Title: Testing the feasibility and acceptability of case-finding and subsequent comprehensive geriatric assessment intervention for older people with HIV with frailty
Funder: Department of Health and Social Care

Abstract: Background: Due to treatment advances HIV has become a long-term condition. It no longer reduces life expectancy, so increasing numbers of people are ageing with HIV. Within the next 10 years, over half of all people living with HIV are projected to be over 50 years of age. Older people (over 50 years) living with HIV (OPWH) often have multiple health problems and frailty leading to loss of independence and poorer quality of life. OPWH experience age-related illness earlier than the HIV-negative population. Yet, this group reports challenges accessing care. They often bounce between services and can face discrimination when using non-specialist HIV services. Intervention: Our joint clinic ( Silver Clinic ) combines experts in HIV and elderly medicine to case-find OPWH and frailty within an HIV-setting and deliver a Comprehensive Geriatric Assessment (CGA). CGA considers the medical, psychological, and social needs of each individual to improve their functional ability (ability to perform daily activities independently) and reduce hospital admissions. CGA has strong evidence in other health conditions, but this is the first study to explore its use for OPWH. Individuals will be seen in the Silver clinic and receive up to three contacts (initial plus two follow-ups). Design: Feasibility randomised controlled trial (RCT) of the Silver Clinic compared to standard care (routine HIV and GP care) for OPWH and frailty. The aim is to determine the feasibility of testing effectiveness in a definitive RCT. As such, our research questions include: Can we recruit sufficient OPWH (8 per week) to the study to make a full RCT feasible? Once recruited, can we retain the majority of participants (85%) in the study? How do OPWH feel about being screened for frailty? How do OPWH feel about being randomised to receive CGA or standard care? What are the active ingredients of CGA, and what outcomes should we measure in an RCT? Does the CGA approach need to be refined before a definitive RCT? Participation: For this feasibility trial we will recruit 84 OPWH and frailty. They will be randomly allocated to receive either the Silver Clinic intervention or standard care following screening during their HIV annual health check. Participants will complete questionnaires to measure symptoms, quality of life and health service use at baseline, 6 months and 12 months. We will interview a selection of the trial participants, including where possible those who exit the study before completion, to explore their experiences of participation in the study including: being screened for frailty, what frailty means for them, the randomisation and trial processes, the frailty measures and the intervention. We will also interview a small number of OPWH and frailty at a second site in London to ensure the intervention design recommendations are relevant to a more heterogeneous population. HIV health and social care professionals will participate in focus groups to explore: their views regarding the potential risks and benefits of frailty screening and the candidate frailty screening measures, experiences of caring for OPWH and frailty, and views on the intervention and standard care.

Lay abstract: What is the problem? People with HIV are living to older ages thanks to effective HIV care and treatments. However, many are experiencing ageing-related health problems. These include frailty (being less able to recover from illness or injury), weakness and falls. They also have trouble with day-to-day activities. These are common problems for older people. However, for people with HIV, they are happening at younger ages. Why do we need to do something about it? People with HIV have ageing related problems as young as 50. Experts in elderly care are specialists in managing these problems. However, people with HIV may not be able to see these specialists as they are too young. Therefore, they may not receive the care that they need. Older people with HIV have many health problems requiring different medications. They also have difficulties managing day-to-day. Services designed for older people with HIV are needed. Guidance has recommended that: Experts in elderly care should help care for older people with HIV Older people with HIV should have regular tests for frailty Currently, older people with HIV are cared for by HIV experts and GPs. However, we do not know which is better: care from HIV experts with GPs, or with elderly care experts? What now? Experts in elderly care use something called a Comprehensive Geriatric Assessment. This is a careful assessment of a person s physical, emotional and social needs. A plan is then put in place to help them to get on better day-to-day. It helps them to remain independent. It also aims to stop them having to go into hospital unless they really need to. This approach is helpful for older people living with many long-term conditions. However, it has not been tested for older people with HIV. The study This study is a feasibility trial . We will recruit 84 older people with HIV and frailty. They will be put into two groups at random after being screened for frailty during their routine HIV annual health check. One group will receive standard care (from HIV experts and GPs). The other group will have a comprehensive geriatric assessment including a cognitive assessment (from HIV and elderly care experts). We will use questionnaires and interviews to answer the following questions: Are older people with HIV happy to be tested for frailty and cognitive impairment? How do they feel about having a Comprehensive Geriatric Assessment? Does a Comprehensive Geriatric Assessment help older people with HIV? Were we able to recruit enough people into the study? Was the study acceptable to older people with HIV?

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE;INFECTION