AMPATH Shapes Care for Older People Living with HIV in Kenya and Beyond
Antiretroviral therapy has transformed HIV from a life-threatening diagnosis into a chronic condition that millions of people will live with for decades. That success has created a new challenge: How can health systems help people living with HIV not only live longer, but age well?
Two members of the AMPATH community are helping answer that question on a global stage.
Dr. Amy Justice speaks about the Commission’s report at the IAS conference.
Amy Justice, MD, PhD, and Jepchirchir “Chiri” Kiplagat, PhD, served on the Lancet HIV Commission on Ageing and HIV, an international effort bringing together researchers, clinicians and community representatives to examine how HIV care must evolve as the population of people living with HIV grows older.
Dr. Justice, a member of the AMPATH Development Council and professor of medicine and professor of public health at Yale University, co-chaired the commission. Dr. Kiplagat, lecturer at Moi University School of Public Health, is an AMPATH investigator and served as a commissioner and co-leader of the commission group focused on prevention, screening and diagnosis.
Dr. Justice was asked by the editors of The Lancet HIV to lead the Commission based on her previous work on ageing and HIV. She and co-chair Keri Althoff identified 10 international commissioners, including Dr. Kiplagat, based on their research and clinical experience.
“We are proposing a new paradigm in the approach to HIV care, one in which ageing well is the goal from the outset of HIV treatment, regardless of the age of the individual when treatment is started,” Dr. Justice said.
That shift has implications for care throughout a person’s life. Dr. Justice said it means addressing delays in diagnosis among people who acquire HIV later in life. It also means using the start of antiretroviral therapy as an opportunity to consider how individuals, communities and health systems can support healthy ageing.
“This will require breaking down the walls of siloed clinic settings to creatively coordinate and integrate services and resources across these domains,” Dr. Justice said. “It will also require overcoming HIV and ageing stigma that can prevent older individuals with HIV from effectively accessing these resources.”
The Commission also calls for care management to be based more on physiological rather than chronological age with a view to what matters most for the individual.
The Commission’s work reflects the remarkable progress of the global HIV response. Longer lives also mean health systems must increasingly address patients with several health conditions, multiple medications, loss of physical function and other issues associated with ageing alongside HIV care.
“For me, the most impactful message is the need to shift from only asking how we help people with HIV live longer to asking how we help them live those additional years in good health, with preserved function, independence and quality of life,” Dr. Kiplagat said.
The issue has particular significance for low- and middle-income countries. Dr. Justice said that in 15 years, more than half of people living with HIV will be age 50 or older and 96% of them will live in low- and middle-income countries.
“One of the things I found particularly valuable about participating in the Commission was the opportunity to bring the perspective of sub-Saharan Africa into a global discussion on ageing with HIV. We need to ensure that health systems that have successfully kept people with HIV alive are equally prepared to help them age well. It is both a recognition of how far the HIV response has come and a call to action for the next phase.”
The Commission’s work took more than two years to complete. Five topical working groups reviewed evidence, identified gaps and developed recommendations. Drafts were reviewed across the Commission and circulated to the international community for comment before undergoing peer review and publication.
Now, the goal is for that research and collaboration to influence what happens in clinics, health systems and communities.
Dr. Kiplagat speaking at the IAS conference.
“I hope the Commission findings influence clinical guidelines, health policy, research priorities and investment, so that healthy ageing becomes part of what we consider successful HIV care around the world,” Dr. Kiplagat said.
Within the AMPATH partnership, Dr. Kiplagat is already helping put that vision into practice. She and colleagues are developing a comprehensive geriatric assessment for adults age 50 and older within routine HIV care. Adapted from a World Health Organization framework, the assessment helps clinicians identify concerns that may otherwise go unnoticed, including falls, cognitive and sensory impairment, depression, multiple health conditions and the use of multiple medications. More than 2,700 older adults have been assessed so far, revealing a substantial burden of needs beyond HIV management.
Her research is also exploring how care for older adults with HIV can extend beyond the clinic. In a separate NIH-funded pilot at AMPATH, community health volunteers provided home-based blood pressure monitoring, medication adherence support, and other services to older adults living with HIV and uncontrolled hypertension. Preliminary findings from the pilot are promising, suggesting improvements in blood pressure control while maintaining HIV viral suppression.
Together, the projects demonstrate how AMPATH is building on the success of HIV care to address the broader health needs that determine whether people can age well.
For Dr. Justice, the Commission’s message underscores how much the HIV response has accomplished while setting a higher goal for its next chapter. Keeping people alive is essential. The challenge now is helping people live those longer lives well.
“Treating with antiretroviral therapy is absolutely necessary, but it is not sufficient for ageing well with HIV,” she concluded.