AFLE-HIV: developing an age-friendly living environment assessment framework for elderly HIV-infected individuals in China

BACKGROUND: As the population of older adults living with HIV in China continues to expand, a pressing gap persists in the availability of validated instruments that appraise whether residential settings meet the compound demands of aging and chronic HIV management. METHODS: This study presents the AFLE-HIV (Age-Friendly Living Environment for Elderly HIV-Infected Individuals) assessment framework, constructed through a sequential mixed-methods design. Latent Dirichlet Allocation was applied to a corpus of 347 peer-reviewed publications to surface latent environmental themes, yielding an initial set of three primary dimensions and 15 candidate indicators. These candidates were then subjected to two iterative rounds of Delphi consultation involving 22 multidisciplinary experts (response rate: 100%), followed by Analytic Hierarchy Process weight calibration. A field-based pilot across 12 residential communities in four Chinese cities was scored independently by four trained assessors. RESULTS: The Delphi process consolidated the framework to three primary dimensions and 13 validated indicators with statistically significant inter-expert agreement (Kendall's [Formula: see text], [Formula: see text]) and satisfactory content validity (item-level CVI [Formula: see text]; scale-level CVI/Ave [Formula: see text]). All AHP consistency ratios remained below 0.1. The pilot test yielded satisfactory scale reliability (Cronbach's [Formula: see text]) and moderate inter-rater concordance (ICC(2,1) [Formula: see text]). CONCLUSIONS: The resulting AFLE-HIV instrument equips community health workers with a structured protocol for diagnosing environmental shortcomings, provides policymakers with an evidence-based basis for directing renovation investments aligned with the HIV care continuum and community-based service delivery models, and offers urban planners actionable benchmarks for age-friendly residential upgrades targeting this underserved population.