The United States is making major progress in responding to the HIV epidemic, building on the remarkable success of effective antiretroviral therapy at promoting health among people living with HIV (PLWH). With high quality care and ongoing treatment, PLWH can live long and healthy lives, and today over half of PLWH in the United States are age 50 and older. However, new challenges emerges as PLWH grow older, and now it’s time for Ryan White program to build new strategies to battle these challenges.
Compared to their HIV-negative age peers, older PLWH have higher rates of comorbidities associated with aging, such as diabetes, cardiovascular disease, cancer, liver disease, and neurocognitive impairment, as well as higher rates of geriatric syndromes, such as falls and frailty. They are also more susceptible to negative mental health outcomes such as depression, which is associated with physical comorbidities and with psychosocial factors such as HIV stigma and loneliness.
Much like in the general population, multiple comorbidities can place older PLWH at an increased risk of functional decline and disability. Because of multiple comorbidities, polypharmacy is common among older PLWH, which increase the risk of drug–drug interaction. All of the above contributes to the increasing needs for the inclusion of sub-specialists and the early screening of comorbid conditions among older PLWH in order to prevent long-term complications.
Since HIV providers may not be proficient in managing multiple comorbidities or the functional decline associated with aging, care for older PLWH will require integration across HIV and aging networks, either adapting or reconfiguring models of care. Given that older PLWH is a rather newly emerging issue, there’s not yet been sufficient evidence to determine which model is the best solution, however Ryan White HIV/AIDS Program can have a key role to play.
The Ryan White HIV/AIDS Program, authorized by Title XXVI of the Public Health Service Act, is a federal funded program that operates across the whole country. More than half of PLWH in the United States receive services through the Ryan White HIV/AIDS Program each year.So far, the program has successfully increased rates of viral suppression (less than 200 copies/mL of blood), significantly reducing the rate of transmission. In 2017, 85.9% of Ryan White clients receiving medical care services are virally suppressed, whereas in 2015, only 59.8% of all PLWH in the US. It’s also narrowed disparities among groups of different ages, genders, races, and regions.
The Ryan White Program is divided into 5 parts. Part F of the program funds to support research, technical assistance, and access-to-care programs, one of which is the Special Projects of National Significance (SPNS) Program. It supports the development of innovative models of care delivery for the emerging needs of the clients of Ryan White Program, which could also be used to fund experimental trials of all models addressing the integration of care delivery for older PLWH, so all models could be properly demonstrated and evaluated, and hence help determine which is the most effective.
Another program under Part F of the Ryan White Program is the AIDS Education and Training Centers (AETC) Program, which also serves a great role in providing care for older PLWH. The program offers funds to support the education and training of health care providers treating PLWH through a network of 8 regional centers and 3 national centers, and could be helpful in training care providers in all fields to be equipped to deliver specialized care for older PLWH.
It is time we consider how to improve and adapt the current health care and support system to offer sufficient medical and psychosocial support services for older PLWH. The Ryan White Program can help lead the way. The O’Neill Institute’s Infectious Diseases Initiative is working on issues related to HIV and aging and that we will release an issue brief later this year.