Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Kent, UK.
Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK.
Drugs Aging. 2023 Mar;40(3):179-240. doi: 10.1007/s40266-022-01003-3. Epub 2023 Jan 20.
Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs and concerns about medicines. This systematic review aims to describe these and to identify interventions to improve medicine optimisation outcomes in older PLWH.
Multiple databases and grey literature were searched from inception to February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials, Abstracts in Social Gerontology, and Academic Search Complete.
Studies reporting interventions/issues affecting older PLWH (sample populations with mean/median age ≥ 50 years; any aspect of medicine optimisation, or concerns). Quality assessments were completed by means of critical appraisal checklists for each study design. Title and abstract screening was led by one reviewer and a sample reviewed independently by two reviewers. Full-paper reviews were completed by one author and a 20% sample was reviewed independently by two reviewers.
Data were extracted by three independent reviewers using standardised data extraction forms and synthesised according to outcomes or interventions reported. Data were summarised to include key themes, outcomes or concerns, and summary of intervention.
Seventy-nine (n = 79) studies met the eligibility criteria, most of which originated from the USA (n = 36). A few studies originated from Australia (n = 5), Canada (n = 5), Spain (n = 9), and the UK (n = 5). Ten studies originated from Sub-Saharan Africa (Kenya n = 1, South Africa n = 6, Tanzania n = 1, Uganda n = 1, Zimbabwe n = 1). The rest of the studies were from China (n = 1), France (n = 1), Germany (n = 1), Italy (n = 1), the Netherlands (n = 1), Pakistan (n = 1), Switzerland (n = 1), Saudi Arabia (n = 1) and Ukraine (n = 1). Publication dates ranged from 2002 to 2022. Sample sizes ranged from 10 to 15,602 across studies. The factors affecting older PLWH's experience of and issues with medicines were co-morbidities, health-related quality of life, polypharmacy, drug interactions, adverse drug reactions, adherence, medicine burden, treatment burden, stigma, social support, and patient-healthcare provider relationships. Nine interventions were identified to target older persons, five aimed at improving medication adherence, two to reduce drug interactions, and two for medicine self-management initiatives.
Further in-depth research is needed to understand older PLWH's experiences of medicines and their priority issues. Adherence-focused interventions are predominant, but there is a scarcity of interventions aimed at improving medicine experiences for this population. Multi-faceted interventions are needed to achieve medicine optimisation outcomes for PLWH.
This study is registered with PROSPERO registration number: CRD42020188448.
感染艾滋病毒的老年人（PLWH）存在合并症和多药治疗的风险增加。然而，对于影响他们对药物的需求和担忧的因素知之甚少。本系统评价旨在描述这些因素，并确定改善老年 PLWH 药物优化结果的干预措施。
从开始到 2022 年 2 月，通过多种数据库和灰色文献进行了搜索，包括 MEDLINE、CINAHL、PsycInfo、PsychArticles、Cochrane 系统评价数据库和 Cochrane 对照试验注册中心、社会老年学摘要和学术搜索完整。
报告影响老年 PLWH（样本人群平均/中位数年龄≥50 岁；药物优化的任何方面，或关注）的干预/问题的研究。每项研究设计均采用关键评估清单进行质量评估。标题和摘要筛选由一名评审员主导，两名评审员独立审查了一个样本。全文审查由一名作者完成，另外 20%的样本由两名评审员独立审查。
79 项研究（n=79）符合纳入标准，其中大部分来自美国（n=36）。少数研究来自澳大利亚（n=5）、加拿大（n=5）、西班牙（n=9）和英国（n=5）。10 项研究来自撒哈拉以南非洲（肯尼亚 n=1，南非 n=6，坦桑尼亚 n=1，乌干达 n=1，津巴布韦 n=1）。其余研究来自中国（n=1）、法国（n=1）、德国（n=1）、意大利（n=1）、荷兰（n=1）、巴基斯坦（n=1）、瑞士（n=1）、沙特阿拉伯（n=1）和乌克兰（n=1）。出版日期从 2002 年到 2022 年不等。研究样本量从 10 到 15602 不等。影响老年 PLWH 药物体验和问题的因素包括合并症、健康相关生活质量、多药治疗、药物相互作用、药物不良反应、依从性、药物负担、治疗负担、污名、社会支持和医患关系。确定了九项针对老年人的干预措施，五项旨在提高药物依从性，两项旨在减少药物相互作用，两项用于药物自我管理倡议。
需要进一步深入研究以了解老年 PLWH 对药物的体验及其优先问题。以依从性为重点的干预措施居多，但针对这一人群改善药物体验的干预措施稀缺。需要采取多方面的干预措施，以实现 PLWH 的药物优化结果。
本研究已在 PROSPERO 注册，注册号为：CRD42020188448。
