Improving Potentially Inappropriate Prescribing (PIP) for Aging People with HIV: An Individualized Approach to be Scaled City-Wide

Anne Monroe
September 14, 2021

Anne Monroe, MD, MSPH (GW) has received an NIH CFAR Administrative Supplement entitled, “Improving Potentially Inappropriate Prescribing (PIP) for Aging People with HIV: An Individualized Approach to be Scaled City-Wide”.

Potentially inappropriate prescribing (PIP), i.e., prescribing when the potential risk outweighs the potential benefit, can negatively affect quality of life and health outcomes in people with HIV (PWH) and multiple comorbidities, complications and coinfections (CCCs). PIP may include prescription of incorrect medication as well as both under- and over-prescribing. It is more common as people age and occurs frequently in PWH. PWH frequently demonstrate uncontrolled comorbidities, which may be due to underprescribing and may contribute to the higher burden of cardiovascular disease in PWH. However, overprescribing is also problematic. As PWH age and develop comorbidities, they are more likely to be prescribed medications for those comorbidities in addition to their antiretroviral therapy (ART) for HIV, leading to polypharmacy which may be inappropriate and can lead to adverse health outcomes. PIP is common among older PWH, can negatively impact quality of life (QOL) and can exacerbate symptoms, impact medication adherence, and cause financial burden. Furthermore, racial disparities in PIP among PWH may exist due to decreased access to care and discrimination in the health system. And finally, social determinants of health (SDOH) have a major impact on health outcomes and must be addressed to achieve improved health outcomes in aging PWH. To advance the field and reduce PIP in aging PWH, we propose observational work to inform an R01-funded intervention within the DC Cohort, a multicenter longitudinal study of PWH receiving HIV care in Washington, DC with over 11,000 consented participants. We will pursue the following aims: 1.) Using existing DC Cohort data, assess the prevalence of PIP in DC Cohort participants aged ≥50 years with at least 1 medical comorbidity in addition to their HIV, and determine whether racial disparities in PIP exist. 2.)  Describe the correlates of PIP among DC Cohort participants aged ≥50 years by expanding DC Cohort Patient Reported Outcomes data collection to capture social determinants of health (SDOH), quality of life (QOL) and symptom burden. 3.) Using the information from Aims 1 and 2, develop an intervention to decrease PIP. The intervention will use the existing DC Cohort dashboard to ensure feasibility and scalability. Our multidisciplinary team at George Washington University and Howard University is uniquely positioned to design an intervention to decrease PIP in aging PWH with CCCs to improve health outcomes that is feasible and scalable.