Understanding service access and usage for people aging with HIV and neurocognitive concerns using the candidacy framework: findings from a community-based research study in 3 Canadian cities

Objectives: In Canada, 50% of people living with HIV and 20% of new infections are in people over 50 years of age. As people age with this chronic disease, 25-50% will develop neurocognitive impairments. HEADSUP!2, a community-based research study, applies the candidacy framework, which describes how people determine their eligibility for health care services, to better understand the experiences of people living with HIV when navigating care services for neurocognitive challenges. Methods: Using a community-based research approach and engaging a peer researcher team throughout the research process, people aging with HIV and experiencing neurocognitive concerns in Montreal and Toronto were recruited through community networks to participate in a qualitative interview. Participants were offered an opportunity to be interviewed by an interviewer with lived experience of HIV. Interview transcripts were analyzed using a participatory team approach for themes related to their candidacy including access, and usage of services and supports from identification of a need to receipt of treatment. Results: 25 people living with HIV participated in qualitative interviews in French or English. Findings suggest participants experienced barriers to care at each level of candidacy. Common experiences included fear of cognitive diagnosis, dismissal of symptoms as "aging", prioritizing co-existing health issues, and lack of knowledge of treatment options. Conclusion: This study highlights that there are barriers at every step of candidacy that limit care for people aging with HIV who experience cognitive concerns. These findings can inform resources and health care services for people aging with HIV and neurocognitive concerns.