HIV behavioural interventions targeted towards older adults: a systematic review

BMC Public Health

Alexandra LC Martiniuk¹  Aneuryn Rozea²  Joel Negin² 

[1] George Institute for Global Health, Sydney, Australia;Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, Australia

关键词: Effectiveness;    Systematic review;    Interventions;    HIV;    Older adults;   

Others  :  1130290
DOI  :  10.1186/1471-2458-14-507

 received in 2013-01-25, accepted in 2014-05-20,  发布年份 2014

【 摘 要 】

Background

The increasing number of people living with HIV aged 50 years and older has been recognised around the world yet non-pharmacologic HIV behavioural and cognitive interventions specifically targeted to older adults are limited. Evidence is needed to guide the response to this affected group.

Methods

We conducted a systematic review of the available published literature in MEDLINE, Embase and the Education Resources Information Center. A search strategy was defined with high sensitivity but low specificity to identify behavioural interventions with outcomes in the areas of treatment adherence, HIV testing uptake, increased HIV knowledge and uptake of prevention measures. Data from relevant articles were extracted into excel.

Results

Twelve articles were identified all of which originated from the Americas. Eight of the interventions were conducted among older adults living with HIV and four for HIV-negative older adults. Five studies included control groups. Of the included studies, four focused on general knowledge of HIV, three emphasised mental health and coping, two focused on reduced sexual risk behaviour, two on physical status and one on referral for care. Only four of the studies were randomised controlled trials and seven – including all of the studies among HIV-negative older adults – did not include controls at all. A few of the studies conducted statistical testing on small samples of 16 or 11 older adults making inference based on the results difficult. The most relevant study demonstrated that using telephone-based interventions can reduce risky sexual behaviour among older adults with control reporting 3.24 times (95% CI 1.79-5.85) as many occasions of unprotected sex at follow-up as participants. Overall however, few of the articles are sufficiently rigorous to suggest broad replication or to be considered representative and applicable in other settings.

Conclusions

More evidence is needed on what interventions work among older adults to support prevention, adherence and testing. More methodological rigourised needed in the studies targeting older adults. Specifically, including control groups in all studies is needed as well as sufficient sample size to allow for statistical testing. Addition of specific bio-marker or validated behavioural or cognitive outcomes would also strengthen the studies.

【 授权许可】

   
2014 Negin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Gebo KA: HIV infection in older people. BMJ 2009, 338:b1460.
• [2]Effros RB, Fletcher CV, Gebo K, Halter JB, Hazzard WR, Horne FM, Huebner RE, Janoff EN, Justice AC, Kuritzkes D, Nayfield SG, Plaeger SF, Schmader KE, Ashworth JR, Campanelli C, Clayton CP, Rada B, Woolard NF, High KP: Aging and infectious diseases: workshop on HIV infection and aging: what is a known and future research direction. Clin Infect Dis 2008, 47(4):542-553.
• [3]Justice AC: HIV and aging: time for a new paradigm. Curr HIV/AIDS Rep 2010, 7(2):69-76.
• [4]Shippy RA, Karpiak SE: The aging HIV/AIDS population: fragile social networks. Aging Ment Health 2005, 9(3):246-254.
• [5]Elford J, Ibrahim F, Bukutu C, Anderson J: Over fifty and living with HIV in London. Sex Transm Infect 2008, 84(6):468-472.
• [6]Orchi N, Balzano R, Scognamiglio P, Navarra A, De Carli G, Elia P, Grisetti S, Sampaolesi A, Giuliani M, De Filippis A, Puro V, Ippolito G, Girardi E, SENDIH group: Ageing with HIV: newly diagnosed older adults in Italy. AIDS Care 2008, 20(4):419-425.
• [7]Pitts M, Grierson J, Misson S: Growing older with HIV: a study of health, social and economic circumstances for people Living with HIV in Australia over the age of 50 years. AIDS Patient Care STDS 2005, 19(7):460-465.
• [8]Negin J, Cumming RG: HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ 2010, 88(11):847-853.
• [9]Hontelez JA, Lurie MN, Newell ML, Bakker R, Tanser F, Barnighausen T, Baltussen R, de Vlas SJ: Ageing with HIV in South Africa. AIDS 2011, 25(13):1665-1667.
• [10]Mills EJ, Barnighausen T, Negin J: HIV and aging–preparing for the challenges ahead. N Engl J Med 2012, 366(14):1270-1273.
• [11]Shisana O, Human Sciences Research Council: South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008: A Turning Tide Among Teenagers. Cape Town: HSRC Press; 2009.
• [12]Simone MJ, Appelbaum J: HIV in older adults. Geriatrics 2008, 63(12):6-12.
• [13]Lazarus JV, Nielsen KK: HIV and people over 50 years old in Europe. HIV Med 2010, 11(7):479-481.
• [14]Cumming RG, Handelsman D, Seibel MJ, Creasey H, Sambrook P, Waite L, Naganathan V, Le Couteur D, Litchfield M: Cohort Profile: the Concord Health and Ageing in Men Project (CHAMP). Int J Epidemiol 2009, 38(2):374-378.
• [15]UNAIDS: AIDS at 30: nations at the crossroads. Geneva: Joint United Nations Programme on HIV/AIDS; 2011.
• [16]UNAIDS: Monitoring the Declaration of Commitment on HIV/AIDS: guidelines on construction of core indicators: 2010 reporting. Geneva, Switzerland: UNAIDS; 2009.
• [17]Demographic and Health Surveys. [http://www.measuredhs.com/ webcite]
• [18]Work Group for the HIV and Aging Consensus Project: Summary report from the Human Immunodeficiency Virus and Aging Consensus Project: treatment strategies for clinicians managing older individuals with the human immunodeficiency virus. J Am Geriatr Soc 2012, 60(5):974-979.
• [19]Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ: A study of sexuality and health among older adults in the United States. N Engl J Med 2007, 357(8):762-774.
• [20]Schick V, Herbenick D, Reece M, Sanders SA, Dodge B, Middlestadt SE, Fortenberry JD: Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med 2010, 7(Suppl 5):315-329.
• [21]Akers AY, Bernstein L, Doyle J, Corbie-Smith G: Older women and HIV testing: examining the relationship between HIV testing history, age, and lifetime HIV risk behaviors. Sex Transm Dis 2008, 35(4):420-423.
• [22]Iwuji CC, Churchill D, Gilleece Y, Weiss HA, Fisher M: Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study. BMC Public Health 2013, 13:397. BioMed Central Full Text
• [23]Orel NA, Spence M, Steele J: Getting the message out to older adults: Effective HIV health education risk reduction publications. J Appl Gerontol 2005, 24(5):490-508.
• [24]Drew O, Sherrard J: Sexually transmitted infections in the older woman. Menopause Int 2008, 14(3):134-135.
• [25]Rose MA: Effect of an AIDS education program for older adults. J Community Health Nurs 1996, 13(3):141-148.
• [26]Neundorfer MM, Harris PB, Britton PJ, Lynch DA: HIV-risk factors for midlife and older women. Gerontologist 2005, 45(5):617.
• [27]Bhavan KP, Kampalath VN, Overton ET: The aging of the HIV epidemic. Curr HIV/AIDS Rep 2008, 5(3):150-158.
• [28]Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A, Suhr JA, Garske JP, Johnson CJ: Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS Behav 2008, 12(6):943-956.
• [29]Winningham A, Corwin S, Moore C, Richter D, Sargent R, Gore-Felton C: The changing age of HIV: sexual risk among older African American women living in rural communities. Prev Med 2004, 39(4):809-814.
• [30]Strombeck R, Levy JA: Educational strategies and interventions targeting adults age 50 and older for HIV/AIDS prevention. Res Aging 1998, 20(6):912-936.
• [31]UNAIDS: HIV and Aging: A Special Supplement to the UNAIDS Report on the global AIDS Epidemic. Geneva, Switzerland: UNAIDS; 2013.
• [32]Philip-Ephraim EE, Gyuse AN, Udonwa NE, Peters EJ, Anyanechi CC: Knowledge and perception of HIV prevention through condom use among midlife and older adults in Calabar, Nigeria. West Indian Med J 2010, 59(4):429-433.
• [33]Negin J, Nemser B, Cumming R, Lelerai E, Ben Amor Y, Pronyk P: HIV attitudes, awareness and testing among older adults in Africa. AIDS Behav 2012, 16(1):63-68.
• [34]Sankar A, Nevedal A, Neufeld S, Berry R, Luborsky M: What do we know about older adults and HIV? A review of social and behavioral literature. AIDS Care 2011, 23(10):1187-1207.
• [35]Heckman TG, Sikkema KJ, Hansen N, Kochman A, Heh V, Neufeld S, Aids: A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults. J Behav Med 2011, 34(2):102-111.
• [36]Souza PM, Jacob-Filho W, Santarem JM, Zomignan AA, Burattini MN: Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls. Clinics (Sao Paulo) 2011, 66(2):261-266.
• [37]Heckman TG, Kochman A, Sikkema KJ, Kalichman SC, Masten J, Bergholte J, Catz S: A pilot coping improvement intervention for late middle-aged and older adults living with HIV/AIDS in the USA. AIDS Care 2001, 13(1):129-139.
• [38]Mack KA, Bland SD: HIV testing behaviors and attitudes regarding HIV/AIDS of adults aged 50–64. Gerontologist 1999, 39(6):687-694.
• [39]Wutoh AK, Elekwachi O, Clarke-Tasker V, Daftary M, Powell NJ, Campusano G: Assessment and predictors of antiretroviral adherence in older HIV-infected patients. J Acquir Immune Defic Syndr 2003, 33(Suppl 2):S106-114.
• [40]Williams E, Donnelly J: Older Americans and AIDS: some guidelines for prevention. Soc Work 2002, 47(2):105-111.
• [41]Vance DE, Burrage JW: Promoting successful cognitive aging in adults with HIV: strategies for intervention. J Gerontol Nurs 2006, 32(11):34-41.
• [42]Orel NA, Wright JM, Wagner J: Scarcity of HIV/AIDS risk-reduction materials targeting the needs of older adults among state departments of public health. Gerontologist 2004, 44(5):693-696.
• [43]Wariki WM, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K: Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. Cochrane Database Syst Rev 2012, 2:CD005272.
• [44]Ota E, Wariki WM, Mori R, Hori N, Shibuya K: Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries. Cochrane Database Syst Rev 2011, 12:CD006045.
• [45]Bain-Brickley D, Butler LM, Kennedy GE, Rutherford GW: Interventions to improve adherence to antiretroviral therapy in children with HIV infection. Cochrane Database Syst Rev 2011, 12:CD009513.
• [46]Wei C, Herrick A, Raymond HF, Anglemyer A, Gerbase A, Noar SM: Social marketing interventions to increase HIV/STI testing uptake among men who have sex with men and male-to-female transgender women. Cochrane Database Syst Rev 2011, 9:CD009337.
• [47]Meader N, Li R, Des Jarlais DC, Pilling S: Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users. Cochrane Database Syst Rev 2010, 1:CD007192.
• [48]Ojo O, Verbeek JH, Rasanen K, Heikkinen J, Isotalo LK, Mngoma N, Ruotsalainen E: Interventions to reduce risky sexual behaviour for preventing HIV infection in workers in occupational settings. Cochrane Database Syst Rev 2011, 12:CD005274.
• [49]Simoni JM, Nelson KM, Franks JC, Yard SS, Lehavot K: Are peer interventions for HIV efficacious? A systematic review. AIDS Behav 2011, 15(8):1589-1595.
• [50]Creek TL, Ntumy R, Seipone K, Smith M, Mogodi M, Smit M, Legwaila K, Molokwane I, Tebele G, Mazhani L, Shaffer N, Kilmarx PH: Successful introduction of routine opt-out HIV testing in antenatal care in Botswana. J Acquir Immune Defic Syndr 2007, 45(1):102-107.
• [51]Kang M, Skinner R, Usherwood T: Interventions for young people in Australia to reduce HIV and sexually transmissible infections: a systematic review. Sex Health 2010, 7(2):107-128.
• [52]Noar SM, Black HG, Pierce LB: Efficacy of computer technology-based HIV prevention interventions: a meta-analysis. AIDS 2009, 23(1):107-115.
• [53]Lovejoy TI, Heckman TG, Suhr JA, Anderson T, Heckman BD, France CR: Telephone-administered motivational interviewing reduces risky sexual behavior in HIV-positive late middle-age and older adults: a pilot randomized controlled trial. AIDS Behav 2011, 15(8):1623-1634.
• [54]Illa L, Echenique M, Saint Jean G, Bustamante-Avellaneda V, Metsch L, Mendez-Mulet L, Eisdorfer C, Sanchez-Martinez M: Project roadmap: reeducating older adults in maintaining AIDS prevention–a secondary intervention for older HIV-positive adults. AIDS Educ Prev 2010, 22(2):138-147.
• [55]Heckman TG, Barcikowski R, Ogles B, Suhr J, Carlson B, Holroyd K, Garske J: A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med 2006, 32(1):27-38.
• [56]Souza PM, Jacob-Filho W, Santarem JM, Silva AR, Li HY, Burattini MN: Progressive resistance training in elderly HIV-positive patients: does it work? Clinics (Sao Paulo) 2008, 63(5):619-624.
• [57]Ruiz M, Kamerman LA: Nutritional screening tools for HIV-infected patients: implications for elderly patients. J Int Assoc Physicians AIDS Care (Chic) 2010, 9(6):362-367.
• [58]Orel NA, Stelle C, Watson WK, Bunner BL: No one is immune: a community education partnership addressing HIV/AIDS and older adults. J Appl Gerontol 2010, 29(3):352-370.
• [59]Altschuler J, Katz AD, Tynan M: Developing and implementing an HIV/AIDS educational curriculum for older adults. Gerontologist 2004, 44(1):121-126.
• [60]Small LF: What older adults know about HIV/AIDS: lessons from an HIV/AIDS education program. Educ Gerontol 2009, 36(1):26-45.
• [61]Agate LL, Mullins JM, Prudent ES, Liberti TM: Strategies for reaching retirement communities and aging social networks: HIV/AIDS prevention activities among seniors in South Florida. J Acquir Immune Defic Syndr 2003, 33(Suppl 2):S238-242.
• [62]Wawer MJ, Sewankambo NK, Serwadda D, Quinn TC, Paxton LA, Kiwanuka N, Wabwire-Mangen F, Li C, Lutalo T, Nalugoda F, Gaydos CA, Moulton LH, Meehan MO, Ahmed S, Gray RH: Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Rakai Project Study Group. Lancet 1999, 353(9152):525-535.
• [63]Coon DW, Lipman PD, Ory MG: Designing effective HIV/AIDS social and behavioral interventions for the population of those age 50 and older. J Acquir Immune Defic Syndr 2003, 33(Suppl 2):S194-205.
• [64]Ybarra ML, Bull SS: Current trends in Internet- and cell phone-based HIV prevention and intervention programs. Curr HIV/AIDS Rep 2007, 4(4):201-207.
• [65]Chiao EY, Ries KM, Sande MA: AIDS and the elderly. Clin Infect Dis 1999, 28(4):740-745.
• [66]Skiest DJ, Keiser P: Human immunodeficiency virus infection in patients older than 50 years: A survey of primary care physicians’ beliefs, practices, and knowledge. Arch Fam Med 1997, 6(3):289-294.
• [67]Morrell RW, Park DC, Kidder DP, Martin M: Adherence to antihypertensive medications across the life span. Gerontologist 1997, 37(5):609-619.
• [68]McDonald-Miszczak L, Maki SA, Gould ON: Self-reported medication adherence and health status in late adulthood: the role of beliefs. Exp Aging Res 2000, 26(3):189-207.
• [69]Barat I, Andreasen F, Damsgaard EM: Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 2001, 51(6):615-622.
• [70]Herbst JH, Glassman M, Carey JW, Painter TM, Gelaude DJ, Fasula AM, Raiford JL, Freeman AE, Harshbarger C, Viall AH, Purcell DW: Operational research to improve HIV prevention in the United States. J Acquir Immune Defic Syndr 2012, 59(5):530-536.