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Frailty screening is Feasible & Recommended by EACS. Implementation of frailty screening for older people living with HIV in Brighton, UK
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The European AIDS Clinical Society (EACS) recommend screening for frailty in PLWH above 50 years old, using screening tools such as the FRAIL scale. Additionally, the EACS has devised an algorithm for frailty screening among PLWH (Figure 1) [3], so that they may then be assessed and the frailty potentially reversed [4]. However, the implementation of screening has been hindered by uncertainty around the best screening tool to use, how feasible it is to do in clinical practice and which healthcare professionals (HCPs) are best suited to conduct screening [5].
/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60-99) years and 21 (0-32) years, respectively.
OBJECTIVE: To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK.
METHOD: Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale.
CONCLUSION: Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society.
"(12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust."
"PLWH want to be told if they are frail, provided it is combined with support strategies. They expressed the importance of honesty and sensitivity,"
"Risks such as falls, cognitive impairment and drug-disease interaction, all of which contribute to frailty."
"This highlights the importance of annual screening to facilitate early identification of frailty in PLWH so that they may gain access to appropriate support while they are still able to attend, in an attempt to halt or slow the progress of frailty"
"Fifty-six per cent of patients screened as frail were on integrase inhibitor-based therapy, reflecting the recent changes in prescribing practices. In ageing people with HIV, new-generation integrase inhibitors have some advantages compared with other combinations, due to fewer drug-drug interactions and increased barrier for resistance."
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