KNUST Aging and HIV Outcomes - Abstract
Thanks to life-extending HIV therapy, there are an estimated 7 million people with HIV (PWH) aged over 50
years worldwide; 5 million of them live in sub-Saharan Africa, the epicenter of the HIV epidemic. Of the
~312,000 PWH in Ghana in 2019, almost 1 in 6 is aged over 50 years. Geriatric syndromes (e.g., frailty,
multimorbidity) and discrete diseases of aging (e.g., hypertension) threaten these gains in healthier life
expectancy for aging PWH. These threats are particularly troubling in Ghana and sub-Saharan African
countries where access to geriatric care and chronic disease management is limited. Efforts underway in the
region leverage HIV care systems to diagnose and manage chronic diseases of aging. A gap in these efforts is
a focus on geriatric syndromes – multi-factorial clinical conditions, common in older PWH, that do not fit
discrete disease categories. Filling this gap, particularly in the sub-Saharan Africa region, is the next barrier to
extending quantity of life and preserving quality of life for aging PWH. To help fill this gap, our long-term goal is
to provide comprehensive care for geriatric syndromes and diseases of aging without over-diagnosing or over-
treating older PWH. The objectives of the current proposal are to 1) characterize frailty, multimorbidity, and
discrete diseases of aging in older PWH; and 2) identify barriers and facilitators to providing effective patient-
centered healthcare for older PWH. Frailty is associated with HIV, dependency and mortality. It is
characterized by diminished strength, endurance, and functioning. Multimorbidity – multiple, interacting
physical and mental health conditions – is associated with HIV, polypharmacy, morbidity and mortality. We
hypothesize that 1) frailty and multimorbidity are under-recognized and discrete cardiometabolic diseases are
under-diagnosed in older PWH in Ghana; and 2) Infectious Disease Unit referrals for discrete cardiometabolic
diseases are not effective for their management in Ghana. To test these hypotheses, we propose a longitudinal
observational study at the University Hospital Infectious Disease Unit, Kwame Nkrumah University of Science
and Technology (KNUST) in Kumasi, Ghana. The study will enroll 151 PWH who are 50 years and older to
address three specific aims: 1) Characterize frailty and multimorbidity in older PWH in care at the University
Hospital, KNUST; 2) Assess under-diagnosis and management of discrete cardiometabolic diseases in older
PWH; and 3) Identify barriers and facilitators to providing effective, patient centered healthcare to aging PWH.
KNUST Aging & HIV Outcomes (KAHO) study will help identify priorities and opportunities for building an
effective integrated model of HIV and geriatric healthcare in Ghana. This integrated model will extend the gains
in quality life expectancy for Ghanaians and other Africans in similar settings who are aging with HIV.
