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Fredericksen RJ, Mixson LS, Drumright LN, Nance RM, Delaney JAC, Ruderman SA, Whitney BM, Hahn A, Ma J, Mayer KH, Christopoulos KA, Willig AL, Napravnik S, Bamford L, Cachay E, Eron JJ, Saag M, Jacobson J, Kitahata MM, Crane HM. Correlates of Intimate Partner Violence, Including Psychological Partner Violence, in a Multisite U.S. Cohort of People in HIV Care. AIDS Behav 2024:10.1007/s10461-024-04402-2. [PMID: 39014029 DOI: 10.1007/s10461-024-04402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/18/2024]
Abstract
We examined past-year intimate partner violence (IPV), including psychological violence without physical/sexual violence, and health outcomes among people with HIV (PWH) in care in a multi-site U.S. cohort. Between 2016 and 2022, PWH reported 12-month psychological, physical, and sexual IPV in a routine assessment. We used linear and logistic regression models adjusted for age, race/ethnicity, and site to examine relationships with health outcomes. Among 9748 PWH (median age 50 years, 81% cisgender male/16% cisgender female/1% transgender female; 44% non-Hispanic white/36% non-Hispanic Black/15% Hispanic), 9.3% (n = 905) reported any IPV in the past 12 months; half reported psychological IPV without physical/sexual IPV (n = 453). PWH reporting any type of IPV were on average younger than those who did not experience IPV. In adjusted models, any IPV was associated with increased likelihood of unstable housing, HIV viral load detection (HIV viral load ≥ 75 copies/mL), moderate-to-severe depressive symptoms, anxiety with panic symptoms, substance use (methamphetamines, cocaine/crack, illicit opioids, marijuana, heavy episodic/hazardous drinking), and concern about exposure to sexually transmitted infection. PWH reporting any IPV in the past 12 months had 4.2% lower adherence to antiretroviral therapy, 2.4 more HIV-related symptoms, a 1.9 point higher HIV stigma score, and a 9.5% lower quality of life score than those without IPV. We found similar associations among PWH reporting only psychological IPV, without physical/sexual IPV. IPV was common among PWH. Half reporting IPV reported only psychological IPV and had similarly poor outcomes as those reporting physical/sexual IPV, demonstrating the need to assess psychological as well as physical and sexual IPV.
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Affiliation(s)
- R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - A Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - K A Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A L Willig
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - S Napravnik
- University of North Carolina, Chapel Hill, NC, USA
| | - L Bamford
- University of California, San Diego, CA, USA
| | - E Cachay
- University of California, San Diego, CA, USA
| | - J J Eron
- University of North Carolina, Chapel Hill, NC, USA
| | - M Saag
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - J Jacobson
- Case Western Reserve University, Cleveland, OH, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
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2
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Claisse C, Kasadha B, Durrant AC. Perspectives of healthcare professionals and people living with HIV in dialogue: on information sharing to improve communication at the consultation. AIDS Care 2024; 36:6-14. [PMID: 39066725 DOI: 10.1080/09540121.2023.2282034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/06/2023] [Indexed: 07/30/2024]
Abstract
We report on a qualitative Group Survey study involving four healthcare professionals (HCPs) and eight people living with HIV who were recipients of care in the United Kingdom (UK). The survey aimed to bring participants' perspectives into dialogue and establish consensus about how communication between HCPs delivering HIV care and their patients could be improved in the context of the routine care consultation. Responses from both parties were anonymously collated, thematically analysed, and shared back with participants in two subsequent survey rounds to support consensus-building on matters of concern and identify thematic insights. In this paper, we report three themes for informing future designs of tools and services to support communication between patients and HCPs: Patient-clinician relationship for trusted sharing; Self-reporting psychosocial information to support Whole-person care; and Perceived barriers for online trusted sharing with HCPs. Our findings highlight key areas of concern and further investigation is needed to understand how self-reported information may be meaningfully captured, interpreted and processed by HCPs in ways that are trusted by patients who voice privacy and security concerns.
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Affiliation(s)
- Caroline Claisse
- School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Leibowitz AS, Luu MN, Flamm JA, Hare CB, Dumoit Smith J, Iturralde E, Dilley J, Silverberg MJ, Satre DD. Racial, ethnic, and age disparities in the association of mental health symptoms and polysubstance use among persons in HIV care. PLoS One 2023; 18:e0294483. [PMID: 38015975 PMCID: PMC10684077 DOI: 10.1371/journal.pone.0294483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018-2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09-1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11-1.96), 1.07 (0.74-1.54), and 1.10 (0.85-1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Alexandra N. Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Amy S. Leibowitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Mitchell N. Luu
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Jason A. Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, CA, United States of America
| | - C. Bradley Hare
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, United States of America
| | - Jaime Dumoit Smith
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
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Moody K, Nieuwkerk PT, Bedert M, Nellen JF, Weijsenfeld A, Sigaloff KCE, Laan L, Bruins C, van Oers H, Haverman L, Geerlings SE, Van der Valk M. Optimising HIV care using information obtained from PROMs: protocol for an observational study. BMJ Open 2023; 13:e073758. [PMID: 38011973 PMCID: PMC10685965 DOI: 10.1136/bmjopen-2023-073758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Successful antiviral therapy has transformed HIV infection into a chronic condition, where optimising quality of life (QoL) has become essential for successful lifelong treatment. Patient-reported outcome measures (PROMs) can signal potential physical and mental health problems related to QoL. This study aims to determine whether PROMs in routine clinical care improve quality of care as experienced by people with HIV (PWH). METHODS AND ANALYSIS We report the protocol of a multicentre longitudinal cohort studying PWH at Amsterdam University Medical Centres in the Netherlands. PROMs are offered annually to patients via the patient portal of the electronic health record. Domains include anxiety, depression, fatigue, sleep disturbances, social isolation, physical functioning, stigma, post-traumatic stress disorder, adherence, drug and alcohol use and screening questions for sexual health and issues related to finances, housing and migration status. Our intervention comprises (1) patients' completion of PROMs, (2) discussion of PROMs scores during annual consultations and (3) documentation of follow-up actions in an individualised care plan, if indicated. The primary endpoint will be patient-experienced quality of care, measured by the Patient Assessment of Chronic Illness Care, Short Form (PACIC-S). Patients will provide measurements at baseline, year 1 and year 2. We will explore change over time in PACIC-S and PROMs scores and examine the sociodemographical and HIV-specific characteristics of subgroups of patients who participated in all or only part of the intervention to ascertain whether benefit has been achieved from our intervention in all subgroups. ETHICS AND DISSEMINATION Patients provide consent for the analysis of data collected as part of routine clinical care to the AIDS Therapy Evaluation in the Netherlands study (ATHENA) cohort through mechanisms described in Boender et al. Additional ethical approval for the analysis of these data is not required under the ATHENA cohort protocol. The results will be presented at national and international academic meetings and submitted to peer-reviewed journals for publication.
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Affiliation(s)
- Kevin Moody
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Pythia T Nieuwkerk
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Psychology and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Bedert
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannine F Nellen
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Kim C E Sigaloff
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laura Laan
- Infectious Diseases, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Claire Bruins
- Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hedy van Oers
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry and Psychological Care, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry and Psychological Care, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne E Geerlings
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marc Van der Valk
- Infectious Diseases and Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
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Yoshino Y, Wakabayashi Y, Kitazawa T. Changes in health and sleep quality after anti-retroviral treatment modification in Japanese people living with HIV. J Infect Chemother 2023; 29:948-952. [PMID: 37327872 DOI: 10.1016/j.jiac.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Anti-retroviral treatment (ART) modification for treatment simplification is performed in virologically controlled people living with Human Immunodeficiency Virus (PLWH). However, studies on the impact of these stable treatment modifications on health-related quality of life (HRQoL) measured using patient-reported outcomes (PROs) in clinical practice are scarce; this was the focus of this study. METHODS PLWH who visited Teikyo University Hospital between October 2019 and March 2021, and whose ART was changed to a newly recommended single-tablet regimen for treatment simplification, were included in the study. HRQoL and sleep quality were evaluated using the Short-Form (SF) 8 and Pittsburgh Sleep Quality Index (PSQI) global score, respectively, at two time points: before and after treatment modification. Comorbidities, duration of Human Immunodeficiency Virus diagnosis, ART initiation, ART regimens, and blood test data before and after treatment were assessed. The SF-8 was used to calculate the physical component summary (PCS) and mental component summary (MCS) scores. RESULTS Forty-nine patients (all male) were included into the study. There was no change in the PCS score before and after ART modification. The MCS score significantly improved from 48.50 ± 6.56 to 50.76 ± 4.37 (p = 0.0159). Thirteen patients' ARTs were changed to dolutegravir/lamivudine. Their HRQoL and sleep quality changes were further analyzed. Their MCS and PSQI scores had improved significantly. Thirty patients' ARTs were changed to bictegravir/tenofovir alafenamide/emtricitabine; however, there were no significant changes in their HRQoL or PSQI score. CONCLUSION ART modification for treatment simplification based on PROs may improve the HRQoL of PLWH.
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Affiliation(s)
- Yusuke Yoshino
- Teikyo University School of Medicine, Department of Microbiology and Immunology, Japan; Teikyo University Hospital, Department of General Internal Medicine, Infectious Disease Group, Japan.
| | - Yoshitaka Wakabayashi
- Teikyo University Hospital, Department of General Internal Medicine, Infectious Disease Group, Japan
| | - Takatoshi Kitazawa
- Teikyo University Hospital, Department of General Internal Medicine, Infectious Disease Group, Japan
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Antunes A, Racha-Pacheco R, Esteves C, Tavares A, Mendez J, Pacheco P, Short D. PRO-Act: a healthcare provider workshop outlining the added value of implementing PROs in routine HIV practice. J Patient Rep Outcomes 2023; 7:50. [PMID: 37261556 DOI: 10.1186/s41687-023-00584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Patient Reported Outcomes (PROs) are an evidenced way of adding value to routine clinical care. As a source of unique information on the effect of a medical condition and its treatment from the patients' perspective (Mercieca-Bebber et al. in Patient Relat Outcome Meas 9: 353-367, https://doi.org/10.2147/PROM.S156279 , 2018), PROs allow for an improved assessment in routine clinical care of symptoms, side effects, functional outcomes (physical, sexual, social, emotional, cognitive functioning), and health-related quality of life (HRQoL). By helping to align healthcare providers' interventions with what matters most to the patient, PROs contribute to the individualized choice of Anti-Retroviral Therapy (Carfora et al. in PLoS ONE 17(4): e0267030, https://doi.org/10.1371/journal.pone.0267030 , 2022) as a paramount component of tailored and person-centred care management, in routine clinical practice. This article outlines a practical framework and process tested in Portugal to raise awareness of PROs' added value, and to help guide first steps in the implementation and seamless integration of PROs, in routine HIV care.
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Affiliation(s)
- António Antunes
- ViiV Healthcare Medical Department, Rua Dr. António Loureiro Borges, nº 3 - Arquiparque - Miraflores, 1495-131, Algés, Portugal
| | | | - Catarina Esteves
- Infectious Diseases Ward, Hospital de Cascais, Av. Brigadeiro Victor Novais Gonçalves, 2755-009, Alcabideche, Portugal
| | - Ana Tavares
- ViiV Healthcare Medical Department, Rua Dr. António Loureiro Borges, nº 3 - Arquiparque - Miraflores, 1495-131, Algés, Portugal
| | - Josefina Mendez
- Hospital Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | | | - Duncan Short
- ViiV Healthcare Implementation Science Department, 980 Great West Road, Brentford Middlesex, TW8 9GS, UK
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7
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Parisot Iii PE, Wheeler F, Bonnet K, Rebeiro PF, Schember CO, McCainster K, Cooper RL, Berthaud V, Schlundt DG, Pettit AC. Patient-Reported Outcomes Collection at an Urban HIV Clinic Associated With a Historically Black Medical College in the Southern United States: Qualitative Interview Study Among Patients With HIV. JMIR Form Res 2023; 7:e42888. [PMID: 36947109 PMCID: PMC10132038 DOI: 10.2196/42888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Black Americans, particularly in the southern United States, are disproportionately affected by the US HIV epidemic. Patient-reported outcome (PRO) data collection can improve patient outcomes and provide oft-overlooked data on mental health, substance use, and patient adherence to antiretroviral therapy. OBJECTIVE We piloted the use of an electronic tablet to collect PRO data on social and behavioral determinants of health among people with HIV at the Meharry Community Wellness Center, an HIV clinic affiliated with a Historically Black Medical College in Nashville, Tennessee. Our primary objective was to better understand patients' experiences and comfort with using an electronic PRO tool through patient interviews. METHODS We enrolled 100 people with HIV in care at the Meharry Community Wellness Center consecutively to completely validate PRO tools using the Research Electronic Data Capture platform on a hand-held tablet. Using a purposive sampling strategy, we enrolled 20 of the 100 participants in an in-depth interview (IDI). Interview guide development was grounded in the cognitive-behavioral model, in which thoughts, feelings, and behaviors are interrelated. IDIs were audio recorded, transcribed, deidentified, and formatted for coding. A hierarchical coding system was developed and refined using an inductive-deductive approach. RESULTS Among the 100 people with HIV enrolled, the median age was 50 (IQR 42-54) years; 89% (n=89) were Black, 60% (n=60) were male, and 82% (n=82) were living below 100% of the federal poverty level in 2016. Five major interview themes emerged: overall experience, question content, sensitive topics, clinic visit impact, and future recommendations. IDI participants felt that the tablet was easy to use and that the question content was meaningful. Question content related to trauma, sexual and drug use behaviors, mental health, stigma, and discrimination elicited uncomfortable or distressing feelings in some participants. Patients expressed a strong desire to be truthful, and most would complete these surveys without compensation at future visits if offered. CONCLUSIONS The use of an electronic tablet to complete PRO data collection was well received by this cohort of vulnerable persons in HIV care in the southern United States. Despite some discomfort related to question content, our cohort overwhelmingly believed this was a meaningful part of their medical experience and expressed a high desire for truthfulness. Future research will focus on scaling up the implementation and evaluation of PRO data collection in a contextually appropriate manner while obtaining input from providers and staff to ensure that the collected data are both applicable and actionable.
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Affiliation(s)
- Paul E Parisot Iii
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Facerlyn Wheeler
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States
| | - Kemberlee Bonnet
- Department of Psychological Science, Vanderbilt University, Nashville, TN, United States
| | - Peter F Rebeiro
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, United States
- California Department of Public Health, Richmond, CA, United States
| | - Korlu McCainster
- Meharry Community Wellness Center, Department of Infectious Disease, Meharry Medical College, Nashville, TN, United States
| | - Robert L Cooper
- Meharry Community Wellness Center, Department of Infectious Disease, Meharry Medical College, Nashville, TN, United States
| | - Vladimir Berthaud
- Meharry Community Wellness Center, Department of Infectious Disease, Meharry Medical College, Nashville, TN, United States
| | - David G Schlundt
- Department of Psychological Science, Vanderbilt University, Nashville, TN, United States
| | - April C Pettit
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, United States
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Chen LY, Sun HY, Chuang YC, Huang YS, Liu WD, Lin KY, Chang HY, Luo YZ, Wu PY, Su YC, Liu WC, Hung CC. Patient-reported outcomes among virally suppressed people living with HIV after switching to Co-formulated bictegravir, emtricitabine and tenofovir alafenamide. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023:S1684-1182(23)00034-8. [PMID: 36806364 DOI: 10.1016/j.jmii.2023.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND While some evidence has suggested the benefits of co-formulated bictegravir, emtricitabine and tenofovir alafenamide (B/F/TAF) in improving the quality of life of people living with HIV (PLWH), patient-reported outcome studies that focus on Asian population remain scarce. We aimed to determine the changes in HIV-related symptom burden in virally-suppressed PLWH switching to B/F/TAF in a real-world setting. METHODS PLWH on stable antiretroviral therapy (ART) for ≥6 months with plasma HIV RNA <200 copies/mL who decided to switch to B/F/TAF were eligible for the study. Participants' experience with 20 symptoms were assessed using HIV Symptom Index at baseline and weeks 24 and 48. Responses were dichotomized in two ways: 1) present vs. not present; and 2) bothersome vs. not bothersome, and compared across time points. RESULTS Six hundred and thirty participants (prior regimen, 94.4% integrase inhibitor-based) who completed week 48 visit were included in the analysis. Forty-eight weeks after switching to B/F/TAF, six symptoms were significantly less prevalent, and seven symptoms were significantly less bothersome. Improvement was more pronounced in participants whose prior regimen was elvitegravir-based versus dolutegravir-based. Logistic regression results showed that prior dolutegravir-based ART and pre-existing diabetes independently predicted improvement in diarrhea/loose bowels and muscle aches/joint pain, respectively. Despite the overall improvement, some symptoms persisted in a substantial proportion of participants. CONCLUSIONS Virally-suppressed PLWH might benefit from a regimen switch to B/F/TAF to reduce the prevalence and level of bother of HIV-related symptoms. Nevertheless, additional multidisciplinary interventions are warranted to further alleviate the symptom burden of PLWH.
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Affiliation(s)
- Ling-Ya Chen
- Centre of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital Cancer Centre, Taipei, Taiwan
| | - Kuan-Yin Lin
- Centre of Infection Control, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsi-Yen Chang
- Centre of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Zhen Luo
- Centre of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Ying Wu
- Centre of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
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9
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Aiyegbusi OL, Hughes SE, Peipert JD, Schougaard LMV, Wilson R, Calvert MJ. Reducing the pressures of outpatient care: the potential role of patient-reported outcomes. J R Soc Med 2023; 116:44-64. [PMID: 36758615 PMCID: PMC9944235 DOI: 10.1177/01410768231152222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The global demand for hospital treatment exceeds capacity.The COVID-19 pandemic has exacerbated this issue, leading to increased backlogs and longer wait times for patients. The amount of outpatient attendances undertaken in many settings is still below pre-pandemic levels and this, combined with delayed referrals, means that patients are facing delays in treatment and poorer health outcomes. Use of digital health technologies, notably the use of remote symptom monitoring systems based on patient-reported outcomes (PROs), may offer a solution to reduce outpatient waiting lists and tailor care to those in greatest need. Drawing on international examples, the authors explore the use of electronic PRO systems to triage clinical care. We summarise the key benefits of the approach and also highlight the challenges for implementation, which need to be addressed to promote equitable healthcare delivery.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Liv Marit Valen Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, 7400, Herning, Denmark
| | - Roger Wilson
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, B15 2TT, UK
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10
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Short D, Wang X, Suri S, Hsu TK, Jones B, Fredericksen RJ, Crane HM, Musten A, Bacon J, Wang Y, Gough KA, Ramgopal M, Berry J, Lober WB. Risk Factors for Suboptimal Adherence Identified by Patient-Reported Outcomes Assessments in Routine HIV Care at 2 North American Clinics. Patient Prefer Adherence 2022; 16:2461-2472. [PMID: 36090124 PMCID: PMC9462952 DOI: 10.2147/ppa.s378335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Use of patient-reported outcomes assessments (PROs) can improve patient-provider communication and focus provider attention on current health issues. This analysis examines the association between suboptimal antiretroviral therapy (ART) adherence and factors obtained through PROs among people with HIV (PWH) at 2 North American outpatient clinics. PATIENTS AND METHODS Immediately before a clinic visit, PWH completed self-administered PROs. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models to identify sociodemographic and health-related factors (satisfaction with ART, difficulty meeting housing costs, depression, intimate partner violence, risk of malnutrition, smoking status, alcohol use, and substance use) associated with suboptimal adherence (defined as self-reporting <95% or <80% adherence). Multiple imputation was performed to account for missing data in the multivariate analyses. RESULTS Of 1632 PWH, 1239 (76%) responded to the adherence assessment; of these, 268 (22%) and 106 (9%) reported <95% and <80% adherence, respectively. Of 1580 PWH who responded, 354 (22%) were dissatisfied with their HIV medication. Of responding PWH, 19% reported moderate-to-severe depression, 23% indicated they were at risk of malnutrition, 34% were current smokers, and 62% reported substance use in the past 3 months. Dissatisfaction with ART was significantly associated with <95% and <80% adherence in the unadjusted analysis (unadjusted OR [95% CI], 3.38 [2.51-4.56] and 4.26 [2.82-6.42], respectively) and adjusted analysis (adjusted OR [95% CI], 2.76 [1.91-4.00] and 3.28 [1.95-5.52], respectively); significance remained after multiple imputation. In adjusted analyses, no risk of malnutrition was significantly associated with reduced odds of <95% adherence after multiple imputation (adjusted OR [95% CI], 0.714 [0.511-0.997]); no other factors were associated with <95% or <80% adherence. CONCLUSION These results suggest that implementation of PROs evaluating treatment satisfaction may provide value to adherence management in routine HIV care.
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Affiliation(s)
- Duncan Short
- ViiV Healthcare, Brentford, UK
- Correspondence: Duncan Short, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK, Tel +44 7827 282971, Email
| | | | | | | | | | | | - Heidi M Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | | | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | | | | | | | - William B Lober
- Center for AIDS Research, University of Washington, Seattle, WA, USA
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11
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Cramon PK, Bjorner JB, Groenvold M, Boesen VB, Bonnema SJ, Hegedüs L, Feldt-Rasmussen U, Rasmussen ÅK, Watt T. Implementation of thyroid-related patient-reported outcomes in routine clinical practice. Front Endocrinol (Lausanne) 2022; 13:1000682. [PMID: 36246917 PMCID: PMC9554589 DOI: 10.3389/fendo.2022.1000682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Patient-reported outcomes (PROs) are increasingly used in clinical practice to improve clinical care. Multiple studies show that systematic use of PROs can enhance communication with patients and improve patient satisfaction, symptom management and quality of life. Further, such data can be aggregated to examine health levels for patient groups, improve quality of care, and compare patient outcomes at the institutional, regional or national level. However, there are barriers and challenges that should be handled appropriately to achieve successful implementation of PROs in routine clinical practice. This paper briefly overviews thyroid-related PROs, describes unsolved quality of life issues in benign thyroid diseases, provides examples of routine collection of PROs, and summarizes key points facilitating successful implementation of thyroid-related PROs in routine clinical practice. Finally, the paper touches upon future directions of PRO research.
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Affiliation(s)
- Per Karkov Cramon
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- QualityMetric Incorporated, LLC, Johnston, RI, United States
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Victor Brun Boesen
- Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Torquil Watt
- Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Torquil Watt,
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