Barriers, Facilitators and Implementation Strategies for Conducting Geriatric Assessment and Care in Kenya: Perspectives of Women Living with HIV

Abstract

Due to expanded antiretroviral therapy access and increases in life expectancy for people living with HIV (PLHIV), a growing population of PLHIV requires screening and care for aging-related conditions such as osteoporosis and frailty. However, geriatric services remain scarce and largely unintegrated into the HIV care setting in many sub-Saharan African countries. Understanding the contextual factors that influence participation in geriatric assessment and care among Kenyan women aging with HIV is important to inform clinical practice and policy for delivery of geriatric services in this population. This study examines the barriers, facilitators, and recommended strategies for conducting geriatric assessment and care in Kenyan women ≥ 50 years aging with HIV. We conducted two focus group discussions (FGDs) with Kenyan women living with HIV ≥ 50 years who were receiving follow-up care at Kenyatta National Hospital and participated in Comprehensive Geriatric Assessment. Participants were randomly sampled, including women with and without co-morbidities and across age categories above 50 years. FGDs were conducted in person in English and Swahili, audio-recorded, translated, and transcribed. Data was analyzed using thematic analysis with both deductive and inductive coding approaches and guided by the socio-ecological model (SEM). Patient-identified barriers, facilitators and recommendations for conducting geriatric assessment and care were identified. In May 2025, 13 women living with HIV (11 with comorbidities and 2 without) participated in FGDs. The median age of clients was 65 years (interquartile range = 55, 72). Key barriers included limited awareness of aging-related conditions and normalization of symptoms, fragmented health service locations, limited navigation accommodations for older patients, and significant out-of-pocket health service costs. Key facilitators included positive peer perceptions of CGA, strong health-seeking motivation, high institutional trust, and attentive patient provider-communication. Recommended strategies included establishing appropriate navigation and care coordination accommodations for older patients, colocating geriatric and chronic disease services with clinic services, and ensuring affordable access to geriatric and chronic disease care. This study provides an important first step in identifying contextual factors that influence geriatric assessment and care for Kenyan women aging with HIV. Overall, women expressed positive views on Comprehensive Geriatric Assessment. The results suggest that sustainable integration of geriatric services into routine care for PLHIV requires strategies to improve care coordination, enhance aging-related patient education, and reduce financial barriers to health services.