# Social Frailty among Older Kenyan Women Living with and without HIV Infection

> **NIH NIH R21** · UNIVERSITY OF WASHINGTON · 2020 · $194,375

## Abstract

Project Summary
In 2017, there were 19.6 million people living with HIV in eastern and southern Africa, of whom 56% were
women. As the antiretroviral therapy scale-up continues and mortality declines, the number of older individuals
with HIV infection is increasing. In Kenya, the proportion of persons living with HIV aged 50 or older is
expected to increase from 13% in 2011 to 51% in 2040. Unfortunately, little attention has been paid to the
needs of the rapidly growing population of older HIV-positive African women, who are disadvantaged relative to
men economically, socially, and politically, and may face specific challenges with respect to ART adherence,
persistent viral suppression, and overall health. This R21 application aims to determine the importance of
social frailty in the overall health and well-being of Kenyan women aged 40 and over. Our work will address the
following specific aims: (1) to characterize social frailty using a social vulnerability index (SVI) and a social
network inventory among 300 Kenyan women aged 40 years and over, using stratified sampling to enroll equal
numbers of HIV-positive and HIV-negative women with a range of ages; (2) to evaluate associations between
SVI score category and both clinical frailty and disability in this population, testing whether HIV status modifies
the association between SVI and either clinical frailty or disability; and (3) to explore associations between SVI
score category and both viral suppression and ART adherence among the 150 participants living with HIV
infection. Innovative aspects include a focus on an understudied, vulnerable population at high risk for adverse
outcomes, adaptation of an existing SVI to the Kenyan context, comparison of social frailty and social network
characteristics by HIV status, and examination of the relationship between social frailty and viral suppression,
with use of hair antiretroviral levels to determine if viremia is due to treatment non-adherence. The highly
productive research team assembled for this application includes Dr. Graham, an experienced clinical
epidemiologist; Dr. McClelland, a women’s health researcher; Dr. Simoni, a sociobehavioral scientist; Dr.
McCormick, an experienced geriatrician; and Dr. Mandaliya, a laboratory scientist and pathologist. This team is
supported by the Medical Officer In-Charge for a large Comprehensive Care Clinic (Dr. Otieno) and the County
Government (Dr. Abubakar) in Mombasa, Kenya and by an expert in social network research (Dr. Kennedy),
an expert on antiretroviral level testing (Dr. Gandhi), and the CFAR Biometrics Core (Dr. Holte) in the US. This
study will build on our team’s expertise and long experience with research on HIV and women’s health in
Mombasa, Kenya. The proposed work will provide important insights into how social frailty impacts the health
of older women living with and without HIV infection, and how interventions to reduce morbidity and promote
healthy aging could best be targeted to mee...

## Key facts

- **NIH application ID:** 9984239
- **Project number:** 5R21AG063602-02
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Susan Marie Graham
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $194,375
- **Award type:** 5
- **Project period:** 2019-08-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9984239

## Citation

> US National Institutes of Health, RePORTER application 9984239, Social Frailty among Older Kenyan Women Living with and without HIV Infection (5R21AG063602-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9984239. Licensed CC0.

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