Adapting Peer Navigation for Older People with HIV

Transcript:Adapting Peer Navigation for Older People with HIV:
Adapting Peer Navigation for Older People with HIV in Ukraine 19 July 2023 Sheela Shenoi MD MPH Julia Rozanova PhD AIDS Program, Yale School of Medicine Disclosure: My spouse worked for Merck until 2007 and retains company stock in his retirement account. There are no conflicts with respect to this presentation. Increasing incidence of older adults with HIV Observed a significant increase in older adults with HIV among incident HIV cases Older adults were significantly more likely to present with AIDS compared to younger age groups Loss to follow up from HIV care was 3.6 times greater among OPWH compared to younger adults OPWH were 50% more likely not to initiate ART Older adults were significantly more likely to experience mortality within the year of diagnosis compared to younger age groups Rozanova et al 2021; Allen et al 2021 Table 1. Percent of sample with CD4 count < 200 cells/mL at time of HIV diagnosis by age. Rozanova J, Zeziulin O, Rich KM, Altice FL, Kiriazova T, et al. (2021) An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care. PLOS ONE 16(9): e0256627. https://doi.org/10.1371/journal.pone.0256627 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256627 Table 2. Standardized mortality ratios by age group, 2016–2018. Rozanova J, Zeziulin O, Rich KM, Altice FL, Kiriazova T, et al. (2021) An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care. PLOS ONE 16(9): e0256627. https://doi.org/10.1371/journal.pone.0256627 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256627 ADAPT-IT To facilitate the adaptation of existing evidence-based interventions (EBI) in novel situations. Structured 8-phase process to modify an EBI without competing or contradicting its core tenets. Initially developed for adapting EBI for patients with HIV Wingood et al 2008; nccmt.ca Wingood et al 2008; nccmt.ca ADAPT-IT: Assessment Who is the new target population? Older people with HIV A) In-depth interviews (n=30) Inability to accept diagnosis Identity was challenged “I’m a decent person, I did nothing bad” Resilience: experience managing life altering events B) Phone survey (n=123) 74% requested peer support Vast majority did not want to meet in person; preferred phone or video due to perceived shame, deemed non-intrusive Allen et al 2021; Rozanova et al 2020 ADAPT-IT: Decision Which EBI is going to be selected? Is it going to be adopted or adapted? Based on our review of the literature, consultation with local stakeholders, and our own formative work, we selected peer navigation Peer navigation required adaptation to the older adult context Subsequent adjustments required for: covid19 surges