QR Code-Enabled Self-Access Lifestyle Education in Older People Living With HIV: Pragmatic Pilot Quasi-Experimental...

Frailty is prevalent and dynamic in older people living with HIV and is associated with adverse outcomes. Lifestyle support is recommended but difficult to deliver at scale. Digital self-access education may help, although evidence in older, multimorbid populations is limited.

This study aims to evaluate 6-month changes in frailty phenotype and related outcomes after a QR code-enabled self-access lifestyle education program on Mediterranean diet and exercise routines for people living with HIV aged ≥60 years.

We conducted a pragmatic, single-arm, quasi-experimental exploratory pretest-posttest evaluation in the HIV outpatient clinic of University Hospital Costa del Sol (Marbella, Spain). Participants received a trifold leaflet with QR codes linking to curated YouTube videos on Mediterranean diet and aerobic or resistance exercise, as an adjunct to usual care. Frailty was assessed using the Fried frailty phenotype. Secondary outcomes included frailty criteria, patient-reported measures (Insomnia Severity Index [ISI], 10-item Connor-Davidson Resilience Scale [CD-RISC-10], University of California, Los Angeles, Loneliness Scale [ULS], and Hospital Anxiety and Depression Scale categories), physical activity (International Physical Activity Questionnaire), Mediterranean diet adherence (MEDAS), and inflammatory and immunologic markers. Frailty transitions were summarized descriptively; paired dichotomous variables were analyzed with McNemar test, and continuous variables with a paired t test or Wilcoxon signed-rank test. All tests were 2-tailed.

Of 52 enrolled participants, 50 (96.2%) were included at 6 months. Frailty transitions were frequent and bidirectional and occurred only between adjacent states. Of 4 frail participants at baseline, 2 transitioned to prefrail; of 25 prefrail participants, 5 improved to robust and 6 progressed to frail; and of 21 robust participants, 10 transitioned to prefrail. No statistically significant changes were observed in inflammatory and immunologic markers, physical activity, or MEDAS scores. Insomnia improved (from a median ISI score of 6.5, IQR 4-9 to a median of 4.0, IQR 2-7; P=.001; r=0.49), resilience increased (median CD-RISC-10 32.0, IQR 28-36 to 37.0, IQR 33-40; P<.001; r=0.65), and loneliness worsened (median ULS 34.5, IQR 30-39 to 38.0, IQR 34-42; P=.001; r=0.49). Grip strength did not improve among participants with impaired baseline strength.

In this uncontrolled exploratory study, selected psychosocial outcomes changed over 6 months after delivery of a QR code-enabled lifestyle education strategy, whereas no clear short-term changes were observed in lifestyle, strength, or biomarker outcomes. Findings should be interpreted as exploratory and hypothesis-generating rather than causal.