People aging with HIV – protecting a population vulnerable to effects of COVID-19 and its control measures

Figures & data

Table 1. THRIVE program services.

Medical services	Wrap-around psychosocial support services
Primary Care and HIV Specialty Care	Social worker assigned to each patient Home based case management Employment counseling Housing coordination Emergency financial assistance Transportation assistance Nutritional counseling, nutritional supplements, grocery store vouchers Mental health counseling Substance abuse counseling Peer support coaches Support groups
Vaccinations STI testing and treatment Cancer screenings: cervical and anal Papinocolou smear, colposcopy, high resolution anoscopy, referrals for others On-site laboratory Mental health care Buprenorphine maintenance therapy DAART pharmacy Clinical HIV pharmacists
HIV Prevention
nPEP PrEP
HCV Specialty Care
HCV evaluation and treatment Dedicated HCV pharmacist Fibroscan

Key: STI, sexually transmitted infection; DAART, directly administered antiretroviral therapy; nPEP, non-occupational post-exposure prophylaxis; PrEP, pre-exposure prophylaxis; HCV, hepatitis C virus.

Table 2. Assessments utilized in STRONG study.

Parameter assessed	Tool used
Depression	Patient Health Questionnaire 9 (PHQ9)
Anxiety	General Anxiety Disorder 7 (GAD7)
Cognition	Montreal Cognitive Assessment (MoCA)
Physical performance	Short physical performance battery (SPPB)
Functional status (activities of daily living)	Older Americans Resources and Services (OARS)
Frailty	Fried Frailty Index
Nutritional risk	DETERMINE
Current HIV status	Most recent CD4 count and HIV RNA values
Cardiovascular risk	Recorded tobacco use status, lipid levels, diagnosis of hypertension or diabetes, and use of anti-hypertensives, diabetes medications, statin drugs, and aspirin; ASCVD risk score and recommendations
Renal disease	Urinalysis, GFR (UA with blood or protein, or GFR <60 defined as abnormal); HIV Primary Care guidelines
Liver disease	Liver function panel (AST, ALT, total bilirubin or alkaline phosphatase > ULN defined as abnormal); HIV Primary Care guidelines
HIV history (medical and personal experience)	socio-demographic questionnaire via patient self-report
Advanced care planning	socio-demographic questionnaire via patient self-report
Substance use, housing, employment, relationships, finances, educational attainment, support system, caregiving, community engagement	socio-demographic questionnaire via patient self-report

Key: AST, aspartate aminotransferase; ALT, alanine aminotransferase; ULN, upper limit of normal; MSM, man who has sex with men

Table 3. Risk factors for COVID-19 severity (Centers for Disease Control and Prevention, 2021).

	Prevalence in STRONG cohort
Race
Non-white	95% African American
Gender
Male	59% male
Age
Increased; over 65 years	Mean 59 years Range 50–73 years
Co-morbidities
Obesity, overweight	33% obese, 29% overweight
Diabetes mellitus (type 1, 2)	22% diabetes mellitus
Cardiac disease (coronary artery disease, congestive heart failure, hypertension, cardiomyopathy)	76% hypertension ASCVD risk score average 17.7% ASCVD risk score range 2.1–57.1%
Cerebrovascular disease, neurological conditions, including dementia	MoCA average score 21.8 of 30 MoCA score range 10–29 78% cognitive impairment
Liver disease	14% abnormal liver function
Renal disease	59% abnormal glomerular filtration rate, hematuria, or proteinurea
Smoking, former or current	57% current smokers 80% ever smokers
Substance use	3% current heavy alcohol use 47% ever heavy alcohol use 3% current drug use 71% ever drug use 42% ever injection drug use
Mental illness	34% mild depression 21% moderate or severe depression 22% mild anxiety 22% moderate or severe anxiety
Lung disease (COPD, interstitial lung disease, pulmonary fibrosis, pulmonary hypertension, cystic fibrosis, asthma)	Not assessed
Pregnancy	Not assessed
Solid organ or blood stem cell transplant	Not assessed
Cancer, immunosuppressive medications, immune deficiencies	Not assessed
Sickle cell disease, thalassemia	Not assessed
Down Syndrome	Not assessed

Key: ASCVD, artherosclerotic cardiovascular disease; MoCA, Montreal Cognitive Assessment; COPD, chronic obstructive pulmonary disease.

Table 4. Patient listening session sample questions and responses.

Sample Questions

“What does it mean to be a long-term survivor?”

“What are you most concerned about during this time in your life?”

“What factors in your life have helped you age well? What factors have made getting older more difficult for you?”

“Do you have the social support that you want/need?”

Sample Responses

Gaps in social network

“For me, I had 5 kids, I'm all alone now. I don't have a love in my life, it's just me. … deep down inside, I don't wanna be alone … I don't wanna die alone … .”

Social support challenges due to life course changes

“I live alone, my kids are adults, you know, the nest is empty, so I'm home alone a lot and I have so many problems … a lot of things I can't really do, they're difficult for me to do at home.”

Social interaction providing purpose

“I think even being out just doing those things would give me purpose and help me … I live alone. Most of the time I am alone, but when I get out amongst the living I feel so much better”

Effect of support groups on well-being

“I really need the support groups to get me out the house, to keep me active and focus on what I need to be doing for myself. It's very important to me.”