Social Isolation and the HIV Positive Woman over 50 Impact on Positive Treatment Outcomes

1
Social Isolation and the HIV Positive Woman over
50Impact on Positive Treatment Outcomes
Regina Ubaldi-Rosen, MSN, CRNP Kimberly
VanVladricken, MSN, CRNP
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Social Isolation and the HIV Positive Woman over
50 Significance

• The Centers for Disease Control reports for the
  years 2000 through 2003 an increase in the
  estimated number of HIV/AIDS cases in the age
  groups over 45.
• Survival rates after AIDS diagnosis decreased as
  age of diagnosis increased.
• HIV positive women over 50 are impacted by
  socio-economic disadvantage, decreased social
  supports and stigma.

3
Social Isolation and the HIV Positive Woman over
50 Background

• Previous studies have linked psycho-social issues
  to HIV disease progression.
• Most studies performed in men and younger women.
• Linkages to depression/loneliness and increased
  mortality have been made in older individuals.
• While tools exist to measure depression and
  loneliness, no quantitative measurement of
  isolation is available.

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Social Isolation and the HIV Positive Woman over
50 Research Objectives

• Creation of a validated measurement tool in the
  area of isolation.
• Exploration of the meaning of isolation in this
  cohort.
• Investigate the effect of isolation on treatment
  outcome in HIV positive women over 50.

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Social Isolation and the HIV Positive Woman over
50Research Questions

• How does social isolation impact positive
  treatment outcome in the HIV positive woman over
  50?
• What does the concept of isolation mean to this
  cohort?
• How do the variables of culture and
  socio-economic status impact ones definition of
  isolation?

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Social Isolation and the HIV Positive Woman over
50Data Collection Methodology
Qualitative Phase
Phase II

HIV Focus Groups (2) (Women gt 50 y.o.a.)
Application of Validated Isolation Tool
HIV Focus Groups (2) (Women gt 50 y.o.a)
Quantitative Analysis Isolation / Outcome
Correlate
Unstructured Interviews (HIV /- Women gt50 y.o.a.)
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Social Isolation and the HIV Positive Woman over
50Demographics

• Women
• Aged 50 -70 years of age
• Income 600.00-800.00 per month
• Medicare, Medicaid insured
• Home subsidy recipients

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Social Isolation and the HIV Positive Woman over
50Key Findings

• Isolation is something you do to yourself, when
  you cant deal with people or things anymore
• Others just dont understand me
• When I isolate myself, I wont answer the phone
  or door
• I make people who care about me go away, then
  when they are gone, Im afraid they wont come
  back
• Isolation is different than loneliness or
  depression

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Social Isolation and the HIV Positive Woman over
50Case Study 1 Patient Background

• 51 yr old, African American female
• Active medical patient for 5 yrs
• Reports 100 adherence to ARVs
• CD4-120/VL 55,000 copies prior to therapy
• Initiated Truvada/Reyataz/Norvir
• No history of OIs

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Social Isolation and the HIV Positive Woman over
50Case Study 1 Current Situation

• CD4 350/VL lt50 copies
• Recent missed clinic appointments
• Complaints of low energy
• All I want to do is go home and go to sleep
• Admits to avoiding phone calls and not answering
  door
• Score of 17 on Isolation Tool

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Social Isolation and the HIV Positive Woman over
50Case Study 1 Intervention/Outcome

• Becks Depression Index (BDI) Quick Test
• CBC /diff/ platelets
• Chemistries, LFTS TFT
• Lipid Panel, Hepatitis Panel
• Iron Binding Studies
• Fecal Occult Blood testing
• Gyn exam

• Score 6 out of 21
• Hgb/Hct- 7.2/21.4
• Iron Studies- deficiency anemia
• Administration Iron/Procrit
• Uterine Fibroids
• Ibuprofen therapy
• Increased socialization
• Increased Case Manager activity

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Social Isolation and the HIV Positive Woman over
50Case Study 2Patient Background

• 55 yr old, African Refugee Woman, English
  speaking
• Arrived in U.S. from Liberia-Ghana lt1yr ago
• Communicates many concerns/questions at visit
• HIV tested positive upon immigration
• Requests HIV re-test on first clinic visit
• I do not believe I have this virus
• Has not disclosed status to family/friends
• Initial labs- CD4-242/VL-44,000 copies
• Initiated Combivir/Sustiva

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Social Isolation and the HIV Positive Woman over
50Case Study 2Current Situation

• CD4- 560/VL- lt50 copies
• Reports 100 adherence to ARVs
• Requires assistance with hiding medications
• Appears less communicative with decreased eye
  contact at visits
• Reports feelings of sadness and fear to African
  Outreach Coordinator regarding her non-disclosure
  to husband and family
• Score- 7 out of 20 on Isolation Tool

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Social Isolation and the HIV Positive Woman over
50Case Study 2Intervention/Outcome

• BDI Quick Test ?
• CBC /diff/ platelets
• Chemistries, LFTS TFT
• Lipid Panel, Hepatitis Panel
• Cultural Care Team Approach
• Regular visits with African Outreach Coordinator

• Results inconclusive/Cultural Issues
• All labs WNL