Golden Compass

Golden Compass, a program launched by the Ward 86 outpatient HIV clinic at San Francisco General Hospital in 2017, aims to serve the unique needs of older adults with HIV. Golden Compass shifts away from a primary emphasis on HIV-related health outcomes and instead adopts a comprehensive care model designed to address comorbidities that arise with older age. Ward 86 provides geriatric and cardiology consultation services and interactive, educational group sessions for patients. Golden Compass helps address the large, yet preventable, gaps in knowledge about geriatric HIV care, resulting in high rates of patient and provider satisfaction and substantial provider reach.

San Francisco, CA

Implementation Guide
False
Emerging intervention
Emerging intervention
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Clinical service delivery model
Icon for HIV Care Continuum
Beyond the care continuum
Icon for Focus Population
People over 50 years of age
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RWHAP Part A; Non-RWHAP
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RWHAP-funded clinic or organization; Hospital or hospital-based clinic
Need Addressed

With the increased availability of antiretroviral therapy (ART), the life expectancy of people with HIV has significantly improved, nearing that of the general population. Consequently, the population of older people with HIV has risen steadily; 50% of people with HIV in the U.S.—and 60% of those living in San Francisco1—are aged 50 years and older. These people are more susceptible to age-related concurrent health conditions, like cardiovascular disease and osteoporosis, that stem from multiple factors such as chronic inflammation from HIV, adverse effects from ART medication, and lifestyle factors. Older populations are often less aware of HIV risk factors and less inclined to be tested for HIV, resulting in delays in the initiation of their HIV care.2

“I have lived with HIV for an extremely long time, [I don’t know about] the long-term effects and consequences of that later in life, as well as being on antiretroviral medicines.”

Core Elements
A weekly consultative geriatrics clinic

Through Golden Compass, Ward 86 offers geriatric consultations with initial sessions lasting 60 minutes. During the consultations, the geriatrician and patient develop a treatment plan. Assessments include screening for depression, and evaluating cognition, functional status, falls and gait, along with reviewing social supports. Information gained from these assessments is shared with the patient’s primary care provider, and patients are linked to dental, audiology, optometry, and ophthalmology services based on results. Additionally, patients review their medications with a pharmacist and may meet with a social worker.

A bimonthly consultative cardiology clinic

A cardiologist with specialized knowledge in HIV conducts consultations for patients aged 50 years and older. Electrocardiography is available at Ward 86; all other necessary tests are conducted within the San Francisco General Hospital campus. The cardiology consultant determines whether follow-up visits are needed. 

Group classes

Golden Compass prioritizes community building and forming social relationships. Group classes are available to patients on a drop-in basis, with no limit on how many classes they can attend. Between February 2017 and April 2018, three series of two-hour brain health classes took place, with each occurring weekly for a duration of nine weeks. Currently, a support group meets on a weekly basis facilitated by a Ward 86 social worker. Wellness Club, a 50-minute exercise course that has been available on an ongoing basis, focuses on strength training, cardiovascular fitness, and balance.

Health care coverage enrollment and other supports

Golden Compass supports client enrollment into Medicare Advantage plans, which provide health care coverage to many people ages 65 and older. Support for enrollment into these plans is critical given the complexity of the plans and the specific health care needs of the aging population with HIV. Golden Compass also works with multiple organizations that serve older adults (e.g., the local Area Agency on Aging) to provide tailored supports, including transportation and home health care.

Outcomes

From January 2017 to June 2018, 198 patients participated in the Golden Compass program; these patients were served by 28 staff members and 39 clinicians at Ward 86. Among these participants, 20% of patients and 63% of providers completed satisfaction surveys. Nine providers and 10 patients participated in qualitative interviews.

CategoryInformation
Evaluation data
  • Surveys, interviews, attendance records
Measures

  • Reach is defined as the percentage of clinic patients ages 50 and older who engaged in at least one Golden Compass program element.
  • Satisfaction is defined as patient or provider reported satisfaction with care overall and with different aspects of services.
  • Adoption is defined as provider uptake of the program, including directing patients to geriatrics and cardiology clinics.
Results

  • Reach: 17% of people aged 50 years or older participated in at least one program element
  • Patient satisfaction: Satisfaction with care overall: 97%; 100% satisfied with geriatrics clinic, 100% satisfied with cardiology clinic, 93% satisfied with classes
  • Provider satisfaction: Satisfaction with care overall: 90%; 94% satisfied with geriatrics clinic, 94% satisfied with cardiology clinic, 90% satisfied with classes
  • Adoption: 85% of providers had referred at least one patient to the geriatrics clinic; 59% referred to the cardiology clinic

Source: Greene M, Myers J, Tan JY, et al. The Golden Compass Program: Overview of the initial implementation of a comprehensive program for older adults living with HIV. J Int Assoc Provid AIDS Care. 2020;19.

"[The program] is another set of eyes on taking care of my health, they’re like, How can we support this person? What could we do to make it easier for them?”

Planning & Implementation

Program framework. Golden Compass is built on the “four points” framework: 

  • North (heart and mind) 
  • East (bones and strength)
  • West (dental, hearing, and vision)
  • South (network and navigation)

Outreach and program promotion. Golden Compass was introduced to patients and providers through a two-pronged strategy. Flyers and handouts were posted around the Ward 86 clinic to advertise the program components; staff and providers were familiarized with the program through a series of routine staff meetings. 

Patient referral. Patients were most commonly referred to the clinic by their primary care providers, although social workers and registered nurses could also make referrals. 

Brain health class development. The brain health classes were led by a gerontologist who developed the curriculum with an emphasis on cognitive domains pertinent to HIV-associated neurocognitive disorder.

Sustainability

The Ward 86 clinic is located in the San Francisco General Hospital and is funded by the Ryan White HIV/AIDS Program. The Golden Compass program also received support from AIDS Walk San Francisco, the San Francisco Department of Public Health, San Francisco General Hospital Foundation, Gilead HIV and Aging Positively Program, and Design Industries Foundation Fighting AIDS.

Lessons Learned

  • Group classes are an essential part of Golden Compass because older adults (especially those who are LGBTQ+) may be more likely to suffer from social isolation. Golden Compass reported that sessions are always well attended because they are highly valued.
  • Given clients can lose their medication or provider coverage with a change in plan, Golden Compass provides intensive support navigating Medicare plan selection.

"[The program should] incorporate all these things: pharmacy care, social care, primary care physician and all of it working seamlessly, it would be less work for the clinic. . . if it's staffed right, having something for 50 and older. . . would really work well.”

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