Ageing with HIV: Exploring older people's experiences with medicines

Background: As of 2023, nearly 40 million people globally live with HIV. Antiretroviral therapy has extended life expectancy, with ageing presenting unique challenges: Older people living with HIV (PLWH) face earlier onset of comorbidities, complex polypharmacy and stigma. Currently in the UK, standard care includes specialist clinics to manage HIV and primary care to manage comorbidities. Aim: This thesis sought to gain a deeper understanding of the medicine-related experiences and needs of older individuals living with HIV. Methods: A systematic review (chapter 2) was undertaken to identify interventions targeted to improve medicine optimisation outcomes in older PLWH. The findings informed a mixed-methods study design exploring the medicine related experiences and needs of older PLWH and the views of the healthcare professionals looking after them. Quantitative studies used secondary (chapter 4) and primary (chapter 5) data collected via cross-sectional surveys. Chapter 4’s survey included the Living with Medicines Questionnaire version 3 (LMQ-3), and the Stigma Scale for Chronic Illnesses 8-item version (SSCI-8), chapter 5’s included the mini-LMQ, and the Multidimensional Scale of Perceived Social Support (MSPSS). Qualitative studies utilised semi-structured interviews in older PLWH (chapter 6) and healthcare professionals providing care for PLWH (chapter 7). Quantitative data were analysed using IBM SPSS version 27. Qualitative data were transcribed and analysed using NVIVO (release 1.7.1). Results: The systematic review (chapter 2) highlighted a lack of interventions targeted specifically for improving medicine experiences in older PLWH, with the majority of the nine interventions found amongst 79 articles being aimed at adherence. Although, the initial study analysing secondary-data found high medicine burden in a minority of PLWH (chapter 4), free-text comments showed an array of negative experiences with medicines and stigma. In contrast, the second study (chapter 5), found a high medicine-related burden in a majority of PLWH. Further exploration in chapter 6 highlighted two distinct groups among older PLWH: longterm survivors who have adapted over time and those diagnosed later in life who are still adjusting with their diagnosis describing higher associated medicine and treatment burden. Comorbidities often posed greater challenges than HIV itself for some. In chapter 7, staff reemphasised the complex challenges faced by older PLWH managing their healthcare. The need for improved collaboration between HIV clinics and primary care was stressed, as poor communication complicates polypharmacy and care coordination. Conclusion: This thesis contributes to the growing understanding of the ageing HIV population, highlighting the challenges they face and strategies to enhance their medications and healthcare. It emphasises the need for a holistic, patient-centred approach that addresses their complex and interconnected needs, and better communications between healthcare professionals.