R21TW012653

Knust Aging and HIV Outcomes - Abstract

Thanks to life-extending HIV therapy, there are an estimated 7 million people with HIV (PWH) aged over 50 years worldwide; 5 million of them live in sub-Saharan Africa, the epicenter of the HIV epidemic.

Of the ~312,000 PWH in Ghana in 2019, almost 1 in 6 is aged over 50 years. Geriatric syndromes (e.g., frailty, multimorbidity) and discrete diseases of aging (e.g., hypertension) threaten these gains in healthier life expectancy for aging PWH.

These threats are particularly troubling in Ghana and sub-Saharan African countries where access to geriatric care and chronic disease management is limited. Efforts underway in the region leverage HIV care systems to diagnose and manage chronic diseases of aging.

A gap in these efforts is a focus on geriatric syndromes - multi-factorial clinical conditions, common in older PWH, that do not fit discrete disease categories. Filling this gap, particularly in the sub-Saharan Africa region, is the next barrier to extending quantity of life and preserving quality of life for aging PWH.

To help fill this gap, our long-term goal is to provide comprehensive care for geriatric syndromes and diseases of aging without over-diagnosing or over-treating older PWH. The objectives of the current proposal are to 1) characterize frailty, multimorbidity, and discrete diseases of aging in older PWH; and 2) identify barriers and facilitators to providing effective patient-centered healthcare for older PWH.

Frailty is associated with HIV, dependency, and mortality. It is characterized by diminished strength, endurance, and functioning. Multimorbidity - multiple, interacting physical and mental health conditions - is associated with HIV, polypharmacy, morbidity, and mortality.

We hypothesize that 1) frailty and multimorbidity are under-recognized and discrete cardiometabolic diseases are under-diagnosed in older PWH in Ghana; and 2) infectious disease unit referrals for discrete cardiometabolic diseases are not effective for their management in Ghana.

To test these hypotheses, we propose a longitudinal observational study at the University Hospital Infectious Disease Unit, Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana. The study will enroll 151 PWH who are 50 years and older to address three specific aims: 1) characterize frailty and multimorbidity in older PWH in care at the University Hospital, KNUST; 2) assess under-diagnosis and management of discrete cardiometabolic diseases in older PWH; and 3) identify barriers and facilitators to providing effective, patient-centered healthcare to aging PWH.

Knust Aging & HIV Outcomes (KAHO) study will help identify priorities and opportunities for building an effective integrated model of HIV and geriatric healthcare in Ghana. This integrated model will extend the gains in quality life expectancy for Ghanaians and other Africans in similar settings who are aging with HIV.

Kwame Nkrumah University Of Science And Technology

NOT APPLICABLE

93.989 - International Research and Research Training

Fogarty International Center (FIC) [HHS - NIH]

Ghana

Foreign

HIV-associated Non-Communicable Diseases Research at Low- and Middle-Income Country Institutions (R21 Clinical Trial Optional) (PAR-21-246)

Amendment Since initial award the total obligations have increased 123% from $142,833 to $318,514.