Frailty and frailty screening: a qualitative study to elicit perspectives of people living with HIV and their health care professionals

Objectives People living with HIV (PLWH) are an ageing population, with an increasing prevalence of frailty. Management of frailty requires assessment, communication and information sharing with patients. However, evidence regarding the meaning of frailty for this population, and the acceptability of frailty screening is limited. This study aimed to explore perceptions of older PLWH and HIV professionals towards frailty and routine screening for frailty. Methods Data collection consisted of in-depth individual qualitative interviews with older PLWH and focus groups with HIV professionals purposively sampled from outpatient HIV clinics in London and Brighton, UK. Verbatim pseudonymised transcripts were analysed using reflexive thematic analysis supported by NVivo. Results 45 PLWH were interviewed, and 12 HIV professionals participated in two focus groups. Frailty was described as a series of losses around: mobility, social inclusion, independence and mental acuity, which could happen at any age. Regarding language, for PLWH explicitly using the word frail was acceptable during screening when approached sensitively, and alongside provision of information and ?support to slow the progression of frailty. However HIV professionals described concerns using the word frail for fear of causing distress or offence. Conclusion Professionals described frailty in terms of functional deficits, while PLWH described a loss of personhood. Although there is a clear desire among PLWH to be informed of their frailty status, approaching conversations about frailty with understanding and compassion is vital. To gain the most from the screening, it is essential frailty status is shared alongside a clear plan of actionable steps in their care.