Yale University

Developing social capital interventions to improve viral suppression and quality of life among HIV- positive aging populations in New Haven, CT

Principle Investigator(s):

Funder: National Institute of Mental Health
Project period: 07/17/2019 - 07/16/2020
Grant Type: Research

Abstract Text:

In the United States (US) in 2016, 21.3 percent of individuals diagnosed with HIV were late (i.e., CD4+ count <200 cells/μL or presence of an AIDS-defining illness, within three months of an initial HIV diagnosis or). However, late HIV diagnosis prevalence was 36.3 among individuals age 55 and older. In New Haven, CT— the setting for this study, between years 2010 and 2015, 68 percent of those diagnosed late were ages 50 + compared to 32 percent among those of younger age. Individuals diagnosed with HIV late have high likelihood of premature death because they miss opportunities for earlier antiretroviral therapy (ART) to suppress the virus. From a population perspective, reducing HIV to undetectable levels can lower HIV transmission risk in communities. HIV-positive aging populations are a priority to target for public health interventions because they (and their partners) are living longer yet have to manage chronic diseases in addition to HIV. However, currently, we know little scientifically about the determinants of HIV care engagement among the HIV-positive aging population. What we do know from studies in the wider population is that social factors play a greater role influencing HIV outcomes such as late diagnosis. Social capital—collective resources generated through social connections that individuals or groups can leverage is relevant for HIV care engagement and prevention.

This proposal advances OAR priorities and is innovative based on several features (e.g., study design, population from real world settings, and among individuals age 50 years and older). We conduct a sequential exploratory mixed-methods study to AIM1: identify and quantify sources of social capital at multiple levels among the HIV-positive aging population and examine the association with virologic suppression and quality of life indicators, AIM2: develop a multilevel intervention (e.g., interpersonal and community-level) designed to augment social capital mechanisms to improve virologic suppression and quality of life, AIM3: evaluate the transferability of the intervention across other geographic regions. These findings are intended to provide preliminary data for an R01 intervention to the National Institute of Aging (e.g., PAR-17-321) to improve viral suppression and quality of life among the HIV-positive aging population in Connecticut.

IMPACT: The median life expectancy in the US general population is 81.1 years and roughly 70 years among HIV infected individuals in the US who initiated treatment early. If we do not intervene NOW, we will continue of this population to experience suffering in their life and potentially exacerbate disparities in life expectancy.