Table 1 Summary of included articles

Among HIV-Negative Older Adults

Small 2009 [60]

Knowledge

Individuals aged 50 years and older N = 50

Both quantitative and qualitative data were gathered during each session and included a pre-survey and immediate post-37-item-survey, a focus group, and an HIV educational curriculum.

Four HIV education training sessions each lasting three hours covering the following topics: (a) Introduction and Overview, (b) Identifying Myths and Stereotypes, (c) HIV Facts, and (d) Provision of Resources.

No

Interest in HIV prevention and education (composite of two questions)

HIV knowledge was not significantly (p = .273) higher in the posttest (mean = 10.92) than in the pretest (mean = 10.32)

Substantive knowledge about HIV and AIDS remained low among respondents, and there was no significant change in knowledge after the administration of the modified curriculum

Purposive sampling USA

Substantive HIV knowledge (composite of 15 questions)

Orel et al. 2010 [58]

Knowledge

11 participants of 89 aged 60 and older completed both questionnaires N = 11 USA

Before and after questionnaires

“No One is Immune Project” –six-hour education and prevention workshop held at senior centre. Post-test questionnaire administered immediately after workshop.

No

45-item HIV/AIDS Knowledge Questionnaire

Increase in % answering correct

Workshop increased knowledge of HIV among older adults

● HIV can be spread by mosquitoes (48 to 98)

● you cannot get HIV when getting a tattoo (25 to 78)

● women are always tested for HIV during their pap smears (12 to 100)

● No data provided on overall changes in scores

Altschuler et al. 2004 [59]

Knowledge

Adults aged 50 years and older USA N = 40

Verbal feedback after educational program

3 hour educational program. Curriculum includes overview, myths and stereotypes, facts and resources.

No

Group feedback on HIV awareness, HIV perceptions and ability to speak to health care providers

Participants identified learning that HIV was relevant to their lives; feeling empowered to speak up to their health care providers; positive impression being able to discuss a taboo topic.

Qualitative results suggest that education program can help individuals discuss HIV with partners.

Rose 1996 [25]

Knowledge

Individuals aged >60 recruited at senior citizen meal sites USA

Pre and post-test cross-sectional survey

20-30 minute age-specific AIDS education program delivered at meal site and educational pamphlet. Consisted of statistics and facts about HIV, prevention measures and case studies of elderly people with HIV. Post-test administered immediately following education program.

No

Questionnaire measured HIV knowledge and perceptions of susceptibility to HIV (Likert scales)

Significant increase in total knowledge about AIDS (p < 0.001), perceived susceptibility (p < 0.01) and perceived severity (p < 0.001)

Age specific education program significantly increased HIV-related knowledge at senior citizen meal sites

Pre-intervention N = 458

Post-intervention N = 318

Among HIV-Positive Older Adults

Lovejoy et al. 2011 [53]

Risk behaviour

HIV-infected adults 45-plus years old who reported engaging in at least one occasion of unprotected sex in the 3 months prior to enrolment N = 100 USA

Randomised controlled trial

Telephone delivered motivational interviewing (MI) (client-focused and directive form of counselling) to reduce risky sexual behaviour

Yes (N = 23)

Episodes of unprotected sex in past 3 months

Participants in the 4-session MI arm engaged in the fewest occasions of unprotected sex at 3 and 6 month follow-up. Controls had on average 3.24 times as many occasions of unprotected sex (95% CI 1.79-5.85). Furthermore, 1-session MI participants had four times as many unprotected sex acts as 4-session MI participants at 3-month (OR = 3.98 [2.38–6.67]) and 6-month (OR = 4.39 [2.56–7.46]) follow-up.

Four sessions of telephone-delivered MI reduces sexual risk behaviour among HIV-positive older adults

3 arms – 4-sessions (N = 39), 1 session (N = 38) or nothing/control (N = 23).

Ruiz and Kamerman 2010 [57]

Referral for care

HIV-positive patients aged >60 years N = 57 USA

Descriptive

Functional screening for detection of comorbidities and referral for further care if failed in 3 or more domains

No

Referrals for comorbid conditions

17 patients were referred due to problems in multiple domains including cognitive dysfunction (10), problems in daily living (8), nutritional issues (6), depression (5), and mobility (5)

Screening for comorbidities among HIV-positive older adults can facilitate referral for further care likely to improve quality of care and outcomes

Illa et al. 2010 [54]

Risk behaviour

HIV-positive, 45 or older, sexually active in last 12 months

Randomised controlled trial

Project ROADMAP (re-educating older adult in maintaining AIDS prevention).

Yes

Sexual risk (number of partners, partner HIV status, sexual acts, condom use)

Inconsistent condom use with partners of negative or unknown serostatus reduced from 9% at baseline to 1.3% at 6 month follow-up among intervention group (p = .003); reduced from 4% to 3% with control group (p = .999)

Group psycho-educational sessions reduced unprotected sexual acts with partners of unknown or negative serostatus

Intervention group: educational brochure and four psycho-educational group sessions designed for HIV-positive older adults. Sessions focused on information, motivation, behavioural skills and risk reduction behaviours. Control: educational brochure only.

N = 241 (149 intervention group and 92 in control group) USA

HIV knowledge (33 item measure) Sexual self-efficacy

Heckman et al. 2001 [37]

Coping

HIV-positive individuals aged 50 years and older attending AIDS service organizations

Pilot pre- and post-test cohort study

Coping improvement group intervention

No

Severity of HIV-related Life Problem Scale

Increased social wellbeing (2.20 to 2.41, p < 0.05)

Group sessions focusing on coping strategies had limited impact on coping and stress but increased social wellbeing among HIV-positive older adults

Ways of coping Questionnaire Functional assessment of HIV Infection Scale

Marginal non-significant change in coping (p < 0.10)

Marginal non-significant decrease in stress associated with AIDS-related loss and health concerns (p <0.10)

Provision of Social relations

Marginal non-significant increase in support from friends (p < 0.10)

Heckman et al. 2006 [55]

Coping

HIV-positive individuals aged 50 years and older recruited from AIDS service organizations with diagnosis of depression or dysthymia N = 90 USA

Randomised controlled trial with delayed treatment control Embedded cohort study Assessed pre, post (within 1 week of completion) and at3 months

12, 90 minute sessions, telephone delivered weekly coping improvement group intervention to reduce psychological distress 1) Immediate treatment (n = 44) 2) Delayed treatment (control) (n = 46)

Yes, delayed treatment, control group

Geriatric depression scale (GDS) Symptom checklist 90-revised (SCL-90-R)

Intervention group reported fewer psychological symptoms (p = 0.05), less life stressor burden (p = 0.058), less use of avoidant coping strategies (p = 0.05) and marginally higher levels of coping self-efficacy (p = 0.10) compared to controls with no effect on depressive symptoms, loneliness or use of engagement coping Within cohorts IG: significant decrease in depressive symptoms (p < 0.003) psychological symptoms (p < 0.001), life-stressor burden (p < 0.03) and avoidance coping (p < 0.04) at 3 months Delayed group: significant decrease in psychological symptoms (p < 0.03), life stressor burdens (p < 0.001), loneliness (p < 0.03) and greater coping self-efficacy (p < 0.04) following intervention

Telephone delivered coping group sessions among HIV-positive people with depression were effective in reducing psychological symptoms and stress

HIV-related life-stressor burden scale UCLA Loneliness Scale (10-item)

The Ways of Coping Checklist (WOCC)

Coping self-efficacy Scale

Heckman et al. 2011 [35]

Coping

HIV-positive individuals aged 50 years or older with Beck Depression Inventory-II score 10 or more and Modified mini-mental state examination score of 75 or greater. N = 295 USA

Randomised controlled trial 3 arms

1) 12 90 minute sessions face-to-face coping improvement (FFCI) group intervention (n = 104)

Yes

Geriatric Depression Screening Scale

Both FFCI and IPSG participants reported fewer depressive symptoms than controls post-intervention, 4- and 8-month follow-up. This effect was not always statistically significant (p’s < 0.01-0.1). IPSG reported fewer depressive symptoms compared to control.

An age-appropriate coping improvement group intervention was effective in reducing depressive symptoms in HIV + older adults. The effect was more pronounced amongst subjects suffering greater levels of depressive symptoms.

Completed using audio-computer assisted self interviews (A-CASI)

2) 12 session interpersonal support group (IPSG) intervention (n = 105)

3) Individual therapy upon request (ITUR) control (n = 86). Subjects had access to standard psychosocial services available in the community.

Effect size greater for subset of participants with mild, mod and severe depression at baseline

Souza et al. 2008 [56]

Physical support

Subjects HIV+, older than 60 (Mean 65.6+/- 2.9), sedentary at baseline. 3 subsequently excluded due to >3/12 absence from training program N = 11.

Prospective Case series study

1 year resistance training program 4 exercises targeting major muscle groups 3 sets 8-12 reps at light, mod and heavy resistance respectively 2 sessions/week, one year

No

Anthropometric indices: Body mass, circumferences and skin folds Body composition (DEXA) Strength and functional tests: Sub-maximum weight lifted Two functional tests performed every 4 months assessing walking speed, and sit-to-stand performance.

No significant change in weight Strength improvements of between

Following one year of progressive resistance training HIV positive older adults showed significant improvements in strength and functional capacity, no changes in body composition and improved immunological indices.

74-97% (p’s = 0.003-0.021)

Functional tests: decreased times for sit-stand (2.00 to 1.57 s, p = 0.003) and walking 2.4 m (9.25 to 6.58 s, p = 0.003)

All subjects medical able to complete training and not using cortico- or anabolic steroids Brazil

Souza et al. 2011 [36]

Physical support

Subjects HIV+, age > = 60 (M = 64.4 +/- 3.0) Ave. 9 year history of HIV, recruited at Hospital in Sao Paulo, Brazil N = 11 with 21 controls All subjects medically able to complete training and not using cortico- or anabolic steroids

Controlled trial

Progressive resistance exercise 2 sessions per week for 1 year.

Yes, age, activity and gender matched HIV–controls (N = 21)

Strength and functional tests: Sub-maximum load monitored bi-monthly Functional test of walk and sit-stand speeds. Anthropometric and metabolic indices: Weight; BMI Lipid and glycaemic profiles (values registered in clinical record immediately before and after training program)

Although weaker at baseline, HIV + subjects increased weight lifted from 1.52 to 2.33 times baseline, a significantly greater improvement than controls (1.21-1.48, p < 0.01) HIV + lighter, significantly lower BMI (p = 0.007 pre and p = 0.004 post) Faster at walking tests (significant, p = 0.036 pre-, not significant post-training). HIV + significantly faster at sit-to-stand after training than controls (p = 0.005) Fasting BSL significantly improved in both groups (p’s = 0.027-0.037).

Progressive resistance exercise training produced increased strength and functional gains in older adults living with HIV, with gains superior to those seen in age-matched HIV- controls. An effect was also seen on metabolic indices.

Five exercises utilised major muscle groups

3 sets 12/10/8 repetitions at sub-maximum load