Examining the Impact of the Golden Compass Clinical Care Program for Older People with HIV: A Qualitative Study

Abstract

The combined burden of geriatric conditions, comorbidities, and HIV requires a model of HIV care that offers a comprehensive clinical approach with people 50 years or older with HIV. Golden Compass is an outpatient, multidisciplinary HIV-geriatrics program with an onsite HIV geriatrician, cardiologist, pharmacist, and social worker, offering specialist referrals, care navigation, and classes on improving functional status and cognition. Participants (13 patients and 11 primary care providers) were recruited using a non-probability sampling method to participate in semi-structured interviews on the perceived impact of Golden Compass on care delivered to older people with HIV. Interviews were transcribed verbatim and framework analysis used to analyze the transcripts. The perceived impacts of Golden Compass by patients and providers were organized by the Compass points (Northern: Heart and Mind, Eastern: Bones and Strength, Southern: Navigation and Network, Western: Dental, Hearing, and Vision). Overall, patients valued the focus on functional health and whole-person care, leading to greater trust in the ability of providers. Providers gained new skills through the geriatrics, cardiology and/or pharmacist consultations. The HIV-geriatrics specialty approach of Golden Compass improved functional ability and quality of life for older adults with HIV. Few integrated care programs for older people with HIV have been evaluated. This study adds to the limited literature demonstrating high patient and provider satisfaction with a HIV-care model that incorporated principles of geriatric medicine emphasizing a comprehensive approach to sustaining functional ability and improving quality of life.

Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough?

“… 117 In follow-up surveys, patients and providers saw improvements across multiple domains, including quality of life, as a result of participation in Golden Compass. 118 …”

Considerations for long-acting antiretroviral therapy in older persons with HIV

“…Lastly, LAI-ART implementation may present additional opportunities to comprehensively address unique HIV care and treatment needs of older PWH, as highlighted by other comprehensive HIV care programs [86]. For instance, the need for more frequent clinic visits for injections may be leveraged to facilitate other preventive healthcare or chronic disease monitoring.…”

Exploring implementation considerations forgeriatric‐HIVclinics: A secondary analysis from a scoping review onHIVmodels of geriatric care

“…Almost all models of care (n = 11/14, 79%) incorporated a multidisciplinary team [14-16, 20, 43-49] into the delivery of care. The most common method of access to geriatric-HIV services described in the studies was via clinician referral when there was a perceived clinical need [14,16,20,[43][44][45] (n = 6/11, 55%); however, self-…”

“…Accordingly, incorporating geriatricians into HIV models of care has become a popular approach to support older adults living with HIV [16,18,19]. While existing research has begun to describe some of these models of care [14,16,19,20], no scoping review to date has summarized the facilitators of and barriers to their successful implementation. This information is required to create evidence-informed guidelines that direct the future development, delivery and implementation of geriatric-HIV models of care, and should be a priority for healthcare systems caring for older adults living with HIV.…”