Riassunto analitico
Background: My Smart Age with HIV (MySAwH) is a multi-center prospective ongoing study designed to empower older adults living with HIV (OALWH) to achieve Healthy Ageing. It is based on evaluation of HIV variables, a standardized comprehensive geriatric assessment and patient-related outcomes gathered at study visit and by mean of an Internet of Medical thing framework (IoMT) which include a fitness tracking wearable device and a dedicated smart phone app (MySAwH App).
Objective: We aimed to characterise longitudinally negative and positive health features in OALWH from different geographical regions. Negative health features were conceptualised as deficit accumulation and described by mean of a Frailty Index (FI) and a Healthy Index (HI) assessed in the clinic (Conceptual Model 1). Positive health features were conceptualised as functional ability and described by Intrinsic Capacity (IC) and Environment assessed using IoMT framework (Conceptual Model 2).
Material and methods: This is a 9 months-follow up interim analyses of OALWH recruited in MySAwH study. 224 OALWH were recruited from 3 countries. Inclusion criteria were: being aged>50 years, undergoing stable ART, routine access to a smartphone and willingness to use the fitness tracking device, willingness to be trained to use MySAwH App.
With regards to Conceptual Model 1, FI was obtained including deficits evaluation and HIV variables assessed by health professionals at the clinic. HI comprised a composite of deficits evaluation and HIV variables as well as self-reported outcomes assessed through questionnaires, fitness tracking device and MySAwH App.
With regards to Conceptual Model 2, IC was fully derived from self-reported outcomes assessed through questionnaires, fitness tracking device and MySAwH App. A Protective index (PI) was evaluated with questionnaires and MySAwH App to measure the influence on health of environmental factors.
Results: 224 OALWH were included in this analysis. 117 (52.23%) from Modena (Italy), 82 (36.61%) from Sidney (Australia) and 25 (11.16%) from Hong Kong (China). Mean age was 58.57 (±5.74) years. 190 (86.76%) patients were men. Median CD4 was 658.5 (480.25-817.75) and 204 (91.07%) patients had undetectable HIV viral load.
With regards to Conceptual Model 1, mean FI at baseline was 0. 29 (±0.1) with no significant difference among the three groups. A non-significant progression of FI was recorded at 9 months follow up (mean value: 0.3 (±0.1)).
Mean HI at baseline was 63.65 (±11.5): respectively 61.68 (±10.84) in Modena group, 68.49 (±11.28)
In Sidney and 56.67 (±10.37) in Hong Kong (p<0.01).
Mean HI at follow up was 64.73 (±12.02) (62.85 (±11.25), 70.02 (±11.36), 54.75 (±20.63) respectively for Modena, Sidney and Hong Kong; p<0.01). HI did not increase significantly at follow up.
With regards to Conceptual Model 2, mean IC at baseline was 0.43 (±0.07) with differences among three groups: 0.45 (±0.05) for Modena, 0.44 (±0.09) for Sidney and 0.36 (±0.06) for Hong Kong (p<0.01).
No substantial increase was seen for IC at 9 months follow up (mean value: 0.43 (±0.09)).
Mean PI at baseline was 0.49 (±0.2). A significant PI difference was observed among the three groups at baseline (0.58 (±0.18) for Modena, 0.4 (±0.18) for Sidney and 0.37 (±0.15) for Hong Kong) and follow up (0.51 (±0.19) for Modena, 0.36 (±0.14) for Sidney and 0.35 (±0.11) for Hong Kong) (p<0.01). Mean PI at follow up was 0.44 (±0.18) with a significant decrease compared to baseline.
Conclusion: The key result of this study was the possibility to operationalize Healthy Ageing into an IC and PI assessment tool. Measuring Healthy Ageing has the potential to substantially modify the way in which clinical practice is conducted focusing on residual wellness rather than a “reactive” identification and treatment of deficits.
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