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.
Highlights
[The HIV geriatrician] found that I had a balance issue on my right side and she sent me to PT for it and so they taught me strengthening exercises...I never knew that and so if someone hadn't have said, "You've got some balance issues," and we're going to send you to PT to help with it [I’d never have done]
Few integrated care programs for older people with HIV have been evaluated. The findings in this and in previous assessments of Golden Compass [15] are consistent with the limited literature demonstrating high patient and provider satisfaction with care models that incorporated geriatric medicine in HIV care [22, 23]
Our findings illustrate that the Golden Compass multidisciplinary team embedded within an HIV clinic contributed to self-reported improved knowledge and confidence among providers in caring for patients, which aligns with other models of HIV care for older adults involving both a general practitioner and specialists [22]
Summary
We use the age of 50 to characterize “older” for people with HIV due to the risk of age-related comorbidities and geriatric conditions at younger ages relative to the general population [2,3,4,5,6]. Managing comorbidities and geriatric conditions requires specialized treatments that in turn put older people with HIV at risk for other clinical complications, including drug-drug interactions [7,8,9]. Golden Compass at Ward 86, a safety-net outpatient HIV clinic, was developed in response to the need for a broader care approach with older people with HIV (Fig. 1) [14, 15]. Additional services include specialist referrals and navigation; classes on improving functional status and cognition [14, 15]
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