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Inceer M, Mayo N. Health-related quality of life measures provide information on the contributors, components, and consequences of frailty in HIV: a systematic mapping review. Qual Life Res 2024; 33:1735-1751. [PMID: 38462582 DOI: 10.1007/s11136-024-03613-3] [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] [Accepted: 01/23/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Frailty in HIV is extensively explored in epidemiological and clinical studies; it is infrequently assessed as an outcome in routine care. The focus on health-related quality of life (HRQL) measures in HIV presents a unique opportunity to understand frailty at a larger scale. The objective was to identify the extent to which generic and HIV-related HRQL measures capture information relevant to frailty. METHODS A systematic mapping review using directed and summative content analyses was conducted. An online search in PubMed/Medline identified publications on frailty indices and generic and HIV-related HRQL measures. Directed content analysis involved identifying contributors, components, and consequences of frailty from the frailty indices based on the International Classification of Functioning, Disability, and Health framework. Summative content analysis summarized the results numerically. RESULTS Electronic and hand search identified 447 review publications for frailty indices; nine reviews that included a total of 135 unique frailty indices. The search for generic and HIV-related HRQL measures identified 2008 records; five reviews that identified 35 HRQL measures (HIV-specific: 17; generic: 18). Of the 135 frailty indices, 88 cover more than one frailty dimension and 47 cover only physical frailty. Contributors to frailty, like sensory symptoms and nutrition, are extensively covered. Components of frailty such as physical capacity, cognitive ability, and mood are also extensively covered. Consequences of frailty namely self-rated health, falls, hospitalization, and health services utilization are incomprehensively covered. HRQL measures are informative for contributing factors, components of frailty, and a consequence of frailty. CONCLUSION HRQL items and measures show a strong potential to operationalize multidimensional frailty and physical frailty. The study suggests that these measures, connected to evidence-based interventions, could be pivotal in directing resources toward vulnerable populations to mitigate the onset of frailty.
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Affiliation(s)
- Mehmet Inceer
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada.
- Patient Centered Solutions, IQVIA, Montreal, QC, Canada.
| | - Nancy Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center (RI-MUHC), Montreal, QC, Canada
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2
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Bradley H, Zhu Y, Duan X, Kang H, Qu B. HIV-Specific Reported Outcome Measures: Systematic Review of Psychometric Properties. JMIR Public Health Surveill 2022; 8:e39015. [PMID: 36222289 PMCID: PMC9782451 DOI: 10.2196/39015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The management of people living with HIV and AIDS is multidimensional and complex. Using patient-reported outcome measures (PROMs) has been increasingly recognized to be the key factor for providing patient-centered health care to meet the lifelong needs of people living with HIV and AIDS from diagnosis to death. However, there is currently no consensus on a PROM recommended for health care providers and researchers to assess health outcomes in people living with HIV and AIDS. OBJECTIVE The purpose of this systematic review was to summarize and categorize the available validated HIV-specific PROMs in adults living with HIV and AIDS and to assess these PROMs using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. METHODS This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of 3 recommended databases (PubMed, Embase, and PsychINFO) was conducted on January 15, 2021. Studies were included if they assessed any psychometric property of HIV-specific PROMs in adults living with HIV and AIDS and met the eligibility criteria. The PROMs were assessed for 9 psychometric properties, evaluated in each included study following the COSMIN methodology by assessing the following: the methodological quality assessed using the COSMIN risk of bias checklist; overall rating of results; level of evidence assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation approach; and level of recommendation. RESULTS A total of 88 PROMs classified into 8 categories, assessing the psychometric properties of PROMs for adults living with HIV and AIDS, were identified in 152 studies including 79,213 people living with HIV and AIDS. The psychometric properties of most included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation were the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the Adult AIDS Clinical Trial Group, and People Living with HIV Resilience Scale. In addition, because of a lack of evidence, recommendations regarding use could not be made for most of the remaining assessed PROMs (received class B recommendation). CONCLUSIONS This systematic review recommends 3 PROMs to assess health outcomes in adults living with HIV and AIDS. However, all these PROMs have some shortcomings. In addition, most of the included PROMs do not have sufficient evidence for assessing their psychometric properties and require a more comprehensive validation of the psychometric properties in the future to provide more scientific evidence. Thus, our findings may provide a reference for the selection of high-quality HIV-specific PROMs by health care providers and researchers for clinical practice and research.
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Affiliation(s)
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Xiyu Duan
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Hao Kang
- Administration Department of Nosocomial Infection, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China.,School of Public Health, China Medical University, Shenyang, China
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3
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Nyongesa MK, Mwangi P, Wanjala SW, Mutua AM, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. Correlates of health-related quality of life among adults receiving combination antiretroviral therapy in coastal Kenya. Health Qual Life Outcomes 2020; 18:169. [PMID: 32503558 PMCID: PMC7275333 DOI: 10.1186/s12955-020-01421-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 05/24/2020] [Indexed: 12/26/2022] Open
Abstract
Background Health-related quality of life (HRQoL) is an important metric of perceived wellbeing in people living with HIV/AIDS (PLWHA). However, research on HRQoL among PLWHA in sub-Saharan Africa is limited. This study investigates factors associated with HRQoL among PLWHA in Kilifi, coast of Kenya. Methods Between February and April 2018, 450 adults living with HIV and on combined antiretroviral therapy (cART) between 18 to 60 years were sequentially recruited from an HIV-specialized clinic. The Functional Assessment of HIV Infection (FAHI) questionnaire, previously adapted for assessing HRQoL in this setting, was slightly modified and administered to participants alongside other measures of sociodemographic, health and treatment characteristics in a face-to-face interview. Results Linear regression analyses indicated that depressive symptoms, HIV-related stigma, non-disclosure of HIV status, living alone, clinic inaccessibility, and presence of any current opportunistic infection were significantly associated with lower HRQoL scores at both the FAHI overall and sub-scale level. Higher physician empathy, male sex, and higher body mass index were significantly associated with better HRQoL scores at both FAHI overall and sub-scale level. Age and longer duration on cART were significantly associated with better HRQoL only at the sub-scale level. Conclusions Interventions aimed at reducing depressive symptoms and HIV stigma, making HIV-related services more accessible, addressing opportunistic infections, strengthening social support systems, serostatus disclosure and put in place caring, respectful, and compassionate model of care are necessary to improve the HRQoL of PLWHA.
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Affiliation(s)
- Moses K Nyongesa
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya. .,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Paul Mwangi
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | | | - Agnes M Mutua
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Hans M Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK.,Institute for Human Development, Aga Khan University, Nairobi, Kenya
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4
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Abstract
Posttraumatic growth after a diagnosis of HIV is positively associated with adjustment, yet stigma and disclosure regret are negatively associated with adjustment. Research into whether posttraumatic growth is experienced while perceiving stigma and disclosure regret is still growing. This study aimed to determine whether posttraumatic growth maintains a positive relation with life satisfaction after controlling for disclosure regret and perceived stigma. Using a cross-sectional design, a questionnaire measuring life satisfaction, health status, depression, posttraumatic growth, disease severity, perceived stigma, disclosure regret, and demographical information was completed by 73 people living with HIV (PLWH). Results showed that all participants had disclosed to at least one person. Regression results showed that after controlling for other variables, including stigma and disclosure regret, posttraumatic growth was positively associated with life satisfaction. The importance of the relation of posttraumatic growth with subjective measures of adjustment may be important for interventions aimed at supporting PLWH.
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Affiliation(s)
- Bridget Dibb
- School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
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5
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Kuloor A, Kumari S, Metri K. Impact of yoga on psychopathologies and quality of life in persons with HIV: A randomized controlled study. J Bodyw Mov Ther 2018; 23:278-283. [PMID: 31103108 DOI: 10.1016/j.jbmt.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 03/12/2018] [Accepted: 07/28/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Evidence suggests that individuals with human immunodeficiency virus (HIV) often exhibit poor physical and mental health, which contributes to a reduced Quality of Life (QoL). Yoga is a form of alternative therapy that has positive influences on general health and QoL. OBJECTIVES This study examined the effects of yoga on i) anxiety, depression, and psychological well-being and ii) QoL among individuals with an HIV positive status. METHODOLOGY Sixty individuals with HIV-positive (aged 30-50 years) from rehabilitation centres across Bangalore were randomly assigned to the yoga intervention group (n = 30; 11 men) or the wait-listed control group (n = 30; 10 men). Participants in the yoga group underwent 8 weeks of intense yoga practice performed an hour a day for 5 days a week. The yoga practice consisted of physical postures, breathing practices, relaxation techniques, and meditation. Participants in the wait-listed control group followed their normal routine. Anxiety, fatigue, depression, and QoL were assessed twice for all subjects in each group - once at the start of the study to establish a baseline and once more at the end of the 2-month study period to assess any changes. Data analysis was performed on the assessments using SPSS software version 10. RESULTS Between group analysis demonstrated that a significantly different reduction in anxiety (p < 0.001), depression (p < 0.001), and fatigue (p < 0.001) was observed in the yoga group compared to the control group, as well as significant improvements in well-being (p < 0.001) and all domains of QoL (p < 0.001) in the yoga group compared to the control group. CONCLUSION This study indicates that yoga intervention appears to improve the psychological health and QoL of individuals who are HIV-positive. Therefore, based on these findings, yoga may be recommended as a complementary therapy to enhance conventional HIV care.
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Affiliation(s)
- Asha Kuloor
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA - deemed to be a University), #1 Eknath Bhavan Gavipuram Circle K G Nagar, Bengaluru, 560019, India
| | - Sony Kumari
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA - deemed to be a University), #1 Eknath Bhavan Gavipuram Circle K G Nagar, Bengaluru, 560019, India
| | - Kashinath Metri
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA - deemed to be a University), #1 Eknath Bhavan Gavipuram Circle K G Nagar, Bengaluru, 560019, India.
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6
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Elafros MA, Birbeck GL, Gardiner JC, Siddiqi OK, Sikazwe I, Paneth N, Bositis CM, Okulicz JF. Patient-Reported Adverse Effects Associated with Combination Antiretroviral Therapy and Coadministered Enzyme-Inducing Antiepileptic Drugs. Am J Trop Med Hyg 2017; 96:1505-1511. [PMID: 28719255 DOI: 10.4269/ajtmh.16-0107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AbstractConcurrent treatment with combination antiretroviral therapy (cART) and an enzyme-inducing antiepileptic drug (EI-AED) is common in resource-limited settings; however, the incidence and impact of adverse effects in cotreated patients is largely unknown. Symptoms of adverse effects were assessed by both spontaneous report and checklist for 145 human immunodeficiency virus (HIV)-infected Zambian adults initiating various treatment combinations, such as cART with an EI-AED (N = 20), cART only (N = 43), or neither drug (untreated; N = 82). At study baseline, the cART + EI-AED group reported more headache, generalized fatigue, problems with concentration, and depression than the untreated group (P < 0.01 for all). At 2 weeks, a greater proportion of cART + EI-AED participants reported increased nausea or vomiting compared with baseline (P < 0.05). Adverse effects did not appear to impact self-reported adherence at 2 weeks as 100% cART adherence was reported in 19 of 20 (95%) and 42 of 43 (98%) cART + EI-AED and cART-only participants, respectively; 100% EI-AED adherence was reported in 19 of 20 (95%) participants. However, adherence at 6 months was suboptimal in both groups with 18 of 33 (56%) participants on cART experiencing greater than 1-week lapse in pharmacy-reported medication supply. Our results highlight the need to educate patients about the increased potential for nausea and vomiting with cART + EI-AED cotreatment. Although adherence was high early during treatment, adherence should be reinforced overtime to minimize the potential for HIV and/or epilepsy treatment failure.
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Affiliation(s)
- Melissa A Elafros
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Gretchen L Birbeck
- Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.,Department of Neurology, University of Rochester, Rochester, New York
| | - Joseph C Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Omar K Siddiqi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Global Neurology Program, Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | | | - Jason F Okulicz
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
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7
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Nyongesa MK, Sigilai A, Hassan AS, Thoya J, Odhiambo R, Van de Vijver FJR, Newton CRJC, Abubakar A. A mixed methods approach to adapting and evaluating the functional assessment of HIV infection (FAHI), Swahili version, for use with low literacy populations. PLoS One 2017; 12:e0175021. [PMID: 28380073 PMCID: PMC5381886 DOI: 10.1371/journal.pone.0175021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/17/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite bearing the largest HIV-related burden, little is known of the Health-Related Quality of Life (HRQoL) among people living with HIV in sub-Saharan Africa. One of the factors contributing to this gap in knowledge is the lack of culturally adapted and validated measures of HRQoL that are relevant for this setting. AIMS We set out to adapt the Functional Assessment of HIV Infection (FAHI) Questionnaire, an HIV-specific measure of HRQoL, and evaluate its internal consistency and validity. METHODS The three phase mixed-methods study took place in a rural setting at the Kenyan Coast. Phase one involved a scoping review to describe the evidence base of the reliability and validity of FAHI as well as the geographical contexts in which it has been administered. Phase two involved in-depth interviews (n = 38) to explore the content validity, and initial piloting for face validation of the adapted FAHI. Phase three was quantitative (n = 103) and evaluated the internal consistency, convergent and construct validities of the adapted interviewer-administered questionnaire. RESULTS In the first phase of the study, we identified 16 studies that have used the FAHI. Most (82%) were conducted in North America. Only seven (44%) of the reviewed studies reported on the psychometric properties of the FAHI. In the second phase, most of the participants (37 out of 38) reported satisfaction with word clarity and content coverage whereas 34 (89%) reported satisfaction with relevance of the items, confirming the face validity of the adapted questionnaire during initial piloting. Our participants indicated that HIV impacted on their physical, functional, emotional, and social wellbeing. Their responses overlapped with items in four of the five subscales of the FAHI Questionnaire establishing its content validity. In the third phase, the internal consistency of the scale was found to be satisfactory with subscale Cronbach's α ranging from 0.55 to 0.78. The construct and convergent validity of the tool were supported by acceptable factor loadings for most of the items on the respective sub-scales and confirmation of expected significant correlations of the FAHI subscale scores with scores of a measure of common mental disorders. CONCLUSION The adapted interviewer-administered Swahili version of FAHI questionnaire showed initial strong evidence of good psychometric properties with satisfactory internal consistency and acceptable validity (content, face, and convergent validity). It gives impetus for further validation work, especially construct validity, in similar settings before it can be used for research and clinical purposes in the entire East African region.
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Affiliation(s)
- Moses K. Nyongesa
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
- Pwani University, Kilifi, Kenya
- * E-mail:
| | - Antipa Sigilai
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
- Pwani University, Kilifi, Kenya
| | - Amin S. Hassan
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Janet Thoya
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Rachael Odhiambo
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Fons J. R. Van de Vijver
- Tilburg University, Tilburg, Netherlands
- North-West University, Potchefstroom, South Africa
- University of Queensland, Brisbane, Australia
| | - Charles R. J. C. Newton
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
- University of Oxford, Oxford, United Kingdom
| | - Amina Abubakar
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
- Pwani University, Kilifi, Kenya
- University of Oxford, Oxford, United Kingdom
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8
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Das A, Detels R, Afifi AA, Javanbakht M, Sorvillo F, Panda S. Formation and psychometric evaluation of a health-related quality of life instrument for children living with HIV in India. J Health Psychol 2016; 23:577-587. [PMID: 27703079 DOI: 10.1177/1359105316671022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In-depth interviews and focus group discussions were conducted to inform the development of an instrument to measure the health-related quality of life of children living with HIV. The QOL-CHAI instrument consists of four generic core scales of the "Pediatric Quality of Life Inventory" and two HIV-targeted scales-"symptoms" and "discrimination." A piloting exercise involving groups of children living with HIV and HIV-negative children born to HIV-infected parents provided evidence for the acceptable psychometric properties and usability of the instrument. It is expected that the QOL-CHAI can serve well as a brief, standardized, and culturally appropriate instrument for assessing health-related quality of life of Indian children living with HIV.
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Affiliation(s)
- Aritra Das
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Roger Detels
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Abdelmonem A Afifi
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Marjan Javanbakht
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Frank Sorvillo
- 1 Fielding School of Public Health, University of California, Los Angeles, USA
| | - Samiran Panda
- 2 National Institute of Cholera and Enteric Diseases, India
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9
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Brandt CP, Jardin C, Sharp C, Lemaire C, Zvolensky MJ. Main and interactive effects of emotion dysregulation and HIV symptom severity on quality of life among persons living with HIV/AIDS. AIDS Care 2016; 29:498-506. [PMID: 27546879 DOI: 10.1080/09540121.2016.1220484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
HIV symptoms are associated with a poorer quality of life (QOL) among persons living with HIV/AIDS (PLWHA). Yet, there is little understanding of emotional factors that impact the relation between HIV symptom severity and QOL. The present study examined the main and interactive effects of emotion dysregulation and HIV symptom severity on multiple indices of QOL, including physical (impact of physical problems related to HIV), psychological (frequency of negative feelings), independence (necessity of medical treatment to function in daily life), social (feelings of acceptance), environmental (satisfaction with living conditions and medical care), and spiritual (fear of the future and death) among a sample of 74 PLWHA. Participants (72.9% male; mean age = 48.24, SD = 7.85) were recruited from AIDS Service Organizations in the United States. Results indicated that higher HIV symptom severity is significantly associated with lower physical and independence QOL, whereas higher emotion dysregulation is significantly associated with lower scores on all measured aspects of QOL. Additionally, results indicated that the interaction of emotion dysregulation and HIV symptom severity was significantly associated with both physical and environmental QOL. The form of the observed significant interactions indicated that HIV symptom severity was related to poorer QOL among those with lower (versus higher) emotion dysregulation. The present findings indicate that emotion dysregulation is related to QOL among PLWHA and may interact with HIV symptom severity to negatively impact certain aspects of QOL. Given the profound impact that HIV has on QOL, this finding is important in understanding these relations mechanistically, and may be important in the development of novel psychological treatment strategies.
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Affiliation(s)
- Charles P Brandt
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Charles Jardin
- b Department of Behavioral Health , Legacy Community Health Services , Houston , TX , USA
| | - Carla Sharp
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Chad Lemaire
- b Department of Behavioral Health , Legacy Community Health Services , Houston , TX , USA
| | - Michael J Zvolensky
- a Department of Psychology , University of Houston , Houston , TX , USA.,c Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , TX , USA
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10
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Abstract
The structure of health-related quality of life (HRQOL) in HIV disease is examined in 205 symptomatic HIV+ individuals receiving care at two West Coast public hospitals. A 64-item HRQOL battery, tapping aspects of HRQOL of particular relevance to individuals with HIV disease, was administered and found to yield reliable self-report data. Confirmatory factor analysis provides support for a two-factor model of HRQOL: (a) a physical health dimension defined by physical function, role function, freedom from pain, disability days, and quality of sex life, and (b) a mental health dimension defined by overall quality of life, emotional well-being, hopefulness, lack of loneliness, will to function, quality of family life, quality of friendships, and cognitive function/distress. Correlations of HRQOL measures with social support, access to care, coping, and symptom measures are reported and discussed.
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Affiliation(s)
- Ron D. Hays
- RAND Social Policy Department and UCLA Department of Medicine,
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11
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Phillips KD, Sowell RL, Rojas M, Tavakoli A, Fulk LJ, Hand GA. Physiological and Psychological Correlates of Fatigue in HIV Disease. Biol Res Nurs 2016; 6:59-74. [PMID: 15186708 DOI: 10.1177/1099800404264846] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson’s r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.
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Affiliation(s)
- Kenneth D Phillips
- College of Nursing, University of South Carolina, 1601 Green Street, Columbia, SC 29208, USA.
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12
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Robbins JL, Phillips KD, Dudgeon WD, Hand GA. Physiological and Psychological Correlates of Sleep in HIV Infection. Clin Nurs Res 2016; 13:33-52. [PMID: 14768766 DOI: 10.1177/1054773803259655] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Insomnia, a common problem associated with HIV disease, is most likely caused by a multitude of factors. This study investigated the correlations between a selected group of physiological and psychological factors and sleep quality in an HIV-infected population. A convenience sample of 79 ethnically diverse HIV-positive adults, ages 24 to 63, completed a number of questionnaires and released their laboratory records for CD4+ cell count and viral load information. Variables significantly related to sleep quality were HIV-related symptoms, total pain, fatigue, depression, state anxiety, and the number of adults in the household. Findings support the need for health care providers to consider factors that contribute to impaired sleep when developing effective care for HIV-infected individuals with sleep disturbance.
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Affiliation(s)
- Jennifer L Robbins
- School of Public Health, Department of Exercise Science, University of South Carolina, USA
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13
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Larson JS. Introduction to the Special Issue. Eval Health Prof 2016. [DOI: 10.1177/016327879702000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Namisango E, Powell RA, Atuhaire L, Katabira ET, Mwangi-Powell F, Harding R. Is Symptom Burden Associated with Treatment Status and Disease Stage among Adult HIV Outpatients in East Africa? J Palliat Med 2014; 17:304-12. [DOI: 10.1089/jpm.2013.0291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | | | - Leonard Atuhaire
- School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | | | | | - Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
- School of Medicine at Guy's, King's & St. Thomas Hospitals, London, London, United Kingdom
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O'Brien KK, Davis AM, Gardner S, Bayoumi AM, Rueda S, Hart TA, Cooper C, Solomon P, Rourke SB, Hanna S. Relationships between dimensions of disability experienced by adults living with HIV: a structural equation model analysis. AIDS Behav 2014; 18:357-67. [PMID: 23132208 DOI: 10.1007/s10461-012-0363-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
As individuals age with HIV it is increasingly important to consider the health-related consequences of HIV and multiple morbidities, known as disability. We assessed relationships between four dimensions of disability among adults living with HIV. We conducted a structural equation modeling analysis using data from 913 participants in the Ontario HIV Treatment Network Cohort Study to determine relationships between four latent variables of disability in the Episodic Disability Framework: physical symptoms and impairments, mental health symptoms and impairments, difficulties with day-to-day activities, and challenges to social inclusion. Results indicated that physical symptoms and impairments, mental health symptoms and impairments and difficulties with day-to-day activities directly or indirectly predicted challenges to social inclusion for adults living with HIV. Challenges to social inclusion were directly predicted by mental health symptoms and indirectly by physical health symptoms via (mediated by) having difficulties carrying out day-to-day activities and mental health symptoms and impairments. These findings provide a basis for conceptualizing disability experienced by people living with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, M5G 1V7, ON, Canada,
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Gentry S, van‐Velthoven MHMMT, Tudor Car L, Car J. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. Cochrane Database Syst Rev 2013; 2013:CD009189. [PMID: 23728687 PMCID: PMC6485935 DOI: 10.1002/14651858.cd009189.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV. OBJECTIVES To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. SEARCH METHODS We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the mode of communication, and whether underlying factors for change were altered. Meta-analyses, each of three studies, were performed for medication adherence and depressive symptoms. A narrative synthesis is presented for all other outcomes due to study heterogeneity. MAIN RESULTS Out of 14 717 citations, 11 RCTs met the inclusion criteria (1381 participants).Six studies addressed outcomes relating to medication adherence, and there was some evidence from two studies that telephone interventions can improve adherence. A meta-analysis of three studies for which there was sufficient data showed no significant benefit (SMD 0.49, 95% CI -1.12 to 2.11). There was some evidence from a study of young substance abusing HIV positive persons of the efficacy of telephone interventions for reducing risky sexual behaviour, while a trial of older persons found no benefit. Three RCTs addressed virologic outcomes, and there is very little evidence that telephone interventions improved virologic outcomes. Five RCTs addressed outcomes relating to depressive and psychiatric symptoms, and showed some evidence that telephone interventions can be of benefit. Three of these studies which focussed on depressive symptoms were combined in a meta-analysis, which showed no significant benefit (SMD 0.02, 95% CI -0.18 to 0.21 95% CI). AUTHORS' CONCLUSIONS Telephone voice interventions may have a role in improving medication adherence, reducing risky sexual behaviour, and reducing depressive and psychiatric symptoms, but current evidence is sparse, and further research is needed.
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Affiliation(s)
- Sarah Gentry
- Peninsula College of Medicine and DentistryExeterUK
| | - Michelle HMMT van‐Velthoven
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt. Dunstans RoadHammersmithLondonUKW6 8RP
| | | | - Josip Car
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt. Dunstans RoadHammersmithLondonUKW6 8RP
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Gakhar H, Kamali A, Holodniy M. Health-related quality of life assessment after antiretroviral therapy: a review of the literature. Drugs 2013; 73:651-72. [PMID: 23591907 PMCID: PMC4448913 DOI: 10.1007/s40265-013-0040-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antiretroviral (ARV) treatment for HIV infection has resulted in significant improvement in immunologic and virologic parameters, as well as a reduction in AIDS-defining illnesses and death. Over 25 medications are approved for use, usually in combination regimens of three or four ARVs. Several ARVs are now available as combinatorial products, which have been associated with better adherence. However, while ARV therapy has prolonged life, ARVs also pose a challenge for quality of life as they can cause significant side effects in addition to the potential for drug toxicity and interaction. Given the many complications, side effects and symptoms of HIV/AIDS in addition to associated medical and psychiatric co-morbidities, the need to understand and assess how these interactions may affect health-related quality of life (HRQOL) has grown. Numerous instruments (some validated, others not) are available and have been applied to understanding how ARV treatment affects HRQOL in those with HIV infection, both in clinical trials and clinical practice. In general, ARV treatment improves HRQOL, but this is dependent on the population being studied, the HRQOL instrument being used and the timeframe during which HRQOL has been studied. This article provides a review of the literature on quality of-life assessment as it relates to ARV treatment in developed countries and briefly reviews the HRQOL instruments used, how they have been applied to ARV utilization, and where future research should be applied in HRQOL assessment and HIV infection.
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Affiliation(s)
- Harleen Gakhar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Amanda Kamali
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark Holodniy
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA. VA Palo Alto Health Care System, 3801 Miranda Ave. (132), Palo Alto, CA 94304, USA
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Anand D, Puri S, Mathew M. Assessment of Quality of Life of HIV-Positive People Receiving ART: An Indian Perspective. Indian J Community Med 2012; 37:165-9. [PMID: 23112442 PMCID: PMC3483509 DOI: 10.4103/0970-0218.99918] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 02/03/2012] [Indexed: 11/29/2022] Open
Abstract
Context: HIV/AIDS is known to affect an individual not only physically but also mentally, socially, and financially. It is a syndrome that builds a vacuum in a person affecting his/her life as a whole. Aims: The purpose of the present study is to evaluate the quality of life (QOL) of people living with HIV/AIDS (PLHIV) receiving ART and its association with Body mass index (BMI) and CD4 count. Study Design: An observational study was performed on PLHIV receiving ART in Orissa, India. Materials and Methods: Data on sociodemographic profile, BMI, and CD4 were gathered from 153 HIV-positive subjects. QOL was assessed using WHOQOL-HIV BREF scale. Results: The overall QOL score of the subjects was moderate; PLHIV with lower BMI also had poorer QOL (P<0.05). Employment affected only the social health domain of the subjects. Men reported poorer level of independence and physical health while women reported poorer social relationships and environment. All the six domains correlated significantly with the overall QOL indicated by the G-facet. Conclusion: Attention toward improving the nutritional status of PLHIV should be accorded high priority to ensure improvement in the overall QOL of PLHIV.
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Affiliation(s)
- Deepika Anand
- Department of Food and Nutrition, Institute of Home Economics, University of Delhi, New Delhi, India
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19
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Edelman EJ, Gordon K, Rodriguez-Barradas MC, Justice, for the VACS Project Team AC. Patient-reported symptoms on the antiretroviral regimen efavirenz/emtricitabine/tenofovir. AIDS Patient Care STDS 2012; 26:312-9. [PMID: 22612469 DOI: 10.1089/apc.2012.0044] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Most patients (80-90%) newly diagnosed with HIV are started on the antiretroviral regimen efavirenz, emtricitabine, and tenofovir (EFV/FTC/TDF). Existing studies of patient tolerability, however, are limited. We compared symptom experiences of patients on EFV/FTC/TDF, and the subsequent impact on health-related quality of life, with those of patients on other combination antiretroviral therapy (cART). We conducted a cross-sectional analysis of the Veterans Aging Cohort Study from February 2008 to August 2009 to compare the symptom experiences of patients on EFV/FTC/TDF vs. other cART, unadjusted and then adjusted for treatment characteristics, and comorbid disease severity. We then assessed the association between EFV/FTC/TDF use and health-related quality of life. Among the 1,759 patients in our analytic sample, EFV/FTC/TDF use was associated with fewer symptoms than was other cART. The use of EFV/FTC/TDF was independently associated with health-related quality of life, and this association was at least partially explained by symptom burden.
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Affiliation(s)
- E. Jennifer Edelman
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kirsha Gordon
- Section of General Internal Medicine, Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Maria C. Rodriguez-Barradas
- Section of Infectious Diseases, Department of Medicine, Michael E. De Bakey VAMC and Baylor College of Medicine, Houston, Texas
| | - Amy C. Justice, for the VACS Project Team
- Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
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20
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Abstract
The objective of this article is to psychometrically validate the HIV symptom distress scale (SDS), an instrument that can be used to measure overall HIV symptom distress or clinically relevant groups of HIV symptoms. A secondary data analysis was conducted using the Collaborations in HIV Outcomes Research US Cohort (CHORUS). Inclusion criteria required study participants (N=5521) to have a valid baseline measure of the AIDS Clinical Trial Group Symptom Distress Module, with an SF-12 or SF-36 completed on the same day. Psychometric testing assessed unidimensionality, internal consistency, and factor structure using exploratory and confirmatory factor analysis, and structural equation modeling (SEM). Construct validity examined whether the new measure discriminates across clinical significance (CD4 and HIV viral load). Findings show that the SDS has high reliability (α=0.92), and SEM supports a correlated second-order factor model (physical and mental distress) with acceptable fit (GFI=0.88, AGFI=0.85, NFI=0.99, NNFI=0.99; RMSEA=0.06, [90% CI 0.06 - 0.06]; Satorra Bentler scaled, C (2) =3274.20; p=0.0). Construct validity shows significant differences across categories for HIV-1 viral load (p<0.001) and CD4 (p<0.001). Differences in mean SDS scores exist across gender (p<0.001), race/ethnicity (p<0.05), and educational attainment (p<0.001). Hence, the HIV SDS is a reliable and valid instrument, which measures overall HIV symptoms or clinically relevant groups of symptoms.
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Affiliation(s)
- Linda G Marc
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
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21
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신승배. A Study on Health related Quality of Life in People Living with HIV/AIDS in Korea. ACTA ACUST UNITED AC 2011. [DOI: 10.15709/hswr.2011.31.4.424] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Low Y, Preud'homme X, Goforth HW, Omonuwa T, Krystal AD. The association of fatigue with depression and insomnia in HIV-seropositive patients: a pilot study. Sleep 2011; 34:1723-6. [PMID: 22131611 DOI: 10.5665/sleep.1446] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Fatigue is a pervasive symptom associated with HIV, resulting in significant functioning impairment; but little is known about its etiology or treatment. In patients with primary insomnia, data have shown improvement in fatigue following successful treatment of insomnia. However, little is known about the role of insomnia in patients with fatigue in HIV. This manuscript seeks to test the hypothesis that insomnia severity is correlated with increased fatigue in HIV-seropositive patients. METHODS Fifty-seven ambulatory HIV-seropositive patients, aged 18-60 years, with a DSM-IV-TR diagnosis of insomnia, were administered the Insomnia Severity Index (ISI), Piper Fatigue Scale (PFS), Hospital Anxiety and Depression scale, and Hamilton Depression Rating Scale (HAM-D). Their most recent CD4 count and time since diagnosis of HIV were recorded. Regression analysis was carried out with PFS as the dependent variable. RESULTS A higher ISI score correlated with higher PFS score, (R2 = 0.1713, P = 0.0042). Overall depression severity was not significantly correlated with PFS score, except in the most severely depressed subgroup, in which the HADS depression score was the strongest predictor of PFS (R2 = 0.182, P = 0.0009). In participants without depression, ISI accounted for most of the variance in fatigue (R2 = 0.6035, P = 0.0011). CONCLUSIONS Greater insomnia severity is associated with greater fatigue severity in HIV seropositive patients. Depression may contribute to both fatigue and insomnia. In the absence of depression, the treatment of insomnia may emerge as a treatment strategy to help alleviate fatigue. Further studies are needed to confirm these data. CLINICAL TRIAL INFORMATION Clinical Trials.Gov: The Treatment of Insomnia in Patients with HIV Disease. Registry Number: NCT00465972. URL: http://www.clinicaltrials.gov/ct2/show/NCT00465972?term = HIV+insomnia&rank = 1.
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Affiliation(s)
- Yinghui Low
- Duke-National University of Singapore School of Medicine
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23
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Troeman ZCE, Spies G, Cherner M, Archibald SL, Fennema-Notestine C, Theilmann RJ, Spottiswoode B, Stein DJ, Seedat S. Impact of childhood trauma on functionality and quality of life in HIV-infected women. Health Qual Life Outcomes 2011; 9:84. [PMID: 21958030 PMCID: PMC3198878 DOI: 10.1186/1477-7525-9-84] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV. METHODS The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL) by evaluating 85 HIV-positive (48 with childhood trauma and 37 without) and 52 HIV-negative (21 with childhood trauma and 31 without) South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Patient's Assessment of Own Functioning Inventory (PAOFI), the Activities of Daily Living (ADL) scale and the Sheehan Disability Scale (SDS). Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Childhood Trauma Questionnaire (CTQ). RESULTS Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA) demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count. CONCLUSIONS In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.
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Affiliation(s)
- Zyrhea C E Troeman
- South African Research Chairs Initiative (SARChI), PTSD program, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
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Schifitto G, Deng L, Yeh TM, Evans SR, Ernst T, Zhong J, Clifford D. Clinical, laboratory, and neuroimaging characteristics of fatigue in HIV-infected individuals. J Neurovirol 2010; 17:17-25. [PMID: 21181521 DOI: 10.1007/s13365-010-0010-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/09/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
Fatigue is among the most common symptoms reported by HIV-infected individuals. Previous reports suggest that the prevalence of fatigue varies by disease status with rates close to 80% in patients with AIDS. However, most studies have not been conducted in the setting of a controlled trial and have not assessed the association of fatigue with cellular markers of brain activity. Data for this study were derived from baseline and longitudinal evaluations in ACTG A5090, a randomized, double-blind, placebo-controlled trial of the Selegiline Transdermal System for the treatment of HIV-associated cognitive impairment. Fatigue was assessed using the Fatigue Severity Scale with scores of >4 considered "fatigued". Participants in a substudy underwent brain magnetic resonance spectroscopy (MRS) imaging, an in vivo method for assessing brain metabolites associated with neuronal and glia activity. Differences between fatigued and non-fatigued participants were evaluated with respect to demographics and clinical characteristics, plasma and CSF HIV-1 RNA concentration, CD4 counts, and brain metabolites. One hundred and twenty-eight participants were enrolled (88% male, median age = 45 years) and 82 participants (64%, 95% confidence interval 55%, 72%) were fatigued at baseline. MRS was conducted in 62 of the 128 participants. Fatigued participants were significantly younger (p = 0.011), had lower Karnofsky scores (p = 0.032), and had higher levels of depressive symptoms on the Center for Epidemiologic Studies Depression (CES-D) scale (p < 0.001) than non-fatigued participants. Statistically significant differences between fatigued and non-fatigued groups were not detected for plasma and CSF HIV-1RNA concentration, CD4 counts, or on neuropsychological tests. MRS revealed significantly lower levels of the cellular energy marker total creatine (p = 0.002) in the basal ganglia of fatigued participants. Statistically significant differences in other brain metabolites were not detected. Longitudinal data showed that fatigue persisted and worse fatigue at baseline was predictor of future fatigue. Among the cognitive tests, baseline Stroop score was associated with future fatigue. Fatigue was present in 64% of A5090 study participants and persisted during the 24 weeks of follow-up. Fatigue was associated with worse functional performance and depressive mood. Lower cellular energy levels in the basal ganglia, as measured by MRS total creatine concentration, suggest energy dysmetabolism in this brain region. This observation, taken together with the association between fatigue and neuropsychological tests of frontal lobe performance is consistent with the hypothesis of a striatal-cortical circuitry involvement in the symptoms of fatigue.
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O'Brien KK, Bayoumi AM, Strike C, Young NL, King K, Davis AM. How do existing HIV-specific instruments measure up? Evaluating the ability of instruments to describe disability experienced by adults living with HIV. Health Qual Life Outcomes 2010; 8:88. [PMID: 20723244 PMCID: PMC2936441 DOI: 10.1186/1477-7525-8-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 08/19/2010] [Indexed: 11/10/2022] Open
Abstract
Background Despite the multitude of health challenges faced by adults living with HIV, we know of no HIV-specific instrument developed for the purpose of describing the health-related consequences of HIV, a concept known as disability. In a previous phase of research, adults living with HIV conceptualized disability as symptoms/impairments, difficulties carrying out day-to-day activities, challenges to social inclusion, and uncertainty that may fluctuate on a daily basis and over the course of living with HIV. In this paper, we describe the extent to which existing HIV-specific health-status instruments capture the experience of disability for adults living with HIV. Methods We searched databases from 1980 to 2006 for English language, HIV-specific, self-reported questionnaires consisting of at least two items that were tested for reliability and validity. We then conducted a content analysis to assess how well existing questionnaires describe disability as defined by the Episodic Disability Framework, a framework that conceptualizes this experience from the perspective of adults living with HIV. We matched items of the instruments with categories of the framework to evaluate the extent to which the instruments capture major dimensions of disability in the framework. Results We reviewed 4274 abstracts, of which 30 instruments met the inclusion criteria and were retrieved. Of the four major dimensions of disability, symptoms/impairments were included in all 30 instruments, difficulties with day-to-day activities in 16, challenges to social inclusion in 16, and uncertainty in 9. Seven instruments contained at least 1 item from all 4 dimensions of disability (breadth) however, the comprehensiveness with which the dimensions were represented (depth) varied among the instruments. Conclusions In general, symptoms/impairments and difficulties carrying out day-to-day activities were the disability dimensions characterized in greatest depth while uncertainty and challenges to social inclusion were less well represented. Although none of the instruments described the full breadth and depth of disability as conceptualized by the Episodic Disability Framework, they provide a foundation from which to build a measure of disability for adults living with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Scoping the field: identifying key research priorities in HIV and rehabilitation. AIDS Behav 2010; 14:448-58. [PMID: 19277858 DOI: 10.1007/s10461-009-9528-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
Abstract
The purpose of this project was to identify key research priorities related to HIV and rehabilitation. We conducted a scoping study which included a literature review of published and grey literature, followed by focus group and interview consultations with 28 participants including people living with HIV, researchers, educators, clinicians, and policy makers with expertise in HIV and rehabilitation. Qualitative content analysis was used to identify emergent themes related to research priorities in HIV and rehabilitation. The resulting Framework of HIV and Rehabilitation Research provided an outline for approaching research in the field. The framework included three overlapping research priorities: (a) living with HIV across the lifespan, (b) disability, and (c) rehabilitation that should be viewed through environmental and/or personal contextual lenses, using different methodological approaches. Six key research priorities from this framework were identified through additional consultation with new and returning participants including: (1) disability and episodic disability, (2) concurrent health conditions aging with HIV, (3) HIV and the brain, (4) labour force and income support, (5) access to and effectiveness of rehabilitation, and (6) development and evaluation of outcome measurement tools. These priorities inform a future plan for HIV and rehabilitation research that will increase our knowledge to enhance practice, programming and policy for people living with HIV.
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Garvie PA, Lawford J, Banet MS, West RL. Quality of life measurement in paediatric and adolescent populations with HIV: a review of the literature. Child Care Health Dev 2009; 35:440-53. [PMID: 19638021 DOI: 10.1111/j.1365-2214.2009.00985.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the quality and utility of currently available self-report generic quality of life (QOL) and health-related quality of life (HRQOL) measures for use with children and adolescents with human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS). METHODS Literature searches were conducted to identify QOL and HRQOL measures developed for, adapted for, or otherwise used with paediatric and adolescent populations with HIV/AIDS. The quality of measures (i.e. item generation techniques, instrument properties including reliability, validity and responsiveness) were compared and critically evaluated. RESULTS Nineteen QOL/HRQOL measures were identified. Item content was generated from the respondent (adult) population in only eight (42%) measures. Seventeen (90%) measures reported internal reliability in the accepted range between 0.70 and 0.90 and four (21%) reported reproducibility statistics in this range. Although validity was reported for 19 (100%) measures, only six (32%) showed evidence for three or more properties, with construct validity being the most commonly reported aspect. The authors of eight (42%) measures reported evidence for responsiveness. CONCLUSIONS While almost all measures reviewed demonstrated adequate psychometric properties, only one-third demonstrated all aspects of validity, and less than half demonstrated responsiveness. None included paediatric or adolescent populations with HIV/AIDS in their development, neglecting to obtain input from target respondents in item generation to determine what health-related and daily functioning factors are of importance to them. Despite noted limitations, the AUQUEI or the SWED-QUAL appear the best currently available generic measure, and the MQOL-HIV the preferred disease-specific measure, at least for use with older adolescents/young adults.
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Affiliation(s)
- P A Garvie
- The Division of Behavioral Medicine, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 740, Memphis, TN 38105-3678, USA.
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Arnold SV, Spertus JA, Jones PG, Xiao L, Cohen DJ. The impact of dyspnea on health-related quality of life in patients with coronary artery disease: results from the PREMIER registry. Am Heart J 2009; 157:1042-9.e1. [PMID: 19464415 DOI: 10.1016/j.ahj.2009.03.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Both angina and dyspnea are prevalent symptoms among post-myocardial infarction (MI) patients. Given their frequent overlap, little is known about the degree to which these symptoms provide independent information in this population. METHODS Using the multicenter Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER), 1,835 patients were administered the Rose Dyspnea Scale (scores range 0-4; higher scores indicate worse dyspnea), Seattle Angina Questionnaire (SAQ; lower scores indicate worse angina), and 12-item Short Form physical component (PCS; lower scores indicate worse physical health status) at 1 and 12 months post-MI. Multivariable regression was used to examine the association between dyspnea and quality of life (QOL) in both cross-sectional and longitudinal analyses as well as its association with rehospitalizations and mortality. RESULTS At 1-month follow-up, 863 patients (47%) reported dyspnea, and 340 (19%) noted moderate to severe dyspnea. After adjusting for sociodemographic and clinical factors including SAQ angina frequency, higher dyspnea scores remained strongly associated with worse QOL in both cross-sectional (1-U dyspnea increase = 2.5-point PCS decrease and 2.4-point SAQ QOL decrease) and longitudinal analyses (1-U dyspnea increase from 1 month to 1 year = 3.8-point PCS decrease and 3.5-point SAQ QOL decrease), and with increased risk of 1-year rehospitalization (hazard ratio 1.15/1 U of dyspnea, 95% CI 1.07-1.24) and 3-year mortality (hazard ratio 1.34/1 U of dyspnea, 95% CI 1.19-1.51; P < .001 for all analyses). CONCLUSIONS Among post-MI patients, dyspnea is common and strongly associated with impaired QOL, more frequent rehospitalization, and reduced survival--independent of both clinical factors and angina. These findings suggest that dyspnea is an important component of disease-specific health status for post-MI patients, and its assessment should be strongly considered in both research studies and clinical practice.
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The univariate and bivariate impact of HIV/AIDS on the quality of life: a cross sectional study in the Hubei Province-Central China. ACTA ACUST UNITED AC 2009; 29:260-4. [PMID: 19399418 DOI: 10.1007/s11596-009-0226-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Indexed: 10/19/2022]
Abstract
This study is aimed to evaluate the quality of life (QOL) for individuals living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Hubei province-central China by using WHOQOL-BREF instrument (Chinese version). One hundred and thirty six respondents (HIV/AIDS individuals) attending out-patient department of Chinese Center for Disease Control and Prevention (Chinese CDC) were administered a structured questionnaire developed by investigators. QOL was evaluated by using WHOQOL-BREF instrument (Chinese version). The results showed that the mean score of overall QOL on a scale of 0-100 was 25.8. The mean scores in 4 domains of QOL on a scale of 0-100 were 82.9 (social domain), 27.5 (psychological domain), 17.7 (physical domain) and 11.65 (environmental domain). The significant difference of QOL was noted in the score of physical domain between asymptomatic (14.6) and early symptomatic individuals (12) (P=0.014), and between patients with early symptoms (12) and those with AIDS (10.43) (P<0.001). QOL in psychological domain was significantly lower in early symptomatic (12.1) (P<0.05) and AIDS patients (12.4) (P<0.006) than in asymptomatic individuals (14.2). The difference in QOL scores in the psychological domain was significant with respect to the income of patients (P<0.048) and educational status (P<0.037). Significantly better QOL scores in the physical domain (P<0.040) and environmental domain (P<0.017) were noted with respect to the occupation of the patients. Patients with family support had better QOL scores in environmental domain. In our research, QOL for HIV/AIDS individuals was associated with education, occupation, income, family support and clinical categories of the patients. It was concluded that WHOQOL-BREF Chinese version was successfully used in the evaluation of QOL of HIV/AIDS individuals in Chinese population and proved to be a reliable and useful tool.
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Reynolds NR, Eller LS, Nicholas PK, Corless IB, Kirksey K, Hamilton MJ, Kemppainen JK, Bunch E, Dole P, Wantland D, Sefcik E, Nokes KM, Coleman CL, Rivero M, Canaval GE, Tsai YF, Holzemer WL. HIV illness representation as a predictor of self-care management and health outcomes: a multi-site, cross-cultural study. AIDS Behav 2009; 13:258-67. [PMID: 17705096 PMCID: PMC3248049 DOI: 10.1007/s10461-007-9297-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 07/23/2007] [Indexed: 11/26/2022]
Abstract
Research has shown that the perceptions that form the cognitive representation of an illness (illness representation) are fundamental to how persons cope with illness. This study examined the relationship of illness representation of HIV with self-care behavior and health outcomes. Data were collected at 16 sites in the United States, Taiwan, Norway, Puerto Rico and Colombia via survey. HIV seropositive participants (n = 1,217, 31% female, 38% African-American/Black, 10% Asian/Pacific Islander and 26% White/Anglo) completed measures of illness representation based on the commonly accepted five-component structure: identity, time-line, consequences, cause, and cure/controllability (Weinman et al. 1996, Psychology and Health, 11, 431-445). Linear regression analyses were conducted to investigate relationships among illness representation, self-care behaviors and quality-of-life outcomes. Components of illness representation were associated with self-care and health outcomes, indicating that the cognitive representation of HIV has consequences for effective illness management. For example, perception that there is little that can be done to control HIV was significantly associated with fewer and less effective self-care activities (F = 12.86, P < .001) and poorer health function in the domain of quality-of-life (F = 13.89, P < .001). The concept of illness representation provides a useful framework for understanding HIV symptom management and may be useful in directing development of effective patient-centered interventions.
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Affiliation(s)
- N R Reynolds
- The Ohio State University, 1585 Neil Ave., Columbus, OH 43210, USA.
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Sakthong P, Schommer JC, Gross CR, Prasithsirikul W, Sakulbumrungsil R. Health utilities in patients with HIV/AIDS in Thailand. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:377-84. [PMID: 20667064 DOI: 10.1111/j.1524-4733.2008.00440.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVES We measured health utility (HU) in Thai HIV/AIDS patients using visual analog scale (VAS), EuroQOL (EQ-5D), and standard gamble (SG), determine the relationships between these HU measures and health-related quality of life (HRQOL) measures of HIV and patient characteristics, and assess the feasibility of the HU methods. METHODS A sample of 120 HIV/AIDS patients was identified at Bamrasnaradura Infectious Disease Institute, Thailand, during September to December, 2004. Face-to-face interviews included VAS, SG, and EQ-5D, HRQOL assessment using the Thai abbreviated version of the World Health Organization quality of life (WHOQOL-BREF THAI) and HIV-related symptom instruments, questions about ease of understanding HU approaches and sociodemographic items. Data were analyzed with repeated-measures ANOVA, followed by Dunn-Bonferroni t-test, intraclass coefficients (ICC), Spearman's rank correlation, and multiple linear regressions. RESULTS The mean (95% confidence interval) HUs were as follows: VAS, 0.79 (0.76-0.82); EQ-5D, 0.80 (0.77-0.84); and SG, 0.65 (0.60-0.70). A significant difference in HU by method was found (P < 0.001). Agreement by ICC was 0.71 for VAS versus EQ-5D, 0.41 for VAS versus SG, and 0.38 for EQ-5D and SG. The regression models showed that WHOQOL-BREF THAI, frequency of HIV symptoms, and patient characteristics could explain approximately 50% of the variation in the VAS and the EQ-5D and 20% in the SG(2). Among these three HU methods, the SG was the most difficult task. CONCLUSION VAS, EQ-5D and SG yielded different HUs for this sample. VAS and EQ-5D showed stronger construct validity with other health measures than SG. From a feasibility perspective, the SG was the least satisfactory of the three approaches.
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Affiliation(s)
- Phantipa Sakthong
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
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Pippalla RS, Chinburapa V, Duval R, Akula RS. Interrelationships of quality of life, compliance, clinical outcomes and life satisfaction: a cross-sectional study on hypertensive geriatrics. J Clin Pharm Ther 2009; 22:357-69. [PMID: 19160721 DOI: 10.1111/j.1365-2710.1997.tb00019.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE (i) To assess quality of life (QoL) profiles in hypertensive geriatrics with SF-36; (ii) to assess the compliance of geriatrics to medications; (iii) to estimate clinical outcomes (reduction in systolic and diastolic blood pressure); (iv) to assess life satisfaction and (v) to explore the interrelationships of QoL, compliance, clinical outcomes and life satisfaction in hypertensive geriatrics. METHOD Fifty-nine hypertensive geriatric patients in cardiology and 65 Plus clinics in West Virginia Hospitals were studied. RESULTS Age showed a significant negative correlation with physical functioning (r = 0.339, P< or =0.0127) and physical role (r=0.335, P< or =0.0148). The physical role facet of SF-36 is correlated with life satisfaction in geriatrics (r = 0.316, P < or =0.0219). A regression analysis (backward stepwise) not including bodily pain (BP) and general health (GH) resulted in a model explaining 22.3% of variance (n = 54, F = 2.252, P < or = 0.0543). Physical role (P < or = 0.0084) and mental health facets (P< or = 0.0184) of SF-36 emerged as the predictors of life satisfaction in elderly hypertensive patients. Emotional role functioning (P < or = 0.0257) and social functioning (P < or = 0.0033) scores predicted levels of diastolic blood pressure in elderly hypertensive patients. However, all eight concepts of SF-36 failed to predict compliance behaviour in geriatrics (n = 53, P < or = 0.6913, R2= 0.110).
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Affiliation(s)
- R S Pippalla
- College of Pharmacy and Pharmaceutical Sciences, Howard University, Washington, DC, USA
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Mkangara OB, Nie S, Wang C, Xu Y, Mweri ST, Kobelo TM, Bapumiia M. Epidemiology of human immuno-deficiency virus and quality of life for people living with HIV/AIDS in China. ACTA ACUST UNITED AC 2008; 28:230-3. [DOI: 10.1007/s11596-008-0230-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Indexed: 11/30/2022]
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Weisscher N, de Haan RJ, Vermeulen M. The impact of disease-related impairments on disability and health-related quality of life: a systematic review. BMC Med Res Methodol 2007; 7:24. [PMID: 17578571 PMCID: PMC1914351 DOI: 10.1186/1471-2288-7-24] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 06/19/2007] [Indexed: 11/20/2022] Open
Abstract
Background To investigate the interchangeability of measures of disability and health-related quality of life (HRQL) by comparing their associations patterns with disease-related impairment measures in patients with a variety of conditions. Methods A systematic literature search of MEDLINE, EMBASE, Web of Science and a hand search of reference lists through January 2006. Studies were included if they reported associations patterns between impairment and disability and between impairment and HRQL. Correlation coefficients were transformed to Fisher's z effect size (ES(z)). Weighted averages were reported as pooled ES(z) with 95% confidence intervals (CI). Results The relationship between impairment and disability was stronger (pooled ES(z) = 0.69; 95% CI, 0.66 – 0.72) than between impairment and HRQL (pooled ES(z) = 0.38; 95% CI, 0.36 – 0.41). The physical component score (pooled ES(z) = 0.43; 95% CI, 0.39 – 0.47) and disease-specific HRQL (pooled ES(z) = 0.46; 95% CI, 0.40 – 0.51) were stronger associated with impairments than the mental component score (pooled ES(z) = 0.28; 95% CI, 0.20 – 0.36) and generic HRQL (pooled ES(z) = 0.36; 95% CI, 0.33 – 0.39). Conclusion This study shows measures of disability and different HRQL domains were not equally related to impairment. Patient's impairments are better reflected in disability measures, than in HRQL instruments. There are many outcomes of interest and precisely defining them and measuring them will improve assessing the impact of new interventions.
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Affiliation(s)
- Nadine Weisscher
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob J de Haan
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marinus Vermeulen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Chiou PY, Kuo BIT, Lee MB, Chen YM, Chuang P, Lin LC. A programme of symptom management for improving quality of life and drug adherence in AIDS/HIV patients. J Adv Nurs 2006; 55:169-79. [PMID: 16866809 DOI: 10.1111/j.1365-2648.2006.03902.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper reports an evaluation of the effect of symptom management programmed on drug adherence, CD4 count and virus load and the quality of life of patients with HIV/AIDS. BACKGROUND Patients with HIV/AIDS have to face the long-term side effects caused by highly active antiretroviral therapy regimens. There has been little research to evaluate the influence of drug intervention side effects on self-care. METHODS Sixty-seven patients with HIV/AIDS were randomly assigned to one-on-one teaching, group teaching, or control groups. All those in the one-on-one and group teaching groups attended a symptom management programme once a week, followed by 3 weeks of continuity and telephone counselling. Those in the control group were offered experimental intervention at the conclusion of data collection. The Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and Quality of Life Index were used to evaluate the effectiveness of the symptom management programme before and at 3 months after the intervention. RESULTS Median differences on the Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and quality of life in both experimental groups were statistically significantly better than in the control group. CONCLUSIONS The symptom management programme can increase self-care ability in managing medication side effects in patients with HIV/AIDS.
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Affiliation(s)
- Piao-Yi Chiou
- School of Nursing, National Yang-Ming University, and Instructor, Mackay Junior College of Nursing, Taipei, Taiwan
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Sousa KH, Kwok OM. Putting Wilson and Cleary to the test: analysis of a HRQOL conceptual model using structural equation modeling. Qual Life Res 2006; 15:725-37. [PMID: 16688505 DOI: 10.1007/s11136-005-3975-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2005] [Indexed: 10/24/2022]
Abstract
Wilson and Cleary (1995) proposed a conceptual model of health-related quality of life (HRQOL) that integrates both biological and psychological aspects of health outcomes. There are five different levels in their model, namely, physiological factors, symptom status, functional health, general health perceptions, and overall quality of life. Their model has been widely applied to different populations, including patients living with cancer, Parkinson's disease, arthritis, and HIV+/AIDS. However, their conceptual model has only been partially examined. That is, the five major concepts have not been examined simultaneously. Using structural equation modeling (SEM), the Wilson and Cleary HRQOL model was validated in patients living with HIV from the AIDS Time-Oriented Health Outcomes Study. The results showed that the HRQOL model fit the data adequately, and the relationships between the constructs were all significant (at p<0.05 level). Based on the modification indexes, an alternative model linking symptom status directly with general health perceptions and overall quality of life was specified. Implication and limitation of the findings are discussed.
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Affiliation(s)
- Karen H Sousa
- College of Nursing, Arizona State University, P.O. Box 872602, Tempe, AZ 85287-2602, USA.
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Ko CH, Yen CF, Yen JY, Yang MJ. Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan. Psychiatry Clin Neurosci 2006; 60:397-403. [PMID: 16884438 DOI: 10.1111/j.1440-1819.2006.01522.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
During the 2003 outbreak, severe acute respiratory syndrome (SARS) spread to more than 30 countries. Not only did it cause severe health problems but it also imposed a great psychological impact on the public. SARS emerged in Taiwan during April 2003. This study investigates the psychosocial impact and the associated factors of depression of the SARS epidemic in Taiwan when the epidemic had just been controlled. A total of 1552 respondents were recruited in the study by random selection from the telephone book. Demographic data, SARS experience, self-perceived health state, neighborhood relationships, and depression were surveyed by telephone interviewing. Respondents were grouped as 'impacted group' and 'non-impacted group' according to whether they or their friends and family had been quarantined, or suspected of being infected. The psychosocial impact and associated factors were compared between the two groups. The 'impacted group' had higher depressive levels, poorer neighborhood relationships, poorer self-perceived health, and a higher economic impact than the 'non-impacted group'. The poorer self-perceived health and economic impact factors were associated with depression. The neighborhood relationship factor was negatively associated with depression for the 'impacted group', but not for the 'non-impacted group'. The 'impacted group' had experienced greater psychosocial impact possibly due to the SARS impact, the economic downturn, poor self-perceived health conditions, and decreased social support systems. An appropriate mental health intervention to improve the self-perceived health condition, to provide instrumental and psychological support for the 'impacted group', and to decrease the stigmatization and discrimination from the public could have buffered the psychological impact from this epidemic disaster.
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Affiliation(s)
- Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
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Abstract
The interactions between oral and systemic health are bi-directional and complex, involving many pathways. Regarding health as not merely the absence of disease, but as a state of total well-being, these interactions profoundly influence the progress of many diseases, and the quality of life and economic performance of HIV-infected individuals and populations. The evidence base for specific interactions is currently weak, partly because few good-quality studies have been published, partly because of the naïveté of the instruments currently available for recording these interactions and their inherent complexity. Recording quality of life should be a fundamental aspect of all future studies. The most significant conclusion of this Workshop is the need for all involved in oral health research and oral health care to be seen as, and to act as, essential partners in comprehensive care for whole patients and communities.
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Affiliation(s)
- N W Johnson
- School of Dentistry and Oral Health, Griffith University, Queensland, Australia.
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Bucciardini R, Murri R, Guarinieri M, Starace F, Martini M, Vatrella A, Cafaro L, Fantoni M, Grisetti R, Monforte AD, Fragola V, Arcieri R, Del Borgo C, Tramarin A, Massella M, Lorenzetti D, Vella S. ISSQoL: A New Questionnaire for Evaluating the Quality of Life of People Living with HIV in the HAART Era*. Qual Life Res 2006; 15:377-90. [PMID: 16547775 DOI: 10.1007/s11136-005-3212-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). METHODS The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n approximately =100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. RESULTS The internal consistence reliability (Cronbach's alpha) was >or=0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. CONCLUSION The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.
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Affiliation(s)
- R Bucciardini
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy.
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Honiden S, Sundaram V, Nease RF, Holodniy M, Lazzeroni LC, Zolopa A, Owens DK. The effect of diagnosis with HIV infection on health-related quality of Life. Qual Life Res 2006; 15:69-82. [PMID: 16411032 DOI: 10.1007/s11136-005-8485-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2005] [Indexed: 10/25/2022]
Abstract
We sought to understand how diagnosis with HIV affects health-related quality of life. We assessed health-related quality of life using utility-based measures in a Department of Veterans Affairs (VA) clinic and a University-based clinic. Respondents assessed health-related quality of life regarding their current health, and retrospectively assessed their health 1 month prior to and 2 months after diagnosis with HIV infection. Sixty-six patients completed the study. The overall mean utilities for health 1 month before and 2 months after diagnosis were 0.87 (standard error 0.037), and 0.80 (0.043) (p<0.005 by rank sign test), but the effect of diagnosis differed between the two clinics, with a substantial decrease in the university clinic and a small non-significant decrease in the VA clinic. The overall mean utility for current health was 0.85 (0.034), assessed on average 7.5 years after diagnosis. When asked directly whether diagnosis of HIV decreased health-related quality of life, 47% agreed, but 35% stated that HIV diagnosis positively affected health-related quality of life. Diagnosis with HIV decreased health-related quality of life at 2 months on average, but this effect diminished over time, and differed among patient populations. Years after diagnosis, although half of the patients believed that diagnosis reduced health-related quality of life, one-third reported improved health-related quality of life.
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Affiliation(s)
- Shyoko Honiden
- VA Palo Alto Health Care System (111A), 3801 Miranda Avenue, Palo Alto, CA
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Clayson DJ, Wild DJ, Quarterman P, Duprat-Lomon I, Kubin M, Coons SJ. A comparative review of health-related quality-of-life measures for use in HIV/AIDS clinical trials. PHARMACOECONOMICS 2006; 24:751-65. [PMID: 16898846 DOI: 10.2165/00019053-200624080-00003] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
With the advent of highly active antiretroviral therapy (HAART), HIV-infected patients are living longer and are concerned not only with a treatment's ability to extend their life but also with the quality of the life they are able to lead. Regulatory authorities are also paying closer attention to the use of health-related quality-of-life (HR-QOL) measures in clinical trials and to the subsequent claims that are made based on the results. This paper reviews existing HR-QOL measures reported in the HIV/AIDS literature since 1990 and identifies those most worthy of consideration for use in future clinical trials.A comprehensive review following predefined selection criteria was conducted. Generic and HIV-targeted measures were assessed for content and practicality for the clinical trial setting. The generic measures were additionally reviewed for the ability to produce preference-based index scores and for the existence of normative general population data. Three generic and six HIV-targeted measures met these selection criteria and were then assessed more fully in terms of their development (HIV-targeted measures), psychometric properties and appropriateness for use in clinical trials.It was determined that each of the selected generic measures (i.e. Medical Outcomes Study [MOS] 36-Item Short Form Survey Instrument [SF-36], EQ-5D, Health Utilities Index [HUI]) could serve as a useful adjunct to an HIV-targeted measure in a trial. The Functional Assessment of HIV Infection (FAHI) and MOS-HIV health survey were deemed the two most appropriate HIV-targeted measures. Each of the measures can be self-administered in < or = 10 minutes and there was ample evidence of their excellent psychometric properties. However, they would not be optimal in all HIV-infected subgroups (e.g. treatment naive vs advanced; adolescents vs older adults) targeted for clinical trial interventions. Although there is no one best HR-QOL measure for use in HIV/AIDS clinical trials, based on our review criteria we identified three generic and two HIV-targeted candidate measures. However, these measures have their limitations and it is clear that greater consensus needs to develop regarding more effective and efficient approaches to HR-QOL measurement in HIV/AIDS clinical trials. Along with the increasingly complex HR-QOL measurement task resulting from changes in the HIV-infected population and shifts in the HR-QOL burden associated with HIV infection and its treatment over the past 25 years, it is increasingly important that HR-QOL outcomes become viable endpoints in HIV/AIDS clinical trials.
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Fish G, Rudman DL. The potential role of occupational therapy in acute care with clients with HIV/AIDS. Occup Ther Int 2006. [DOI: 10.1002/oti.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Sugimoto N, Ichikawa M, Siriliang B, Nakahara S, Jimba M, Wakai S. Herbal medicine use and quality of life among people living with HIV/AIDS in northeastern Thailand. AIDS Care 2005; 17:252-62. [PMID: 15763718 DOI: 10.1080/09540120512331325716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Many people living with HIV/AIDS (PHA) use herbal medicine as one of alternative therapies, where curative options are limited. This study aimed to examine the association between the herbal medicine use and quality of life (QOL) among PHA in northeastern Thailand. Participants were 132 HIV-positive Thai adults who attended the PHA's self-help group meetings from June to July 2002. Health-related QOL scores were measured by self-administered questionnaire from the Medical Outcomes Study-HIV Health Survey. Dimensions of physical function (PF) and mental health (MH) in QOL were assessed. Additional data were collected on herbal medicine use, socio-demographic, psychosocial and HIV-related characteristics. The herbal medicine users had significantly better MH scores than the non-users, while the herbal medicine use was not statistically associated with PF scores. When stratified, herbal medicine users with the following characteristics had significantly better MH scores than the non-users: female, widowed, having no income, reporting any HIV-related symptom, having no instrumental support or receiving subsidies. In conclusion, herbal medicine use was associated with better MH especially among socially vulnerable PHA. This study suggests that herbal medicine has a potential to improve the MH aspect of QOL among socially vulnerable PHA who cannot easily receive antiretroviral therapy in Thailand.
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Affiliation(s)
- N Sugimoto
- Department of International Community Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Jia H, Uphold CR, Wu S, Chen GJ, Duncan PW. Predictors of changes in health-related quality of life among men with HIV infection in the HAART era. AIDS Patient Care STDS 2005; 19:395-405. [PMID: 15989435 DOI: 10.1089/apc.2005.19.395] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In a prospective cohort study between February 2001 and January 2004, baseline and 12-month follow-up data were collected on 226 and 197 men with HIV infection at three infectious disease clinics in a southern state, respectively. While many studies have provided important information on the correlates of health-related quality of life (HRQOL) during HIV infection, little research attention has been directed toward examining the impact of factors on change in HRQOL over time. This study evaluated changes in HRQOL, and examined whether baseline active coping, family social support, depressive symptoms and CD4 cell counts predicted HRQOL changes over time among men with HIV infection. Patients' HRQOL, social support and depressive symptoms were measured with the HIV Cost and Services Utilization Study tool, Coping with HIV Questionnaire, Social Support Appraisals Scale, and Centers for Epidemiological Studies Depression instrument. Multivariate linear regression analyses were conducted to determine the time-related effects of the psychosocial variables and CD4 cell counts on each HRQOL dimension. Our results indicated that higher family support and CD4 cell counts at baseline were predictive of improved changes in physical and social functioning over time, and higher depressive symptoms at baseline were predictive of diminished role functioning, emotional well-being, and general health perception. These findings underline the importance of enhancing family social support, identifying and treating depression, and improving immune function to optimize HRQOL among men with HIV infection.
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Affiliation(s)
- Huanguang Jia
- VA Rehabilitation Outcomes Research Center, Gainesville, Florida 32608-1197, USA.
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Wu AW, Dave NB, Diener-West M, Sorensen S, Huang IC, Revicki DA. Measuring validity of self-reported symptoms among people with HIV. AIDS Care 2005; 16:876-81. [PMID: 15385242 DOI: 10.1080/0954012042000273849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Symptoms are important indicators of health and treatment for people with HIV. Symptoms are measured by patient self-report, but there has been little attention to what is the best method of elicitation. We compared three methods (presence, frequency, and bother) commonly used to measure HIV self-reported symptoms. CD4+ T lymphocyte count and health-related quality of life (HRQL) scales were used to test validity in 160 people with HIV. The average number of symptoms reported was 15.2 (standard deviation 8.4). Correlation coefficients of summary symptom scores using the three methods ranged from -0.30 to -0.36 with HRQL score and from -0.19 to -0.20 with CD4 count (p<0.05). Correlation coefficients of seven specific symptom items with CD4+ counts and HRQL scores for the same concepts were small to moderate (-0.08 to -0.58, p<0.05). For the three methods, the correlation coefficients in general tended to be greater with frequency or bother than presence. However, the differences among the three methods were not statistically significant. We conclude that no single method is superior to the others.
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Affiliation(s)
- A W Wu
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD 21205-1901, USA.
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Mrus JM, Williams PL, Tsevat J, Cohn SE, Wu AW. Gender differences in health-related quality of life in patients with HIV/AIDS. Qual Life Res 2005; 14:479-91. [PMID: 15892437 DOI: 10.1007/s11136-004-4693-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In studies evaluating the general US population, patients in primary care, and patients with chronic conditions, women consistently report poorer health-related quality of life (HRQoL) than men; however, studies evaluating HRQoL in patients with HIV/AIDS have not completely corroborated those findings. The objective of this study was to evaluate gender differences in HRQoL for participants in a large randomized trial comparing antiretroviral regimens. METHODS AIDS Clinical Trials Group (ACTG) 320 was a randomized, blinded, placebo-controlled trial comparing the 3-drug regimen of indinavir + zidovudine (or stavudine) + lamivudine with the 2-drug combination of zidovudine (or stavudine) + lamivudine in subjects with CD4 cell counts less than 200 cells/microl and no prior treatment with protease inhibitors. Nine quality of life domains scored on 0-100 scales were assessed using the ACTG QOL 601-602 Health Survey at 3 points in the trial: baseline, 24 weeks and 40 weeks. Differences between men and women in HRQoL scores were assessed using the Wilcoxon rank-sum test and generalized estimating equation (GEE) models. RESULTS Overall, 202 females and 976 males were randomized to one of two treatment arms. Female participants were more likely to be black or Hispanic and tended to be younger. At baseline, females reported lower HRQoL scores than males in all of the domains except social functioning, and at week 40, women scored lower in all of the domains except overall health. In repeated measures models, women were found to score lower in all HRQoL domains except overall health, with significant differences of 3.5-6.7 points in 3 of the 9 quality of life domains: physical functioning, pain, and energy/fatigue. HRQoL scores improved for participants in the study over time and in response to potent treatment, and the improvements were similar for men and women. CONCLUSIONS Women with HIV/AIDS report substantially poorer HRQoL than men with HIV/AIDS in several HRQoL domains. However, changes in domain scores over time and in response to treatment do not differ significantly by gender, implying that changes in domain scores may be better HRQoL outcomes to compare between HIV-infected men and women in clinical trials than mean domain scores.
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Affiliation(s)
- Joseph M Mrus
- Health Services Research and Development, Department of Veterans Affairs Medical Center, USA
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Abstract
Although various physiological and psychological causes of fatigue in HIV-positive persons have been proposed, it is still not well understood. Bioimpedance analysis has proved to be an easily used, non-invasive measurement of body composition and cellular integrity. This study, looking at whether body composition as measured by bioimpedance analysis is associated with fatigue, is part of a pilot study looking for physiological and psychological biomarkers that could be factors in the fatigue experienced by HIV-positive people. Twenty-nine men and eleven women were measured for height, weight, and bioimpedance analysis. Correlations were examined between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, extracellular mass, and phase angle. Because of the fat redistribution that has occurred with some people taking protease inhibitors, we also examined differences in weight, body mass index, body cell mass, fat-free mass, and fatigue intensity between those taking and those not taking protease inhibitors. There was no association between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, or phase angle, nor were there differences between those taking and those not taking protease inhibitors. However, it was noted that both the phase angle and the ratio of extracellular mass to body cell mass (extracellular mass:body cell mass) were below their respective normal ranges, indicating that the participants were somewhat compromised nutritionally and with regard to cell membrane integrity. Although fatigue was not shown to be related to body composition measurement in this study, further work is needed on the causes of fatigue, because its effects on the lives of HIV-positive people can be devastating.
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Affiliation(s)
- Janet Meynell
- Yancey County Health Department, Burnsville, NC, USA
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Yen CF, Tsai JJ, Lu PL, Chen YH, Chen TC, Chen PP, Chen TP. Quality of life and its correlates in HIV/AIDS male outpatients receiving highly active antiretroviral therapy in Taiwan. Psychiatry Clin Neurosci 2004; 58:501-6. [PMID: 15482581 DOI: 10.1111/j.1440-1819.2004.01292.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Long-term care of human HIV and AIDS cases has raised quality of life (QoL) issues. The aim of this study was to identify QoL in HIV/AIDS male outpatients receiving highly active antiretroviral therapy (HAART) and its correlates in Taiwan. In total, 41 HIV/AIDS male outpatients receiving HAART yet presenting few symptoms of infection, were recruited for the study. Their QoL levels were measured with the Taiwan version of the Short Form of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The relationships between QoL and demographic characteristics, social support, negative stressors, depression, characteristics of HIV infection, attitude toward HIV infection, and adverse effects of HAART, were examined. The results of the analysis reveal that multiple factors affect QoL for HIV/AIDS male outpatients receiving HAART, including severity of depression, deterioration of work function, inconvenience resulting from medication schedules and medical appointments, lack of social support, negative stressors, and adverse effects of HAART. The results provide screening factors so that clinicians can intervene to improve the QoL for their HIV patients.
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Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry and Graduate Institute of Behavior Science, Kaohsiung Medical University, Kaohsiung, Taiwan
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Siegel K, Bradley CJ, Lekas HM. Causal attributions for fatigue among late middle-aged and older adults with HIV infection. J Pain Symptom Manage 2004; 28:211-24. [PMID: 15336333 DOI: 10.1016/j.jpainsymman.2003.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2003] [Indexed: 11/24/2022]
Abstract
Fatigue, a symptom with many possible causes, is highly prevalent among persons with HIV/AIDS. The causal attributions HIV+ individuals make for their fatigue are important because they largely guide the coping responses they use to manage it. In a study to better understand the symptom appraisal process among 100 HIV+ older adults (50+), 49 participants discussed in depth their experience with fatigue. Many participants felt confused, at least initially, about the source of their fatigue, although most offered their HIV disease as a possible cause. However, many who did so also believed it was caused in part by other, generally less threatening causes, such as age, overexertion, or excess weight. HIV medications and other symptoms or comorbidities were also frequently cited as causes of fatigue. Health care professionals and HIV+ peers often helped to shape or reinforce participants' attributions for their fatigue.
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Affiliation(s)
- Karolynn Siegel
- Center for the Psychosocial Study of Health and Illness, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
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