训-INTERNAL(TW009580)，由John Kinuthia博士(KNH)和Carey Farquhar博士领导 (华盛顿大学)。综合方案力求解决执行中的关键差距 公共卫生部门预防和治疗非传染性疾病的科学和流行病学研究 通过公共卫生硕士/博士课程提供实施科学和流行病学方面的长期培训： 内罗毕大学(UON)博士培训(3年)和西雅图公共卫生硕士培训(1年)；1年指导 在肯尼亚的博士后奖学金和关于研究方法的短期面对面和在线培训 肯尼亚。

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.