1
|
Jones KF, Long DM, Bair MJ, Agil D, Browne L, Burkholder G, Clay OJ, Conder K, Durr AL, Farel CE, King K, Johnson B, Liebschutz JM, Demonte W, Leone M, Mullen L, Orris SM, Thomas T, Johnson M, Napravnik S, Merlin JS. Efficacy of a Pain Self-Management Intervention Tailored to People With HIV: A Randomized Clinical Trial. JAMA Intern Med 2024:2821262. [PMID: 39008317 PMCID: PMC11250263 DOI: 10.1001/jamainternmed.2024.3071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/17/2024] [Indexed: 07/16/2024]
Abstract
Importance Chronic pain is a common condition for which efficacious interventions tailored to highly affected populations are urgently needed. People with HIV have a high prevalence of chronic pain and share phenotypic similarities with other highly affected populations. Objective To evaluate the efficacy of a behavioral pain self-management intervention called Skills to Manage Pain (STOMP) compared to enhanced usual care (EUC). Design, Setting, and Participants This randomized clinical trial included adults with HIV who experienced at least moderate chronic pain for 3 months or more. The study was set at the University of Alabama at Birmingham and the University of North Carolina-Chapel Hill large medical centers from August 2019 to September 2022. Intervention STOMP combined 1-on-1 skill-building sessions delivered by staff interventionists with group sessions co-led by peer interventionists. The EUC control group received the STOMP manual without any 1-on-1 or group instructional sessions. Main Outcomes and Measures The primary outcome was pain severity and the impact of pain on function, measured by the Brief Pain Inventory (BPI) summary score. The primary a priori hypothesis was that STOMP would be associated with a decreased BPI in people with HIV compared to EUC. Results Among 407 individuals screened, 278 were randomized to STOMP intervention (n = 139) or EUC control group (n = 139). Among the 278 people with HIV who were randomized, the mean (SD) age was 53.5 (10.0) years; 126 (45.0%) identified as female, 146 (53.0%) identified as male, 6 (2.0%) identified as transgender female. Of the 6 possible 1-on-1 sessions, participants attended a mean (SD) of 2.9 (2.5) sessions. Of the 6 possible group sessions, participants attended a mean (SD) of 2.4 (2.1) sessions. Immediately after the intervention compared to EUC, STOMP was associated with a statistically significant mean difference for the primary outcome, BPI total score: -1.25 points (95% CI, -1.71 to -0.78 points; P < .001). Three months after the intervention, the mean difference in BPI total score remained statistically significant, favoring the STOMP intervention -0.62 points (95% CI, -1.09 to -0.14 points; P = .01). Conclusion and Relevance The findings of this randomized clinical trial support the efficaciousness of STOMP as an intervention for chronic pain in people with HIV. Future research will include implementation studies and work to understand the optimal delivery of the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT03692611.
Collapse
Affiliation(s)
- Katie Fitzgerald Jones
- New England Geriatric Research Education and Clinical Center, Section of Palliative Care, VA Boston Healthcare System, Boston, Massachusetts
| | - Dustin M. Long
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew J. Bair
- VA HSR&D Center for Health Information and Communication, Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Lindsay Browne
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Greer Burkholder
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham
| | - Kendall Conder
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Amy L. Durr
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Claire E. Farel
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Kiko King
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Bernadette Johnson
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Jane M. Liebschutz
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Mireille Leone
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - LaToya Mullen
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of North Carolina at Chapel Hill
| | - Sarah Margaret Orris
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tammi Thomas
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham
| | - Mallory Johnson
- Center for AIDS Prevention Studies, University of San Francisco, San Francisco, California
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Jessica S. Merlin
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
2
|
Feldman MB, Tran TT, Boucher LM, Abdelqader F, Raker AR, Hile SJ. A process and impact evaluation of a peer-led HIV self-management program. EVALUATION AND PROGRAM PLANNING 2023; 96:102175. [PMID: 36459775 DOI: 10.1016/j.evalprogplan.2022.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/24/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
There is evidence that people with HIV (PWH) receive health-related benefits from having peer support and learning self-management skills. This evaluation assessed the effect of The Positive Life Workshop (TPLW)-a 7-session peer-led HIV self-management program-on psychosocial and HIV treatment outcomes. The overall sample included 1360 PWH who completed TPLW during 3/2015-2/2019. Surveys were administered before and after the program, and three months following program completion. Analyses examined changes in outcomes from pre-test to both post-test and 3-month follow-up using non-parametric tests. Subgroup analyses were conducted for 406 participants with ≥ 1 characteristic of the priority population for TPLW (i.e., recent HIV diagnosis, not taking antiretroviral therapy (ART), suboptimal ART adherence, unsuppressed viral load). In the overall sample, there were statistically significant improvements in HIV-related knowledge, social support, patient self-advocacy, and confidence in self-management between pre-test and post-test/3-month follow-up assessment. Analyses for the priority population showed significant increases from pre-test to 3-month follow-up in the proportion of participants who were ≥ 90 % adherent to ART (59-83 %, p < 0.01) and virally suppressed (42 % to 66 %, p < 0.01). The findings suggest the importance of ensuring HIV self-management interventions reach vulnerable populations of PWH who struggle with initiating and maintaining HIV-related health-promoting behaviors.
Collapse
Affiliation(s)
- Matthew B Feldman
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States.
| | - Trang T Tran
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Lisa M Boucher
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent Ottawa, Ontario K1G 5Z3, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada
| | - Faisal Abdelqader
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Amanda R Raker
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Stephen J Hile
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| |
Collapse
|
3
|
Rogal SS, Chinman MJ, DeMonte W, Gibson S, Hoyt-Trapp S, Klima GJ, Jonassaint NL, Liebschutz JM, Kraemer KL, Merlin J. Using Intervention Mapping to Develop a Novel Pain Self-Management Intervention for People with Cirrhosis. Dig Dis Sci 2022; 67:5063-5078. [PMID: 35147816 DOI: 10.1007/s10620-022-07380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/02/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chronic pain is common among patients with cirrhosis and is challenging to treat. While promising, pain self-management (PSM) interventions have not been tailored to this population's needs. AIMS To design a PSM intervention for patients with cirrhosis. METHODS Semi-structured interviews with 17 patients with cirrhosis, 12 hepatologists, and 6 administrators from two medical centers were conducted to inform a rigorous, structured intervention mapping (IM) process. Qualitative content analysis was guided by social cognitive theory (SCT) and the Consolidated Framework for Implementation Research (CFIR) and incorporated into intervention development. A planning group met regularly throughout the intervention, to reach consensus about how to use data and theory to develop the intervention through IM. RESULTS Participants described barriers to PSM behaviors, including the absence of simple, evidence-based interventions for pain for patients with cirrhosis, inadequate provider knowledge, time, and training, and lack of champions, funding, and communication. Patients described high motivation to treat pain using behavioral methods including meditation, prayer, and exercise. The intervention was designed to address barriers to PSM behaviors for patients with cirrhosis, using behavior change methods that address knowledge, self-efficacy, and outcome expectations. The LEAP (Liver Education About Pain) intervention is a 12-week, modular intervention delivered by phone via individual and group sessions with a health coach. CONCLUSIONS People with cirrhosis, hepatologists, and administrators informed this theory-driven, tailored PSM intervention, which was designed to be implementable in the real world.
Collapse
Affiliation(s)
- Shari S Rogal
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA. .,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA. .,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA.
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA.,RAND Corporation, Pittsburgh, PA, 15213, USA
| | - William DeMonte
- Virginia Mason Franciscan Health, Bonney Lake, WA, 98391, USA
| | - Sandra Gibson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA
| | | | - Gloria J Klima
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA
| | - Naudia L Jonassaint
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jane M Liebschutz
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Kevin L Kraemer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jessica Merlin
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| |
Collapse
|
4
|
LIN J, ZHANG W, LAI R. Pain characteristics and countermeasures to improve intraoperative pain for patients with temporomandibular joint disorder during treatment of orthodontics. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.05621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Junsheng LIN
- The First Affiliated Hospital Jinan University, China
| | | | - Renfa LAI
- The First Affiliated Hospital Jinan University, China
| |
Collapse
|
5
|
Fauzi A, Anggraini N, Fatkhurohman N. Self-management: A comprehensive approach to improve quality of life among people living with HIV in Indonesia. BELITUNG NURSING JOURNAL 2021; 7:395-401. [PMID: 37496503 PMCID: PMC10367977 DOI: 10.33546/bnj.1554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/22/2021] [Accepted: 08/28/2021] [Indexed: 07/28/2023] Open
Abstract
Background People living with HIV (PLWH) today have to deal with a chronic condition that requires efficient self-management due to increased longevity. Self-management interventions have been shown to improve physical and psychological symptoms as well as clinical results in chronic diseases. However, few studies have investigated the effect of self-management on quality of life (QOL) among PLWH in Indonesia. Objective To examine the effect of a self-management program on QOL among PLWH in Indonesia. Methods This was a quasi-experimental study with a comparison group in a general hospital in Jakarta, Indonesia. Of the 114 recruited PLWH, 57 were assigned to the intervention group and 57 to the comparison group. The self-management group attended a four-week program workshop. The intervention consisted of five sessions: need assessment and goal setting, maintaining a healthy lifestyle, educational participation to increase communication and self-esteem, and evaluation. The comparison group received standard educational material throughout the leaflet regarding HIV prevention. The post-test assessment was conducted immediately after intervention (T1) and two months (T2) after the intervention in both groups. QOL was measured using the World Health Organization Quality of Life (WHOQOL)-HIV brief Bahasa version. The estimations were obtained using fixed-effect regressions. The differences between T0, T1, and T2 for the intervention and comparison groups were evaluated and compared using the DI Differences method (DID). Results The self-management program improved outcomes relative to the comparison group at T1: 1) overall QOL score increased 8.7% (95% CI 0.021-0.149), 2) physical domain saw a modest increased 8.8% (95% CI 0.017-0.125), 3) psychological domain increased 23.5 % (95% CI 0.085-0.689), and 4) environmental domain showed a modest increase of 18.7% (95% CI 0.053-0.371). At T2, the total QOL score and the physical, psychological, and environmental dimensions were significantly improved compared to the comparison group. Conclusion The self-management program appears to improve the QOL of the life of PLWH. Nurses are advised to provide PLWH with self-management training. Future research on self-management intervention would need to be refined further to ensure that each community achieves consistent intervention outcomes.
Collapse
|
6
|
Nkhoma KB, Mwalabu GT, Bristowe K, Lungu EA, Harding R. "Pain Special Issue" "Stakeholders' perspectives and requirements on pain self-management for adolescents living with HIV/AIDS in Malawi: a cross-sectional qualitative study". AIDS Care 2021:1-14. [PMID: 34152886 DOI: 10.1080/09540121.2021.1939850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Malawi has one of the highest HIV prevalence rates (8.9%), and data suggest 27% pain prevalence among adolescents living with HIV (ALHIV) in Malawi. Pain among ALHIV is often under-reported and pain management is suboptimal. We aimed to explore stakeholders' perspectives and experiences on pain self-management for ALHIV and chronic pain in Malawi. We conducted cross-sectional in-depth qualitative interviews with adolescents/caregiver dyads and healthcare professionals working in HIV clinics. Data were audio-recorded, transcribed verbatim and translated (where applicable) then imported into NVivo version 12 software for framework analysis. We identified three main themes: (1) Experiencing "total pain": adolescents experienced physical, psychosocial, and spiritual pain which impacted their daily life activities. (2) Current self-management approaches: participants prefer group-based self-management approaches facilitated by healthcare professionals or peers at the clinic focussing on self-management of physical, psychosocial, and spiritual pain. (3) Current pain strategies: participants used prescribed drugs, traditional medicine, and non-pharmacological interventions, such as exercises to manage pain. A person-centred care approach to self-management of chronic pain among ALHIV is needed to mitigate the impact of pain on their daily activities. There is a need to integrate self-management approaches within the existing structures such as teen clubs in primary care.
Collapse
Affiliation(s)
| | | | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, London UK
| | | | - Richard Harding
- Kings College London, Department of Palliative Care, Policy & Rehabilitation, Weston Education Centre, London, UK
| |
Collapse
|
7
|
Le Dai D, Pham TVA, Bui TTH, Than TNH, Pham VT, Luong NK, Harding R, Krakauer EL. Symptom prevalence, burden and correlates among people living with HIV in Vietnam: a two-centre self-report study. AIDS Care 2021; 34:887-893. [PMID: 34133248 DOI: 10.1080/09540121.2021.1922577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Physical and psychological symptoms among people living with HIV (PLWH) adversely affect quality of life and treatment adherence. Study objectives were: (i) to determine validity and reliability of a Vietnamese translation of the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) among PLWH in Vietnam; (ii) to measure prevalence and burden of physical and psychological symptoms using the MSAS-SF including the Global Distress Index (GDI), Physical Distress subscale (PHYS), and Psychological Distress subscale (PSY); (iii) to identify symptom burden risk factors. We recruited 567 patients. Cronbach's alpha scores were: total MSAS-SF 0.91, GDI 0.83, PHYS 0.85, PSYCH 0.81. The scale showed good discriminant validity (low vs high function) (p < 0.001). The mean number of symptoms was 7.66, and the most prevalent were "worrying" (41.6%), "lack of energy" (40.6%), "feeling irritable" (40.4%), and "feeling sad" (39.2%). Monthly income below the poverty line was independently associated with increased: GDI,, PHYS, and PSY and a greater number of symptoms. The Vietnamese version of the MSAS-SF is valid to measure symptom prevalence and burden in HIV-positive populations. Here is a high symptom prevalence and burden among PLWH in Vietnam, especially those living in poverty, and a great need for palliative care integrated with HIV treatment.
Collapse
Affiliation(s)
- Duong Le Dai
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam.,Department of Geriatrics - Palliative Care, University Medical Centre, Ho Chi Minh, Vietnam
| | - Thi Van Anh Pham
- Department of Infectious Diseases, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Thi Thanh Huyen Bui
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam.,City Children's Hospital, Ho Chi Minh City, Vietnam
| | - The Ngoc Ha Than
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam.,Department of Geriatrics - Palliative Care, University Medical Centre, Ho Chi Minh, Vietnam
| | - Van Thuc Pham
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Ngoc Khue Luong
- Administration of Medical Services, Ministry of Health, Hanoi, Vietnam
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, UK
| | - Eric L Krakauer
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam.,Department of Global Health and Social Medicine, Harvard Medical School, USA.,Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| |
Collapse
|
8
|
Crowley T, Rohwer A. Self-management interventions for adolescents living with HIV: a systematic review. BMC Infect Dis 2021; 21:431. [PMID: 33962558 PMCID: PMC8105944 DOI: 10.1186/s12879-021-06072-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden. METHODS We considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non-RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form. RESULTS We included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of self-management domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes. CONCLUSION Existing evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126313.
Collapse
Affiliation(s)
- Talitha Crowley
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
9
|
Baker V, Nkhoma K, Trevelion R, Roach A, Winston A, Sabin C, Bristowe K, Harding R. “I have failed to separate my HIV from this pain”: the challenge of managing chronic pain among people with HIV. AIDS Care 2021:1-9. [PMID: 33443450 DOI: 10.1080/09540121.2020.1869148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pain is a highly prevalent and burdensome symptom among people with HIV (PWH). This study aims to identify how the experience of living with HIV and chronic pain influences pain beliefs, health-seeking and pain management. Thirty-nine purposively sampled PWH with chronic pain (sample characteristics = 61% women, 79% Black, Asian and minority ethnic groups, 18% men who have sex with men, 45-54 median age category) participated in focus groups in London. Focus groups were co-facilitated with community members. Transcripts wereanalysed using a thematic approach. Findings revealed that HIV stigma, fractured care pathways, and general practitioners' lack of HIV training are barriers to supported pain management. Unaddressed pain results in poorer mental health and reduced quality of life, which has important clinical implications for HIV treatment adherence. Creating HIV-specific pain resources, activating social networks, and pain self-management techniques are potential solutions. Person-centred assessment and HIV training is needed to help clinicians identify PWH with chronic pain. Clear guidelines need to be developed to identify which health service providers are responsible for chronic pain management in PWH. This study generated a refined version of the Fear Avoidance Model that introduces a dimension of HIV-specific behaviours that impact PWHs seeking chronic pain management.
Collapse
Affiliation(s)
- V. Baker
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - K. Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | | | - A. Roach
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - A. Winston
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, England
| | - C. Sabin
- Faculty of Population Health Sciences, Department of Infection & Population Health, University College London, London, England
| | - K. Bristowe
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - R. Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| |
Collapse
|
10
|
Dong N, Chen WT, Lu H, Zhu Z, Hu Y, Bao M. Unmet needs of symptom management and associated factors among the HIV-positive population in Shanghai, China: A cross-sectional study. Appl Nurs Res 2020; 54:151283. [PMID: 32425335 PMCID: PMC7229465 DOI: 10.1016/j.apnr.2020.151283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) are a vulnerable group who experience multiple physiological and psychological symptoms. A better understanding of unmet symptom management needs will allow researchers to design interventions that are more reflective of deficits in care and more effective at improving patient care. Few studies have focused on unmet needs for symptom management in PLWHA particularly in China. Factors influencing Chinese PLWHA symptom management needs are rarely discussed. AIM The purpose of this study was to investigate the unmet needs for symptom management of PLWHA and how their symptom burden, HIV perceived stigma, and self-management capacity contributes to HIV-related self-management practices in Shanghai, China. DESIGN Study participants were recruited from the outpatient and inpatient HIV/AIDS wards in an infectious hospital in Shanghai, China. Self-administered questionnaires were implemented and medical charts were reviewed. RESULTS A total of 367 participants was recruited from April to September 2017. The results show that 53.1% (195 of 367) of participants presented at least one unmet symptom management need and that symptom burden, as well as perceived stigma, reduced self-management capacity, and no employment significantly affected unmet symptom management needs. CONCLUSION The findings indicate that there is room for improvement in symptom management for Chinese PLWHA. Culturally appropriate interventions focusing on improving symptom burden, decreasing HIV perceived stigma, and enhancing self-management capacity can enhance symptom management in this population.
Collapse
Affiliation(s)
- Ning Dong
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei-Ti Chen
- School of Nursing, University of California, Los Angeles, CA, United States
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| |
Collapse
|
11
|
Edelman EJ, Li Y, Barry D, Braden JB, Crystal S, Kerns RD, Gaither JR, Gordon KS, Manhapra A, Merlin JS, Moore BA, Oldfield BJ, Park LS, Rentsch CT, Skanderson M, Williams EC, Justice AC, Tate JP, Becker WC, Marshall BD. Trajectories of Self-Reported Opioid Use Among Patients With HIV Engaged in Care: Results From a National Cohort Study. J Acquir Immune Defic Syndr 2020; 84:26-36. [PMID: 32267658 PMCID: PMC7147724 DOI: 10.1097/qai.0000000000002310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of self-reported opioid use and their correlates among a national sample of PWH engaged in care. SETTING Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at 8 US Veterans Health Administration (VA) sites. METHODS Between 2002 and 2018, we assessed past year opioid use frequency based on self-reported "prescription painkillers" and/or heroin use at baseline and follow-up. We used group-based trajectory models to identify opioid use trajectories and multinomial logistic regression to determine baseline factors independently associated with escalating opioid use compared to stable, infrequent use. RESULTS Among 3702 PWH, we identified 4 opioid use trajectories: (1) no lifetime use (25%); (2) stable, infrequent use (58%); (3) escalating use (7%); and (4) de-escalating use (11%). In bivariate analysis, anxiety; pain interference; prescribed opioids, benzodiazepines and gabapentinoids; and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. In multivariable analysis, illness severity, pain interference, receipt of prescribed benzodiazepine medications, and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. CONCLUSION Among PWH engaged in VA care, 1 in 15 reported escalating opioid use. Future research is needed to understand the impact of psychoactive medications and marijuana use on opioid use and whether enhanced uptake of evidence-based treatment of pain and psychiatric symptoms can prevent escalating use among PWH.
Collapse
Affiliation(s)
- E. Jennifer Edelman
- Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Yu Li
- Brown University School of Public Health, Providence, RI
| | | | - Jennifer Brennan Braden
- University of Washington School of Medicine, Seattle, WA
- Valley Medical Center Psychiatry and Counseling, Behavioral Health Integration Program
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, NJ
| | - Robert D. Kerns
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | - Kirsha S. Gordon
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Ajay Manhapra
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | - Brent A. Moore
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | | | - Christopher T. Rentsch
- VA Connecticut Healthcare System, West Haven, CT
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Emily C. Williams
- VA Puget Sound Health Services Research and Development and Department of Health Services, University of Washington, Seattle, WA
| | - Amy C. Justice
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Janet P. Tate
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - William C. Becker
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | |
Collapse
|
12
|
Nkhoma K, Ahmed A, Alli Z, Sherr L, Harding R. Is symptom prevalence and burden associated with HIV treatment status and disease stage among adult HIV outpatients in Kenya? A cross-sectional self-report study. AIDS Care 2019; 31:1461-1470. [PMID: 30913897 DOI: 10.1080/09540121.2019.1595514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
People with HIV experience a high prevalence and burden of physical and psychological symptoms throughout their disease trajectory. These have important public and clinical health implications. We aimed to measure: the seven-day period prevalence of symptoms, the most burdensome symptoms, and determine if self-reported symptom burden is associated with treatment status, clinical stage and physical performance. We conducted a cross-sectional study among adult (aged at least 18 years) patients with HIV, attending HIV outpatient care in Kenya. Data was gathered through self-report using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), file extraction (sociodemographic data, treatment status, CD4 count, clinical stage) and through observation using the Karnofsky Performance Scale (KPS). Multivariable ordinal logistic regression assessed the association of symptom burden (MSAS-SF) controlling for demographic and clinical variables. Of the 475 participants approached, 400 (84.2%) participated. Ordinal logistic regression showed that being on HIV treatment was associated lower global distress index (in quartiles) (odds ratio .45, 95% CI .23 to .88; p = 0.019). Pain and symptom burden still persist in the era of antiretroviral therapy. Routine clinical practice should incorporate assessment and management of pain and symptoms irrespective of disease stage and treatment status in order to achieve the proposed fourth "90" in the UNAIDS 90-90-90 targets (that is good quality of life).
Collapse
Affiliation(s)
- Kennedy Nkhoma
- Faculty of Nursing Midwifery and Palliative Care, King's College London, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation , London , UK
| | | | - Zipporah Alli
- Kenya Hospices and Palliative Care Association , Nairobi , Kenya
| | - Lorraine Sherr
- Institute for Global Health, University College London , London , UK
| | - Richard Harding
- Faculty of Nursing Midwifery and Palliative Care, King's College London, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation , London , UK
| |
Collapse
|
13
|
Pain in people living with HIV and its association with healthcare resource use, well being and functional status. AIDS 2018; 32:2697-2706. [PMID: 30289809 DOI: 10.1097/qad.0000000000002021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We describe the prevalence of pain and its associations with healthcare resource utilization and quality-of-life. DESIGN The POPPY Study recruited three cohorts: older people living with HIV (PLWH; ≥50 years, n = 699), younger demographically/lifestyle similar PLWH (less than 50 years, n = 374) and older demographically/lifestyle similar HIV-negative (≥50 years, n = 304) people from April 2013 to February 2016. METHODS Current pain and pain-related healthcare use was collected via a self-reported questionnaire. Logistic regression assessed between-group differences in the prevalence of pain in the past month and current pain after controlling for potential confounders. Associations between current pain and healthcare resource use, reported joint problems, depressive symptoms, quality-of-life and functional status were assessed in PLWH using Mann-Whitney U and chi-squared tests. RESULTS Pain in the past month was reported by 473 out of 676 (70.0%) older PLWH, 224 out of 357 (62.7%) younger PLWH and 188 out of 295 (63.7%) older HIV-negative controls (P = 0.03), with current pain reported in 330 (48.8%), 134 (37.5%) and 116 (39.3%), respectively (P = 0.0007). Older PLWH were more likely to experience current pain, even after adjustment for confounders. Of those with pain in the past month, 56 out of 412 (13.6%) had missed days of work or study due to pain, and 520 (59%) had seen a doctor about their pain. PLWH experiencing current pain had more depressive symptoms, poorer quality-of-life on all domains and greater functional impairment, regardless of age group. CONCLUSION Even in the effective antiretroviral therapy era, pain remains common in PLWH and has a major impact on quality-of-life and associated healthcare and societal costs. Interventions are required to assist clinicians and PLWH to proactively manage pain.
Collapse
|