Background

Global HIV/AIDS statistics (UNAIDS, 2018) estimated 37.9 million people were living with HIV with an estimated 3.6 million aged 50 years or older (UNAIDS, 2013). The majority of these (2.9 million) are in low-and middle-income countries where the percentage of adults 50 years or older living with HIV is above 10%. In high-income countries almost one-third of adults living with HIV are 50 years or older. Elderly patients attending ART clinics have faced a number of challenges related to their HIV status although there have been limited interventions to address them. In sub-Saharan Africa this group has particularly been neglected despite the distinctive healthcare and socio-economic needs.

Description

The elderly clinic was started (July 2019) in response to challenges identified during a support group meeting for the elderly living with HIV specifically to address stigma, adherence and psychosocial support related to HIV and to promote screening and management of non-communicable diseases (NCDs). This clinic was composed of elderly clients aged 50 years and above. Only elderly clients had visits scheduled on Fridays in order to reduce waiting time and allow adequate time for psychosocial support and comprehensive clinical reviews. Staff were sensitized to periodically update the list of elderly clients via review of the electronic database, screen for NCDs, mental health and psychosocial support these clients required.

Lessons learned

• From July to December 2019 the number of elderly clients in the clinic increased from 118 (69 males, 49 females) to 130 (75 males, 55 females) representing 10.2% increase.
• Through basic screening we were able to newly identify clients with diabetes (7), hypertension (10), prostate disorders (3) including one with prostatic cancer, mental health illnesses namely depression (20), anxiety disorders (1) and mild dementia (15) that interfered with their day to day living. Other ailments previously undocumented included arthritis and erectile dysfunction.
• Most clients could not afford some of the screening tests however where medical attention was deemed essential for further management, they were referred to public facilities. Nevertheless, the majority didn’t go because of socioeconomic reasons.
• Health workers lack knowledge about geriatric care and NCDs therefore not all clients are comprehensively screened.

Next steps:

In order to provide comprehensive care, the elderly living with HIV require:

• Trained health workers to adequately respond to their HIV related and other health challenges;
• Provision of subsidized or no cost comprehensive screening and standard health care packages.  

Presented by Ivan Nume (Counselor)