EVALUATION OF SCREENING TOOL OF OLDER PEOPLE'S PRESCRIPTIONS (STOPP) CRITERIA IN AN URBAN COHORT OF OLDER PEOPLE WITH HIV.

Abstract

Background: The validated Screening Tool of Older People's Prescriptions (STOPP) identifies potentially inappropriate prescribing (PIP) - treatments where potential risk outweighs potential benefit. STOPP is particularly important for people aging with HIV and comorbidities, since PIP may exacerbate symptoms and decrease adherence.

Methods: We analyzed data from the DC Cohort, a longitudinal cohort of people with HIV (PWH). We applied STOPP criteria to identify PIP among DC Cohort participants aged ≥50 years who completed a Patient Reported Outcomes (PROs) survey. All medications prescribed in the 2 years prior to PROs survey completion were considered. Negative binomial models were used to evaluate factors associated with PIP and structural equation modeling was used to evaluate whether symptom burden mediates the relationship between PIP and quality of life.

Results: Of 1048 eligible DC Cohort participants, 486 (46%) had at least one PIP. The most common systems implicated were musculoskeletal (23%), analgesic drugs (N=172, 16%), and central nervous system (13%). All baseline characteristics (age, race/ethnicity, gender, HIV transmission risk, SDOH, comorbidities, viral suppression, and type of HIV care site) were significantly associated with PIP in the crude models. In the multivariable model with just demographic variables, the association between age (aIRR: 1.03 (95% CI: 1.02, 1.04)), intravenous drug use (aIRR: 1.68 (95% CI: 1.20, 2.35)), site type (aIRR: 0.75 (95% CI: 0.62, 0.92)) and PIP remained significant (Table 3, Model I). In the fully adjusted multivariable model with demographics and SDOH, the association between between age, intravenous drug use, and PIP remained significant. Statistical evidence that symptom burden mediates the relationship between PIP and each of the QOL dimensions was present.

Conclusion: Future interventions should work to decrease PIP among these high-risk groups, especially for PIPs associated with increased symptom burden.