Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
Department of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia.
J Int AIDS Soc. 2020 Nov;23(11):e25638. doi: 10.1002/jia2.25638.
The rapidly growing epidemic of non-communicable diseases (NCDs) including mental health among aging people living with HIV (PLWH) has put a significant strain on the provision of health services in many HIV clinics globally. We constructed care cascades for specific NCDs and mental health among PLWH attending our centre to identify potential areas for programmatic improvement.
This was a follow-up study of participants recruited in the Malaysian HIV & Aging study (MHIVA) from 2014 to 2016 at the University Malaya Medical Centre (n = 336). PLWH on suppressive antiretroviral therapy (ART) for a minimum of 12 months were invited to participate. At study entry, all participants underwent screening for diabetes (DM), hypertension (HTN) and dyslipidaemia; and completed assessments using the depression, anxiety and stress scale (DASS-21). Screening results were recorded in medical charts and clinical management provided as per standard of care. A subsequent review of medical records was performed at 24 months following study completion among participants who remained on active follow-up. Treatment pathways for NCD treatment and psychiatric referrals were assessed based on local practice guidelines to construct the care cascade.
A total of 329 participants (median age = 43 years, 83% male, 100% on ART) completed follow-up at 24 months. The prevalence of diabetes was 13%, dyslipidaemia 88% and hypertension 44%, whereas 23% presented with severe/extremely severe symptoms of depression, anxiety and/or stress. More than 50% of participants with dyslipidaemia and hypertension were not diagnosed until study screening, whereas over 80% with prevalent psychiatric symptoms were not previously recognized clinically. Suboptimal control of fasting lipids, sugar and blood pressure were found in the majority of participants despite optimal HIV treatment outcomes maintained over this same period. Only 32% of participants with severe/extremely severe mental health symptoms received psychiatric referrals and 83% of these attended their psychiatry clinic appointments.
Systematic screening must be introduced to identify NCDs and mental health issues among PLWH followed by proper linkage and referrals for management of screen-positive cases. Assessment of factors associated with attrition at each step of the care cascade is critically needed to improve health outcomes in our aging patients.
在老龄化的艾滋病毒感染者（PLWH）中，非传染性疾病（NCD）包括心理健康的流行呈快速上升趋势，这给许多全球艾滋病毒诊所的卫生服务提供带来了巨大压力。我们为参加我们中心的 PLWH 构建了特定 NCD 和心理健康的护理级联，以确定方案改进的潜在领域。
这是 2014 年至 2016 年在马来亚大学医学中心（n=336）参加马来西亚艾滋病毒与老龄化研究（MHIVA）的参与者的随访研究。邀请至少接受了 12 个月的抑制性抗逆转录病毒治疗（ART）的 PLWH 参加。在研究入组时，所有参与者均接受糖尿病（DM）、高血压（HTN）和血脂异常的筛查；并使用抑郁、焦虑和压力量表（DASS-21）完成评估。筛查结果记录在病历中，并根据标准护理提供临床管理。在研究完成后 24 个月，对仍在积极随访的参与者进行了后续病历审查。根据当地实践指南评估 NCD 治疗和精神科转诊的治疗途径，以构建护理级联。
共有 329 名参与者（中位年龄为 43 岁，83%为男性，100%正在接受 ART）在 24 个月时完成了随访。糖尿病的患病率为 13%，血脂异常为 88%，高血压为 44%，而 23%的人出现严重/极度严重的抑郁、焦虑和/或压力症状。超过 50%的血脂异常和高血压患者直到研究筛查才被诊断出来，而超过 80%的有明显精神症状的患者以前并未在临床上发现。尽管在同一时期保持了最佳的 HIV 治疗结果，但大多数参与者的空腹血脂、血糖和血压控制不理想。尽管在同一时期保持了最佳的 HIV 治疗结果，但大多数参与者的空腹血脂、血糖和血压控制不理想。尽管在同一时期保持了最佳的 HIV 治疗结果，但大多数参与者的空腹血脂、血糖和血压控制不理想。只有 32%的严重/极度严重心理健康症状的参与者接受了精神科转诊，其中 83%的人参加了他们的精神病诊所预约。
必须引入系统筛查，以确定 PLWH 的 NCD 和心理健康问题，然后对筛查阳性病例进行适当的联系和转诊。需要评估护理级联中每个步骤的流失相关因素，以改善我们老年患者的健康结果。
