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Speaker Name: Dr Charlotte Taderera�

Title: The integrated HIV-geriatric clinic model: Lessons from Newlands Clinic, Harare, Zimbabwe

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Background

  • Population of older people living with HIV (OPLWH) is increasing globally
  • Sub-Saharan Africa (SSA) predictions: 10 million OPLWH >50 years by 2040
  • Higher prevalence of multi-morbidity, increased risk of non-communicable diseases (NCDs) and geriatric syndromes in OPLHIV

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Background

  • Integrated HIV-geriatric care models have been described in high-income settings
  • Paucity of data from low-income settings
  • We describe a new model of care which integrates geriatric assessments with routine HIV care in a low resource setting.

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  • Comprises of a comprehensive geriatric assessment (CGA)
  • Based on the WHO’s Integrated Care for Older People (ICOPE) guidelines 2017
  • Screening tools selected based on regional validation, local guidelines and feasibility

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Newlands Clinic model

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Clinic Model

  • Newlands Clinic clients ≥65 years (n=448) receiving routine HIV-care were invited to attend IHGC for a Comprehensive Geriatric Assessment (CGA):
    • Nurse interview 60 mins (history and examination)
    • Doctor review (hearing, visual, frailty, cognition, QOL)
  • CGA was conducted using a standardised electronic wizard, assessment tools embedded

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Clinic model

  • Geriatric blood panel for every client including HIV viral load, FBC, renal function, lipid profile, vitamin B12 levels
  • Referrals made onsite to the mental and social health department or to specialists in the tertiary institutions
  • We present findings from the first 100 patients reviewed between October 2022 and June 2023

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Results

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  • Median age 69 (range 65-92 yrs)
  • 69% female
  • Median time since diagnosis 16 years (IQR 14-18)
  • Median time on ART 15 (12-17)
  • 100% of attendees had a HIV viral load < 1000 copies/ml (94% <50 copies/ml)

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  • Median number of comorbidities and comedications was 3 (IQR 2-4) and 4 (IQR 3-6) respectively
  • 86% of attendees received new interventions as a result of the IHGC visit

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Results

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Results

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Lessons learnt

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  • Integration of CGA within routine HIV-care highlights the high prevalence of multimorbidity and complex needs of OPLHIV
  • High prevalence of NCDs but minimal HIV-related issues
  • The IHGC identified multiple issues previously unrecognised during routine care
  • Targeted assessment of geriatric domains is essential

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Lessons learnt

  • Minimal training is required to capacitate nurses to effectively deliver a CGA
  • Limitation: time to complete the CGA is a potential barrier to delivery in less well-resourced clinics
  • Data are useful to inform critical management issues in OPLHIV

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Next steps

  • Annual CGA for all patients >50 years
  • Assess effectiveness of the CGA
  • Contribute to development of a gold-standard model of care for OPLHIV

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“Today, I have come to the hospital, on other visits I was just coming to get medication.”

“Today I was really treated, you left nothing out, you looked at me from head to toe and you asked me everything.”

“I have been seen here for years but I have never been evaluated like this.”

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Thank you

Acknowledgements

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  • The Geriatric clinic team: Dr Sara Lowe, Sr Sophia Chikutirwe, Dr Evelyn Matanga
  • The Newlands Clinic team
  • The Newlands Clinic recipients of care
  • Prof Celia Gregson

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