Fewer than 10% of people with HIV complete advance care planning
SAN FRANCISCO — Among eligible people living with HIV at the National University Hospital in Singapore, fewer than 10% completed advance care planning, according to findings presented at IDWeek.
As the HIV population ages, there is an increasing number of older, stable people living with HIV. In Singapore specifically, there have also been late presentations of HIV, predominately among newly diagnosed older people, according to the poster.
“In our setting in Singapore, there’s significant stigma around HIV especially the fear of disclosure,” Brenda Mae Salada, MD, from the division of infectious diseases in the University Medicine Cluster at the National University Hospital in Singapore, told Infectious Disease News. “It’s quite sad, actually.”
Salada and colleagues expressed an urgent need for advance care planning among late presenters, as well as among people living with HIV who have poor adherence to ART.
From January 2016 to December 2017, the HIV care team from Singapore’s National University Hospital identified 127 eligible people living with HIV during multidisciplinary meetings. Using a cascade-of-care model, Salada and colleagues evaluated advance care planning implementation and identified any barriers to its completion. Eligibility criteria included patients 55 years or older, a current CD4 count less than 200, ART nonadherence or reduced life expectancy potentially due to comorbidities.
Of the 127 eligible patients, 55.1% (n = 70) were offered advance care planning, according to the poster. Although 37% (n = 47) accepted planning, only 9.4% (n = 12) actually completed the advance care planning process. Salada and colleagues said 80.9% of those who completed planning were aged 55 years or older. Additionally, 91.4% were male and 72% were Chinese. When comparing the patients who were offered, accepted and completed advance care planning, the researchers observed no significant differences.
According to the poster, the two major patient-centered barriers to advance care planning were social stigmas surrounding HIV — such as isolation, fear of disclosure or lack of a potential spokesperson — and cultural beliefs about death. The main health care provider-centered barrier was identified as time constraint.
People living with HIV are experiencing increased life expectancy, which could increase opportunities for advance care planning if interventions are implemented to address barriers along the care cascade, according to Salada and colleagues. Dedicating time to address stigmas and correct misconceptions and incorporating advance care planning discussions into routine care of people living with HIV is a critical step health care providers should take, according to the poster.
“If there is less stigma associated with disclosure of patients’ HIV diagnosis, decisions can be made early on about their preferences and wishes for future medical decisions, so patients can have better care at the end of their life. These can be discussed and documented through advance care planning,” Salada said. – by Marley Ghizzone
Salada BM, et al. Abstract 1907. Presented at: IDWeek; Oct. 3-7, 2018; San Francisco.
Disclosures: The authors report no relevant financial disclosures.