Patient and provider perceptions of a comprehensive care program for HIV-positive adults over 50 years of age: The formation of the Golden Compass HIV and aging care program in San Francisco

Abstract

ObjectivePeople living with HIV (PLWH) are living longer and developing comorbidities and aging-related syndromes. New care models are needed to address the combined burden and complexity of HIV and its comorbidities in this group. The goal of this study is to describe qualitative data from patients and providers that informed the development of a comprehensive care model for older PLWH.MethodsPatient and provider perspectives on the clinical care and service needs of patients living and aging with HIV were explored via surveys and focus groups at a safety net HIV clinic in San Francisco. We surveyed 77 patients and 26 providers and conducted separate focus groups of older patients living with HIV (n = 31) and staff (n = 20). Transcripts were analyzed using thematic analysis. Themes for a care program were additionally explored using findings from the literature on HIV and aging.FindingsThemes from surveys and focus groups emphasized (a) the need for knowledge expertise in HIV and aging, (b) focus on medical conditions and determinants of health of particular import (e.g. marginal housing) among older PLWH, (c) co-locating specialty services (e.g. cardiology, geriatrics) with primary care, and (d) addressing social isolation. Findings informed the design of a comprehensive, multidisciplinary care model for PLWH called the Golden Compass program composed of four “points”: Heart and Mind (North), Bones and Strength (East), Network and Navigation (South), and Dental, Hearing, and Vision (West).ConclusionBased on patient and clinic staff perspectives from surveys and focus groups, we designed a multidisciplinary program of integrated primary and specialty care, as well as housing and social support, to address the needs of older PLWH within a safety-net infrastructure. Golden Compass launched in 2017 for PLWH older than 50 years. Future research to evaluate the effectiveness of this care program in improving patient outcomes and satisfaction is ongoing.

“Undetectable, Now What?” HIV Provider Opinions on Barriers to Healthy Aging for Older People Living with HIV in North America

“…Our data suggest that HIV provider "buy-in" is key to implementing and disseminating new care models, such as the integration of geriatric assessments. These findings are support by a recently published paper detailing the development of the "Golden Compass HIV and aging care program" that was designed with patient and clinic staff perspectives [31]. The successful implementation of geriatric concepts into HIV care on a wider scale will likely require a) ongoing education of HIV providers on the changing needs of older PLWH and the potential value of geriatric expertise, b) data from randomized clinical trials demonstrating the effectiveness of geriatric care models, and c).…”

The Golden Compass Program: Overview of the Initial Implementation of a Comprehensive Program for Older Adults Living with HIV

“…35 Specifically, the program name, including the idea of a compass, came from focus groups with patients who reported feeling unprepared for their "Golden Years" and who reported needing help navigating the health care system. 35 Using this input, we conceptualized the Golden Compass program as a comprehensive care program for PLWH aged 50 years or older, framed around the 4 points of a compass: (1) Heart and Mind (Northern Point) includes on-site cardiology, cognitive evaluations, and brain health classes; (2) Bones and Strength (Eastern Point) focuses on bone health, fitness, and physical function, through exercise classes and on-site geriatric consultation; (3) Dental, Hearing, and Vision (Western Point) ensures appropriate screenings and linkage to dental, audiology, and optometric/ophthalmology services; and (4) Networking and Navigation (Southern Point) focuses on social and community-building activities. 35 Key features of this program are that patients maintain their primary care provider and access the Golden Compass program within their HIV primary care setting.…”

“…The Golden Compass Program is a geriatric-HIV program designed to address key health-related challenges experienced by older PLWH and consists of consultative geriatrics and cardiology clinics located within the HIV clinic and participatory group classes for patients; the theory-based design of the program is described previously. 35 This evaluation focuses on the period from program inception in January 2017 through June 2018. Importantly, through the use of the RE-AIM framework, this article presents assessment of initial outcomes such as acceptability and satisfaction with the program among patients and providers.…”

Perspectives of Chronic Disease Management Among Persons with HIV: A Qualitative Study

“…Several options that have been explored with varying success. 10,18,19 Given the receptiveness to additional involvement by the clinical support staff, many opportunities arise for the development of innovative models to improve NCD delivery in this context. This multidisciplinary approach could lessen the burden of HIV providers while ensuring that patients are receiving comprehensive NCD care.…”