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

基于艾滋病毒临床的艾滋病毒感染者老年综合症筛查

• 批准号: 10761940
• 负责人: Mary Clare Masters
• 金额: $ 16.3万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10761940
• 关键词: Academic achievement; Address; Adopted; Adoption; Age; Aging; Brain; Caring; Clinic; Clinical; Clinical Investigator; Clinical Research; Cognition; Communicable Diseases; Comprehensive Health Care; Continuity of Patient Care; Data; Dedications; Development Plans; Diagnosis; Early Diagnosis; Elderly; Evaluation; Exhibits; Frequencies; Future; General Population; Geriatric Assessment; Geriatrics; Goals; HIV; Health; Home; Impaired cognition; Impairment; Individual; Intervention; Investigation; Leadership; Literature; Logic; Medical; Medicine; Memory Loss; Mentorship; Methodology; Methods; Modeling; Outcome; Pathway interactions; Patient Preferences; Patient Selection; Patient-Focused Outcomes; Patients; Penetration; Persons; Physical Function; Physical Performance; Population; Premature aging syndrome; Process; Proctor framework; Protocols documentation; Provider; Quality of life; Recommendation; Reporting; Research; Research Infrastructure; Research Methodology; Research Personnel; Risk; Screening procedure; Site; Standardization; Structure; Syndrome; Training; Universities; Vulnerable Populations; Work; aged; antiretroviral therapy; barrier to care; care systems; career; career development; clinical care; cognitive function; cohort; comorbidity; contextual factors; design; disability; evidence base; experience; follow-up; functional disability; healthy aging; implementation evaluation; implementation measures; implementation outcomes; implementation research; implementation science; implementation strategy; improved outcome; medical schools; medical specialties; meetings; mortality; peer; programs; promote resilience; response; satisfaction; scale up; screening; skills; social; social health determinants; user centered design

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.

项目概要和摘要 感染艾滋病毒的老年人 (PWH) 患有更多合并症，并且患老年综合征的风险更高 与未感染艾滋病毒的同龄人相比，其年龄相对较小。 然而，老年病的识别和管理。 艾滋病毒治疗中的综合征仍然是艾滋病毒护理中的一个临床挑战 老年病学评估的频率作为艾滋病毒治疗的一部分。 此外，尚未有针对老年感染者的常规艾滋病毒护理的报道。 将此类评估纳入专门照顾感染者的诊所（艾滋病毒诊所）。 针对临床护理方面的这一空白，我们将利用实施研究和以用户为中心的设计来实施和 评估针对该人群中 2 种关键老年综合征的基于 HIV 临床的筛查干预措施：认知 西北医学传染病中心 (NM-IDC) 提供。 每年为 1,500 多名 PWH 提供护理，其中大约一半年龄在 50 岁或以上。 工作人员将接受培训，以对认知和身体功能进行循证筛查评估， 将对所有接受连续性治疗的 50 岁或以上的感染者进行适当的后续护理教育 具体来说，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。 与主要利益相关者一起进行筛选干预和流程，2) 评估实施结果 针对老年 PWH 身体功能损伤和记忆丧失的筛查和护理途径方案，以及 3) 确定与患者、提供者之间实施结果的可变性相关的背景因素， 和其他临床工作人员，在跨学科研究团队玛丽·克莱尔·马斯特斯 (Mary Clare Masters) 的共同指导下， MD/MSCI，寻求以她之前在艾滋病毒和衰老交叉领域的临床研究经验为基础。 硕士博士将接受实施科学、定性和混合研究方法、参与性研究方面的培训 研究重点是纳入弱势群体（特别是有认知或认知障碍的老年人） 身体功能障碍）并解决健康的社会决定因素以及高级领导技能。 长期研究目标是成为一名独立研究者，专注于实施可扩展和 可持续的干预措施，以减少老年人的功能和损伤并提高其复原力 西北大学范伯格医学院的综合研究基础设施将 促进她实现学术目标，包括评估这种干预措施。 这些数据对临床结果和适当护理的保留及其扩大到其他地点的影响。 对于维持和扩大艾滋病毒老年规划的最适当策略至关重要 未来。