Specialist care of older adults with HIV infection in the UK: a service evaluation

Abstract

We identified two existing and three proposed HIV ageing services. Another 20 clinics (20%) reported an unmet need for a specialist ageing service, suggesting that complex older adults may pose a management challenge. This is the first survey of its kind to attempt to describe the current landscape and opinion around such services. HIV-infected cohorts will continue to age and current models of care may be insufficient, which should prompt services, their users and commissioners to consider what models may best fit current and future demand.

Evaluation of a Combined HIV and Geriatrics Clinic for Older People Living with HIV: The Silver Clinic in Brighton, UK

“…It was gratifying to see that the survey of HCPs indicated appropriate awareness of the Silver Clinic, with many reporting the positive improvement to the management of older PLWH as a consequence of the clinic. However, a recent UK survey identified the existence of only two dedicated HIV-ageing services nationwide, with two-thirds of respondents citing insufficient population as the reason for no perceived need for such a service [48], yet we know that a predominantly older adult HIV population is predicted in the near future [3]. HIV-ageing services are now being reported more widely, mainly in high income settings, which are either based on geriatric syndromes or metabolic comorbidities in PLWH [49].…”

“…However, this is the case for many new services, which are not, at present, being driven by a supporting evidence base. The role of such a clinic, and in particular the role of CGA applied to individuals living with HIV, represents areas of research need within HIV and ageing, which is supported by a nationwide service evaluation on HIV-ageing services that identified a lack of evidence base as a barrier for service development [48]. However, the Silver Clinic is a trail-blazer for other services, with a model that, since conception, meets the recommendations from both the 2019 EACS guidance on frailty screening in PLWH [51] and the 2018 British HIV Association Standards of Care document, which advocates the involvement of a geriatrician with HIV knowledge in the care of service users requiring complex HIV care [52].…”

Gaps in health and social care services to older adults living with HIV: a qualitative study on the perspectives of older adults and service providers

“…The results shed light on the inadequacies that exist within services available to OAHIV, along with the lack of resources specifically geared toward this clientele. Beyond the validation of empirical data and the challenges addressed by other studies 20,22,23 interpreting our results according to the theoretical intersectionality framework helped identify three transversal problems across all formal resources. These are: 1) an inadequacy of resources to respond to the needs associated with HIV and aging, 2) structural problems within the health and social care service system which are amplified for OAHIV, and 3) the multiple forms of discrimination experienced by OAHIV due to their position at the intersection of HIV and aging.…”

“…This reality is supported by the literature. 22 The impact of silos identified by several authors. 18,19 has been confirmed by our study as one of the sources of resource inadequacy.…”

“…18,19 The results of the small body of empirical research addressing HIV and aging confirm the rarity of services that specifically respond to the needs associated with this intersection. [20][21][22][23] The few empirical studies that have considered difficulties experienced by OAHIV regarding their use of formal services have suggested that a primary obstacle to access involves a lack of information on existing resources. 24 Other obstacles related to non-HIV-specialized health and social care services include organizational challenges, with OAHIV citing complexity and accessibility as major issues, including lengthy waiting times for service.…”