Frailty, Latent Health Profiles, and Antiretroviral Therapy: Predicting Success of Skilled Nursing Facility Care in an HIV Population

Abstract

Objectives: People with HIV (PWH) likely need short-term skilled nursing facility (SNF) care more than people with greater financial and social support to remain home. Therefore, we sought to understand how frailty among health profiles with distinct driving conditions, antiretroviral therapy (ART), and sociodemographic factors relate to success of short-term SNF for PWH.Design: Retrospective cohort study. Setting and Participants Short-term SNF stays for PWH.Methods: stays (n = 1640) were identified in a 2014–2019 Medicare 5% random sample. Zero-Inflated Poisson regression estimated rate ratios for home time lost in 1-year post-discharge by age (<65 vs 65+), health profiles established by latent profile analysis, frailty, and days covered by ART.Results: Overall, 716 (44%) SNF stays were aged 65+, 1154 (70%) were male, 764 (47%) were Black, 321 (20%) were frail, and 784 (48%) had ART ?80% of days before admission. There were 3 health profiles: substance use (SU; n = 467), cardiovascular and pulmonary (CV/PULM; n = 665), or multisystem including SU, CV, PULM, and mental health (MULTI; n = 508). Among stays aged <65, SU [rate ratio (95% confidence interval), 1.12 (1.09–1.15)] had more and MULTI [0.87 (0.85–0.89)] had fewer days lost than the CV/PULM group, but any ART carried higher rates of days lost compared with none. Among those aged 65+, SU [0.89 (0.85–0.92)] had fewer days lost, but MULTI [0.97 (0.94–1.00)] was similar in home time loss compared with the CV/PULM group. Having ART <80% of days [1.10 (1.06–1.13)], frailty [1.07 (1.03–1.11)], or pre-frailty [1.07 (1.04–1.10)] had higher rates of days lost.Conclusions and Implications: Although health profiles may help identify conditions most likely impacting health of PWH, frailty may be key to identifying those having the highest needs and at risk for greater home time loss following SNF stays, with this impact varying by age.