Background As the population of older adults living with HIV in China continues to expand, a pressing gap persists in the availability of validated instruments that appraise whether residential settings meet the compound demands of aging and chronic HIV management. Methods This study presents the AFLE-HIV (Age-Friendly Living Environment for Elderly HIV-Infected Individuals) assessment framework, constructed through a sequential mixed-methods design. Latent Dirichlet Allocation was applied to a corpus of 347 peer-reviewed publications to surface latent environmental themes, yielding an initial set of three primary dimensions and 15 candidate indicators. These candidates were then subjected to two iterative rounds of Delphi consultation involving 22 multidisciplinary experts (response rate: 100%), followed by Analytic Hierarchy Process weight calibration. A field-based pilot across 12 residential communities in four Chinese cities was scored independently by four trained assessors. Results The Delphi process consolidated the framework to three primary dimensions and 13 validated indicators with statistically significant inter-expert agreement (Kendall’s <InlineEquation ID="IEq1"><EquationSource Format="TEX">\(W = 0.275\)</EquationSource></InlineEquation>, <InlineEquation ID="IEq2"><EquationSource Format="TEX">\(P < 0.001\)</EquationSource></InlineEquation>) and satisfactory content validity (item-level CVI <InlineEquation ID="IEq3"><EquationSource Format="TEX">\(\ge 0.82\)</EquationSource></InlineEquation>; scale-level CVI/Ave <InlineEquation ID="IEq4"><EquationSource Format="TEX">\(= 0.90\)</EquationSource></InlineEquation>). All AHP consistency ratios remained below 0.1. The pilot test yielded satisfactory scale reliability (Cronbach’s <InlineEquation ID="IEq5"><EquationSource Format="TEX">\(\alpha = 0.812\)</EquationSource></InlineEquation>) and moderate inter-rater concordance (ICC(2,1) <InlineEquation ID="IEq6"><EquationSource Format="TEX">\(= 0.694\)</EquationSource></InlineEquation>). Conclusions The resulting AFLE-HIV instrument equips community health workers with a structured protocol for diagnosing environmental shortcomings, provides policymakers with an evidence-based basis for directing renovation investments aligned with the HIV care continuum and community-based service delivery models, and offers urban planners actionable benchmarks for age-friendly residential upgrades targeting this underserved population.

AFLE-HIV: developing an age-friendly living environment assessment framework for elderly HIV-infected individuals in China

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2026年6月3日

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Quan Wen,
Mazran Ismail,
Muhammad Hafeez Abdul Nasir,
Yanting Wu,
Chaojiang Hu

摘要

Background

As the population of older adults living with HIV in China continues to expand, a pressing gap persists in the availability of validated instruments that appraise whether residential settings meet the compound demands of aging and chronic HIV management.

Methods

This study presents the AFLE-HIV (Age-Friendly Living Environment for Elderly HIV-Infected Individuals) assessment framework, constructed through a sequential mixed-methods design. Latent Dirichlet Allocation was applied to a corpus of 347 peer-reviewed publications to surface latent environmental themes, yielding an initial set of three primary dimensions and 15 candidate indicators. These candidates were then subjected to two iterative rounds of Delphi consultation involving 22 multidisciplinary experts (response rate: 100%), followed by Analytic Hierarchy Process weight calibration. A field-based pilot across 12 residential communities in four Chinese cities was scored independently by four trained assessors.

Results

The Delphi process consolidated the framework to three primary dimensions and 13 validated indicators with statistically significant inter-expert agreement (Kendall’s \(W = 0.275\), \(P < 0.001\)) and satisfactory content validity (item-level CVI \(\ge 0.82\); scale-level CVI/Ave \(= 0.90\)). All AHP consistency ratios remained below 0.1. The pilot test yielded satisfactory scale reliability (Cronbach’s \(\alpha = 0.812\)) and moderate inter-rater concordance (ICC(2,1) \(= 0.694\)).

Conclusions

The resulting AFLE-HIV instrument equips community health workers with a structured protocol for diagnosing environmental shortcomings, provides policymakers with an evidence-based basis for directing renovation investments aligned with the HIV care continuum and community-based service delivery models, and offers urban planners actionable benchmarks for age-friendly residential upgrades targeting this underserved population.