Title: What are the contributors to depression, and barriers and enablers to accessing support and treatment to manage depression, among older people with HIV in England?
Funder: Department of Health and Social Care

Abstract: Research question What are the contributors to depression, and barriers and enablers to accessing support and treatment to manage depression, among older people with HIV in England? Background Most middle-aged or older patients with a major chronic disease have a higher chance of developing depression than those without chronic disease. As HIV-related clinical problems are now rare, the population of people with HIV is ageing, and a third of people with HIV in England are now older than 50. The Positive Voices survey reported that 49% of survey participants had evidence of depression and anxiety, rates that are higher than those in the general population. Currently, there is no clear standardised management pathway for people with HIV with depression. Objectives to appraise the existing evidence of the mechanisms/pathways that contribute to depression among older people with HIV; to describe the prevalence and incidence of depressive symptoms and self-reported diagnosis of depression among participants in the Pharmacokinetic Observations in PeoPle over fiftY (POPPY) Study aged >50 years; to identify factors associated with depressive symptoms and self-reported diagnosis of depression in older people with HIV in POPPY; to determine the proportions of older people with HIV who have depressive symptoms, report a diagnosis, and access healthcare, and thus quantify the potential unmet healthcare needs of older people with HIV who have depression; to explore the barriers and enablers faced by clinicians when diagnosing and managing depression among older people with HIV; and to explore the barriers and enablers faced by older people with HIV when attempting to access appropriate healthcare services for the management of depression.Methods Research will be nested within the POPPY study, which captures a wide range of demographic, lifestyle, clinical and behavioural information relating to the ageing of people with HIV in the UK/Ireland. I will describe the prevalence and incidence of depressive symptoms and self-reported depression diagnosis, and describe the factors associated with each among participants aged >50 years. I will describe the current care pathways to determine the proportion of participants with depressive symptoms who are either not identified as depressed or not receiving care for these symptoms. Finally, I will invite individuals with depressive symptoms and clinicians involved in the care of people with HIV and depression to participate in interviews to understand the barriers in accessing care for depression. Timelines for delivery I aim to complete this study over three years in two phases: quantitative phase (15 months), qualitative phase (17 months). Anticipated impact and dissemination By gaining an understanding of the factors which contribute to the development of depression in people with HIV, and of the barriers for the optimal diagnosis and management of people with HIV with depression, my research will support the optimisation of guidelines for monitoring people with HIV for depressive symptoms. Through interviewing both service providers and users, I aim to provide stakeholders with key information on how to improve care pathways specifically for older people with HIV and depression, ensuring they are accessible and acceptable to this population.

Lay abstract: Aim(s) I want to understand why it is more common for people with HIV to develop depression, and why it may be difficult for some of them to access the best care and treatment for this. I am particularly interested in depression that occurs in older people with HIV.Background One in three people with HIV in England are now over the age of 50, and the number of people with additional healthcare conditions in this population is increasing. People with HIV appear to be more likely to develop depression than people without HIV. Though we do not know why this happens, people with HIV who do have depression may find it hard to take their HIV treatment. As a result, this can mean that their HIV may cause additional health problems. The care that is available for people with HIV and depression may vary in different clinics or in different parts of the country, which may mean that it is hard for people to understand how and where they should get mental healthcare if they are experiencing depressive symptoms. Design and methods I will use a large study (the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study) of older people with and without HIV to study the factors that may contribute to the development of depression. By looking closely at a group of people with HIV and depression and determining how many access healthcare for depressive symptoms, I will measure the need for mental healthcare in this group. I will conduct in-depth interviews with people suffering with depression to understand the reasons why they may find it hard to access the most appropriate services and treatments, and I will try to understand the problems that HIV clinicians may experience when diagnosing and treating depression in people with HIV. Patient/service user, carer and public involvement I will be developing a representative community advisory board (CAB) through a consultation process with the UK CAB. We will be recruiting six members for a CAB, who will meet formally at four points over the study. Each meeting has been scheduled to help with understanding the findings, as well as developing the next steps of the study. The CAB and community support groups will be involved in recruiting members to the study to ensure we have a diverse group of people who represent all types of individuals who may need help for depression. I will also support members of the CAB in the development of a guide that will help people understand how and where to go when they require mental healthcare. Dissemination Through this research, I hope to develop a clear system for healthcare staff to identify people who may have depressive symptoms and ensure they are directed or referred to the most appropriate treatment pathway when they need help. I also hope to understand barriers experienced by people with HIV and depression when trying to get the care they need. Through the CAB and community HIV services, I hope to raise awareness of depressive symptoms and the pathway to access care to help reduce stigma related to poor mental health in this community, with the overall goal of improving emotional health and wellbeing for people with HIV as they age.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH;INFECTION