Comprehensive geriatric assessment for people living with HIV and frailty: A mixed‐methods feasibility randomized controlled trial

Objective Prevalence of geriatric syndromes including frailty among people living with HIV is increasing and at younger ages. There is no gold standard model of care for people with HIV and frailty. This study aimed to determine the acceptability of a comprehensive geriatric assessment and management plan, delivered jointly by a geriatrician and HIV physician (the Silver Clinic) in outpatient HIV services, and also the feasibility of conducting a randomized controlled trial (RCT) of the Silver Clinic compared with standard care. Design Mixed‐methods single‐centre, parallel, two‐arm feasibility RCT. Methods People living with HIV ≥50 years old, who screened as frail using the FRAIL scale were randomized to: usual care or the Silver Clinic. Randomization was stratified by age and sex, target N = 84. The primary objective was to determine whether a definitive trial is feasible. Results Twenty‐five participants (46% of n = 55 eligible patients) were randomized. One hundred percent of participants attended their 6‐month follow‐up and 91% at 12 months. More than 90% of the outcome measures were completed at all time points. Interviews revealed study processes and outcome measures were acceptable, and that the intervention was valued by people living with HIV and frailty. Conclusions Delivering a comprehensive geriatric assessment jointly by a geriatrician and HIV physician was feasible and acceptable. Retention and completion of outcome measures were high, although recruiting sufficient frail individuals from one site was challenging. A RCT to determine the effectiveness of the Silver Clinic is warranted, but will require a multicentre design and an extended recruitment period to address recruitment challenges.