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Substance Use | There is a need to integrate treatment for substance use with primary, mental, and behavioral health providers. Doing so may be clinically important at managing better HIV prevention efforts among older at-risk adults and OPWH. Promoting the importance of sustainable, social support systems may be one way to address quality-of-life impacts. |
Stigma and Discrimination | Evidence shows that a high percentage of people aging with HIV experience stigma or other discrimination as a barrier to accessing care. This highlights the need to support providers and their staff with competency training to provide a more welcoming environment for all PWH or at risk for HIV. |
Medical Home | Disproportionately high rates of comorbid conditions coupled with an increased need to coordinate ongoing and long-term HIV care indicates that there is a large need for a medical home to consolidate care coordination for the whole person. Better care coordination could address comorbidities and the psychosocial issues that impact PWH and affect their health outcomes. |
HIV and Health | Acquiring and living with HIV can lead to psychological difficulties, reduced mental health, and poorer quality of life. To that end there is a need for: greater referrals to psychosocial support services; more questions asked by providers to assess neurocognitive impairment and memory loss issues; and, linkage to outpatient assistance for older PWH with managing all the specificity and levels of participation that comes with having multiple health conditions. |
Care Coordination | There is a need for providers to build relationships with community-based organizations to coordinate along the HIV status neutral continuum. Increased outreach is also needed for older PWH who live alone and/or take care of themselves when ill or injured. Telehealth outreach is a key tool for reaching the people who reported reducing their PCP visits due to COVID-19 and other reasons for social isolation. |
Payer Information | Health insurance coverage is insufficient for many older adults with HIV. Older PWH also may need additional wraparound and navigation services, such as transportation, to access their providers. |
Pharmacy | The interplay between polypharmacy and the high rates of comorbidities requiring medication is a concern because of the risk of drug-drug interactions and how extended use of medication can result in a high rate of resistance. There is also a need for earlier comprehensive panels and screening in HIV-positive patients—as well as enhanced care coordination between pharmacies and providers. |
Social Support | Social isolation is a main stressor across aging groups, so there is a need to provide PWH with socially engaging activities, especially given limitations and restrictions with COVID-19. |
Barriers to Access | COVID-19 created a number of barriers to accessing care, but there exist structural barriers that need to be addressed to support medical visits, such as cost, wait times, and transportation; timely and affordable access to medication; increased insurance and payment navigation support; and culturally sensitive, stigma-free medical environments. |
Telehealth | Telehealth has emerged as a new vehicle for reaching PWH and its use and reach is likely to extend beyond the COVID-19 pandemic. Telehealth services need more investment in as a viable and low-cost option for reaching PWH and coordinating care. |
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