Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

Abstract

BackgroundPeople living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC’s aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. MethodsWe conducted a multi-stakeholder mixed-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. ResultsSixty-nine stakeholders from countries including Canada (n=62;90%), the United Kingdom (n=5;7%), United States (n=1;1%) and Australia (n=1;1%) attended the International Forum on HIV, Aging and Rehabilitation. Stakeholders represented community-based organizations (n=20;29%), academic institutions (n=18;26%), community or institutional healthcare organizations (n=11;16%), research or knowledge production organizations (n=10;14%), and organizations representing government or industry (n=10;14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: 1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; 2) prevalence, severity and impact of frailty; 3) community and social participation aging with HIV; 4) strategies for chronic disease management and healthy aging with HIV; 5) facilitators and barriers to access to and engagement in, rehabilitation; 6) effectiveness of rehabilitation interventions for healthy aging with HIV; and 7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. ConclusionsThese priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.

Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV

“…Integrated healthcare models tailored to reflect the multimorbidity-related needs of PLHIV in different geographical settings have the potential to deliver better health outcomes, if implemented equitably 51 , and can do so costeffectively 52 . By addressing the prevention, screening, and management of comorbidities in a person-centered manner, guided by the needs of individual patients, health systems can also respond flexibly to the multidimensional process of aging with HIV, taking into account both chronic and episodic healthrelated needs 53 . The priorities of PLHIV may differ from those of service providers.…”

Action for better brain health among people living with HIV: protocol for a randomized controlled trial

“…This project will be the first to test whether GMT can augment adherence to health recommendations among people living with HIV experiencing cognitive difficulties. This work aligns with three research priorities outlined by CIHRRC, including exploring community and social participation aging with HIV; identifying strategies for chronic disease management and healthy aging with HIV and; determining the effectiveness of rehabilitation interventions to support healthy aging with HIV [73].…”

Optimizing the antiretroviral treatment focusing on long-term effectiveness and a person-centred approach. Consensus Guidance Using a Delphi Process

“…The panel recognized the evaluation of PROMs as an important tool in the care of PLWH and considered it key in therapeutic strategy studies, where they feel that HRQoL domain should contribute the global evaluation of the effectiveness of a treatment [3,94,95]. HRQoL monitoring into clinical and community services can provide a direct feedback on the person-centred perspective on the effectiveness of interventions, has the potential to identify PLWH who would benefit from specific services and to address modifiable factors that negatively impact on HRQoL [96]. The results of this Delphi consensus have some limitations to consider.…”