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Sirisegaram L, Kokorelias KM, Zhabokritsky A, Walmsley S. Navigating complex care for older women with HIV: role of geriatrician support. THE LANCET. HEALTHY LONGEVITY 2024; 5:100649. [PMID: 39527956 DOI: 10.1016/j.lanhl.2024.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/19/2024] [Accepted: 09/27/2024] [Indexed: 11/16/2024] Open
Affiliation(s)
- Luxey Sirisegaram
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto M5G 1X5, ON, Canada; Division of Geriatric Medicine Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto M5G 1X5, ON, Canada; Department of Occupational Science & Occupational Therapy Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alice Zhabokritsky
- Infectious Diseases Department of Medicine, University of Toronto, Toronto, ON, Canada; Infectious Diseases, Department of Medicine, University Health Network, Toronto, ON, Canada; Canadian Institutes of Health Research, Canadian HIV Trails Network, Vancouver, BC, Canada
| | - Sharon Walmsley
- Infectious Diseases Department of Medicine, University of Toronto, Toronto, ON, Canada; Infectious Diseases, Department of Medicine, University Health Network, Toronto, ON, Canada; Canadian Institutes of Health Research, Canadian HIV Trails Network, Vancouver, BC, Canada
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Prevalence and Correlates of Self-Rated Successful Aging Among Older Women Living With HIV. J Acquir Immune Defic Syndr 2020; 82 Suppl 2:S162-S169. [PMID: 31658205 PMCID: PMC6830959 DOI: 10.1097/qai.0000000000002175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite marked gains in longevity attributable to antiretroviral therapy (ART), older women living with HIV (OWLH) experience substantial health challenges, and few studies addressed whether they can achieve successful aging (SA). This is among the first studies examining prevalence and psychosocial correlates of self-rated SA (SRSA) among OWLH and women at risk of HIV.
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Odlum M, Black D, Yoon S, Maher C, Lawrence S, Osborne J. Exploring HIV concern in a population of Dominican American women midlife and older. BMC Public Health 2019; 19:1429. [PMID: 31672141 PMCID: PMC6824013 DOI: 10.1186/s12889-019-7810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The feminization and ethnic diversification of HIV infection, has resulted in a call for gender- and culture-specific prevention strategies for at-risk groups including Latinos in the United States. The steadily changing demographic profile of the AIDS epidemic challenges prevention strategies to remain relevant and up-to-date, particularly in populations of women midlife and older where an understanding of risk remains under explored. As the CDC requests country-specific HIV risk profiles for Latino communities in the US, understanding the socio-economic, behavioral and personal risk reasons of HIV risk for older Dominican women is critical for prevention. METHODS We conducted focus group discussions informed by the Theory of Gender and Power (TGP). The three constructs of the TGP: 1) Affective influences/social norms; 2) Gender-specific norms and. 3) Power and Authority guided the thematic analysis and identified themes that described the socio-cultural and contextual reasons that that contribute to perceptions of HIV risk. RESULTS Sixty Dominican American women ages 57-73 participated in our focus group discussions. Sexual Division of Labour: 1) Economic Dependence; 2) Financial Need and 3) Education and Empowerment. Sexual Division of Power: 4) HIV Risk and 5) Relationship Dynamics. Cathexis: Affective Influences/Social Norms: 6) HIV/AIDS Knowledge and 7) Prevention and Testing. Importantly, participants were concerned about partner fidelity when visiting the Dominican Republic, as the country accounts for the second highest HIV rates in the Caribbean. CONCLUSIONS Our results confirm previous findings about perceptions of HIV risk and provide additional insight into aging-related aspects of HIV risk for Latino women midlife and older.
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Affiliation(s)
- Michelle Odlum
- Columbia University School of Nursing, 560 W 168 St, New York, NY, 10032, USA.
| | - Danielle Black
- Columbia University School of Nursing, 560 W 168 St, New York, NY, 10032, USA
| | - Sunmoo Yoon
- Columbia University Medical Center, New York, NY, 10032, USA
| | - Cassidy Maher
- Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Steven Lawrence
- Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Jennel Osborne
- Columbia University School of Nursing, 560 W 168 St, New York, NY, 10032, USA
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Odlum M, Yoon S. Understanding Comorbidities and Their Contribution to Predictors of Medical Resource Utilization for an Age- and Sex-Matched Patient Population Living With HIV: Cross-Sectional Study. JMIR Aging 2019; 2:e13865. [PMID: 31516123 PMCID: PMC6746060 DOI: 10.2196/13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/19/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than 60% of people aging with HIV are observed to have multiple comorbidities, which are attributed to a variety of factors (eg, biological and environmental), with sex differences observed. However, understanding these differences and their contribution to medical resource utilization remains challenging as studies conducted exclusively and predominantly among males do not translate well to females, resulting in inconsistent findings across study cohorts and limiting our knowledge of sex-specific comorbidities. OBJECTIVE The objective of the study was to provide further insight into aging-related comorbidities, their associated sex-based differences, and their contribution to medical resource utilization, through the analysis of HIV patient data matched by sex. METHODS International Classification of Disease 9/10 diagnostic codes that comprise the electronic health records of males (N=229) and females (N=229) were categorized by individual characteristics, chronic and mental health conditions, treatment, high-risk behaviors, and infections and the codes were used as predictors of medical resource utilization represented by Charlson comorbidity scores. RESULTS Significant contributors to high Charlson scores in males were age (beta=2.37; 95% CI 1.45-3.29), longer hospital stay (beta=.046; 95% CI 0.009-0.083), malnutrition (beta=2.96; 95% CI 1.72-4.20), kidney failure (beta=2.23; 95% CI 0.934-3.52), chemotherapy (beta=3.58; 95% CI 2.16-5.002), history of tobacco use (beta=1.40; 95% CI 0.200-2.61), and hepatitis C (beta=1.49; 95% CI 0.181-2.79). Significant contributors to high Charlson scores in females were age (beta=1.37; 95% CI 0.361-2.38), longer hospital stay (beta=.042; 95% CI 0.005-0.078), heart failure (beta=2.41; 95% CI 0.833-3.98), chemotherapy (beta=3.48; 95% CI 1.626-5.33), and substance abuse beta=1.94; 95% CI 0.180, 3.702). CONCLUSIONS Our findings identified sex-based differences in medical resource utilization. These include kidney failure for men and heart failure for women. Increased prevalence of comorbidities in people living long with HIV has the potential to overburden global health systems. The development of narrower HIV phenotypes and aging-related comorbidity phenotypes with greater clinical validity will support intervention efficacy.
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Affiliation(s)
- Michelle Odlum
- Columbia University School of Nursing, New York, NY, United States
| | - Sunmoo Yoon
- Columbia University Irving Medical Center, New York, NY, United States
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Solomon P, O’Brien KK, Nixon S, Letts L, Baxter L, Gervais N. Qualitative longitudinal study of episodic disability experiences of older women living with HIV in Ontario, Canada. BMJ Open 2018; 8:e021507. [PMID: 29678993 PMCID: PMC5914902 DOI: 10.1136/bmjopen-2018-021507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To examine the episodic disability experiences of older women living with HIV over time. DESIGN Qualitative longitudinal study, conducting semistructured in-depth interviews on four occasions over a 20-month time frame. Inductive thematic analyses were conducted cross-sectionally and longitudinally. SETTING Participants were recruited from HIV community organisations in Canada. PARTICIPANTS 10 women aged 50 years or older living with HIV for more than 6 years. RESULTS Two major themes related to the episodic nature of the women's disability. Women were living with multiple and complex sources of uncertainty over time including: unpredictable health challenges, worrying about cognition, unreliable weather, fearing stigma and the effects of disclosure, maintaining housing and adequate finances, and fulfilling gendered and family roles. Women describe strategies to deal with uncertainty over time including withdrawing and limiting activities and participation and engaging in meaningful activities. CONCLUSIONS This longitudinal study highlighted the disabling effects of HIV over time in which unpredictable fluctuations in illness and health resulted in uncertainty and worrying about the future. Environmental factors, such as stigma and weather, may put older women living with HIV at a greater risk for social isolation. Strategies to promote dealing with uncertainty and building resilience are warranted.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Nixon
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Larry Baxter
- Community HIV Volunteer, Halifax, Nova Scotia, Canada
| | - Nicole Gervais
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Frazier EL, Sutton MY, Tie Y, Collison M, Do A. Clinical Characteristics and Outcomes Among Older Women with HIV. J Womens Health (Larchmt) 2017; 27:6-13. [PMID: 28836885 DOI: 10.1089/jwh.2017.6380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To inform the development of HIV care strategies for older women with HIV infection, an understudied group, we compared the psychosocial, behavioral, and clinical characteristics of HIV-positive women aged ≥50 (older women) with those aged 18-49 (younger women). METHODS We examined factors among HIV-positive women in care using data from the 2009 through 2013 cycles of a nationally representative sample of HIV-positive adults in care (Medical Monitoring Project). We compared psychosocial, clinical, and behavioral factors among women aged ≥50 years at interview versus those aged <50 years. We calculated weighted frequency estimates and performed logistic regression to compute adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for the comparison of characteristics among women aged ≥50 versus <50 years. RESULTS Of 22,145 participants, 6186 were women; 40.7% (CI 39.1-42.3) were ≥50 years, and 32.7% of older women reported being sexually active. Compared with women <50 years, women aged ≥50 years were more likely to be dose adherent (aPR = 1.19; CI 1.07-1.33), prescribed antiretroviral therapy and have sustained viral load suppression (aPR = 1.03; CI 1.00-1.18), and were less likely to report any depression (aPR = 0.92; CI 0.86-0.99), to report condomless sex with a negative or unknown partner if sexually active (aPR = 0.56; CI 0.48-0.67), and to have received HIV/sexually transmitted infection (STI) prevention counseling from a healthcare provider (aPR = 0.82; CI 0.76-0.88). CONCLUSIONS These data suggest that older women in HIV care have more favorable outcomes in some clinical areas, but may warrant increased HIV/STI prevention counseling from their care providers, especially if sexually active.
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Affiliation(s)
- Emma L Frazier
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Madeline Y Sutton
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Yunfeng Tie
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .,2 ICF International , Atlanta, Georgia
| | - Maggie Collison
- 3 Internal Medicine Residency Program, Boston Medical Center , Boston, Massachusetts
| | - Ann Do
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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