CDC: U.S. Falls Short in Improving QoL for Older People With HIV

In 2022, none of the 5 quality-of-life (QoL) goals set by the U.S. National HIV/AIDS Strategy (NHAS) were met for adults with HIV ages 50 or older, and if the trend continues, it’s unlikely 2025 NHAS goals will be met either, according to CDC data.

In this population of persons with diagnosed HIV (PWH), rates of participants reporting good or better health, as well as reductions in rates of unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing, fell short of changes needed to achieve 2025 NHAS goals, according to Linda Beer, PhD, of the CDC’s National Center for HIV/AIDS in Atlanta, and colleagues.

In 2022, the NHAS set goals for five areas to improve QoL among people with HIV by 2025:

• 95% reporting good or better health
• 9.4% reporting unmet need for mental health services
• 5.9% reporting unemployment
• 9% reporting hunger or food insecurity
• 7.4% reporting unstable housing or homelessness

Most of those needs were not on target to be met among older PWH, the researchers reported in Morbidity and Mortality Weekly Report. Overall, the five indicators changed little during 2017 to 2022 among those ages 50 years or older.

Among PWH ages 50 and older, 65% (95% CI 62.7-67.2) reported good or better health in 2022, about the same percentage as in 2018 (65.6%, 95% CI 63.5-67.6).

This percentage of the study population reporting good or better health would have to increase by about 46% to achieve 2025 NHAS goals, the researchers wrote. The other targets would have to decrease by about 26% to 56% from 2022 estimates to hit their goals.

In 2017, 18.8% (95% CI 15.4-22.1) of older PWH reported unmet needs for mental health services, and this increased somewhat to 21.5% (95% CI 16.5-26.5) in 2022. Minimal changes in symptoms of depression or generalized anxiety disorder were found among those with mental health needs from 2017 through 2022, the investigators reported.

Unemployment among PWH ages 50 and older declined from 11.7% (95% CI 9.7-13.6) to 8.0% (95% CI 6.6-9.5) from 2017 to 2022.

Food insecurity changed little among older PWH during 2017 through 2022, decreasing from 17.9% (95% CI 15.4-20.4) in 2017 to 14.1% (95% CI 12.5-15.8) in 2022. One notable exception, however, was that PWH ages 65 or older actually exceeded the NHAS 2025 goal by 2022.

The rate of unstable housing or homelessness was 14.7% (95% CI 13.0-16.4) in 2018 among PWH age 50 or older, decreasing somewhat to 12.5% (95% CI 10.8-14.2) in 2022. Except during the 2022 cycle, unstable housing or homelessness was lower among those age 65 or older than other age groups.

Other than the goals for food insecurity among people with HIV age 65 and older, “for all other indicators and age groups, the magnitude of improvement required to meet 2025 goals suggests these QoL goals will not be met if recent trends continue,” Beer and colleagues wrote.

Due to advances in HIV treatment, the population of PWH and those ages 50 years or older is growing, the researchers noted. This population not only has different healthcare needs but also other unique factors that impact their quality of life.

“Improving QoL and addressing social determinants of health requires a multisectoral approach that moves beyond clinical care,” the researchers emphasized.

In 2022, the NHAS adopted the five QoL indicator goals to assess changes in quality of life among older people with diagnosed HIV by 2025. Beer and co-authors analyzed data collected from a survey of U.S. adults with diagnosed HIV conducted 2017–2022 to assess progress toward the NHAS 2025 QoL indicator goals among people with HIV ages 50 and older.

The investigators analyzed data collected during the 2017–2022 cycles of the Medical Monitoring Project, an annual survey of U.S. adults with HIV. Data from 13,475 PWH ages 50 years and older were included in the study, sampled from 16 states, Puerto Rico, and Washington, D.C., and from the National HIV Surveillance System. PWH were stratified into those ages 50 to 64 and those 65 and older.

The authors noted that recall or social desirability biases could have resulted in measurement errors.