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

项目总结和摘要 老年艾滋病毒感染者（PWH）经历更多的合并症，并增加了老年综合征的风险 比没有感染艾滋病毒的同龄人更年轻。然而，老年人的识别和管理 综合征的PWH仍然是艾滋病护理的临床挑战。老年医学评估的频率， 没有关于老年威尔斯亲王医院接受常规艾滋病护理的报告。此外，迄今为止还没有任何研究严格评估 在专门为威尔斯亲王医院提供护理的诊所（艾滋病诊所）内综合进行这类评估。解决 在临床护理中的这一差距，我们将使用实施研究和以用户为中心的设计来实施， 评估该人群中2种关键老年综合征的基于HIV诊所的筛查干预措施， 和身体功能损害。西北医学传染病中心（NM-IDC） 我们每年为超过1，500名威尔斯亲王医院的病人提供护理服务，其中约一半是50岁或以上的老人。NM-IDC诊所 将对工作人员进行培训，以管理认知和身体功能的循证筛查评估， 会教导所有50岁或以上的威尔斯亲王医院职员， 诊所里的护理。具体而言，我们的目标是：1）利用以用户为中心的设计来选择实施策略， 与主要利益攸关方一道进行筛选干预和进程，2）评估 老年威尔斯亲王医院身体功能受损和记忆力减退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。在跨学科研究团队的共同指导下，玛丽克莱尔马斯特斯， 医学博士/MSCI，旨在建立在她以前的临床研究经验，在艾滋病毒和老龄化的交叉点。 博士硕士将接受实施科学，定性和混合研究方法，参与性 研究的重点是纳入弱势群体（特别是有认知能力或 身体功能障碍）和解决健康的社会决定因素，以及高级领导技能。她 长期的研究目标是成为一个独立的研究者，专注于实施可扩展的， 采取可持续的干预措施，减少老年人的功能和认知障碍，提高他们的复原力 PWH。西北大学范伯格医学院的综合研究基础设施将 帮助她实现学业目标。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适当护理的保留及其扩大到其他地点。这些数据 至关重要的是，为维持和扩大艾滋病毒老年病方案提供最适当的战略， 未来

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.