An older HIV-infected individual-centric framework for age-friendly living environment assessment in China: integrating topic modeling, Delphi consensus, and hierarchical needs analysis

Older people living with HIV (OPLHIV) encounter environmental barriers associated with aging, chronic treatment, stigma, privacy, and uneven access to services. Quantifying how far observed community conditions fall below context-specific expectations is essential for directing age-friendly interventions. This study develops a needs-based benchmarking framework for monitoring expected–observed performance gaps. A purposively assembled corpus of 1,086 items comprised 206 government policy documents, 318 academic abstracts, and 562 respondent-level survey text records formed by concatenating each participant’s available answers to three open-ended questions. Latent Dirichlet Allocation (LDA) topic modeling and a two-round Delphi study involving 28 multidisciplinary experts informed a final system of 35 indicators across three conceptual hierarchies: medical and health safety, daily living environment, and social inclusion and participation. Expected performance targets were informed by policy standards and expert judgments, while observed performance was derived from the reported community assessments. The Age-Friendly Living Environment Assessment Score (AFLEAS) summarizes benchmark attainment at indicator, hierarchy, and community levels. Application across 12 communities in Kunming, Chengdu, Guangzhou, and Nanning yielded a mean overall AFLEAS of 0.68. Social inclusion and participation showed the lowest mean score (0.53), followed by medical and health safety (0.71) and daily living environment (0.82). Six diagnostic performance patterns highlighted stigma, anti-discrimination community norms, privacy protection, and psychosocial support as the largest reported shortfalls. AFLEAS provides interpretable gap profiles and cross-city benchmarks for policy prioritization.