Testing the feasibility and acceptability of case-finding and subsequent comprehensive geriatric assessment intervention for older people with HIV with frailty

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.