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Oladejo TS, Myezwa H, Ajidahun AT, Ibeneme S. Health-related quality of life and associated factors among people living with HIV/AIDS in Lagos, Nigeria. Afr J Prim Health Care Fam Med 2024; 16:e1-e8. [PMID: 39221739 PMCID: PMC11369543 DOI: 10.4102/phcfm.v16i1.4519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Although people living with HIV (PLWH) now have a longer life expectancy due to antiretroviral therapy, several factors impact their health-related quality of life (HRQoL). Understanding the dimensions and determinants of HRQoL among PLWH is crucial to developing solutions to improve their overall wellbeing. AIM This research aimed to explore the HRQoL and its associated factors among PLWH in Lagos, Nigeria. SETTING Seven HIV testing and treatment centres in Lagos. METHODS A cross-sectional survey was conducted with 385 participants. Socio-demographic and HRQoL data were obtained using questionnaires and the Medical Outcomes Study HIV Health Survey (MOS-HIV). Logistic regression models were used to identify variables that were associated with quality of life. RESULTS The physical health summary and mental health summary scores measured by the MOS-HIV were 54.2 ± 5.3 and 56.3 ± 6.7, respectively. Being married, having higher levels of education, shorter duration of HIV and higher income levels were significantly associated with better HRQoL. The duration of HIV was found to have an inversely proportional influence on the quality of life of PLWH, both in physical health (χ2 = 9.477, p = 0.009) and mental health (χ2 = 11.88, p = 0.004) dimensions. CONCLUSION The HRQoL of PLWH in Lagos, Nigeria was relatively low. Education, duration of HIV, marital status and income level are predictors of HRQoL.Contribution: This study is valuable for healthcare professionals and policymakers, providing them with essential information to tailor interventions and allocate resources effectively to improve the overall wellbeing of PLWH in Nigeria.
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Affiliation(s)
- Temitope S Oladejo
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Burger RL, Cohen CR, Mocello AR, Dworkin SL, Frongillo EA, Weke E, Butler LM, Thirumurthy H, Bukusi EA, Weiser SD. Relationship Power, Antiretroviral Adherence, and Physical and Mental Health Among Women Living with HIV in Rural Kenya. AIDS Behav 2023; 27:416-423. [PMID: 36001201 PMCID: PMC9908627 DOI: 10.1007/s10461-022-03775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Little is known about the association of gender-based power imbalances and health and health behaviors among women with HIV (WWH). We examined cross-sectional baseline data among WWH in a cluster-randomized control trial (NCT02815579) in rural Kenya. We assessed associations between the Sexual Relationship Power Scale (SRPS) and ART adherence, physical and mental health, adjusting for sociodemographic and social factors. SRPS consists of two subscales: relationship control (RC) and decision-making dominance. Women in the highest and middle tertiles for RC had a 7.49 point and 8.88 point greater Medical Outcomes Study-HIV mental health score, and a 0.27 and 0.29 lower odds of depression, respectively, compared to women in the lowest tertile. We did not find associations between SPRS or its subscales and ART adherence. Low sexual relationship power, specifically low RC, may be associated with poor mental health among WWH. Intervention studies aimed to improve RC among WWH should be studied to determine their effect on improving mental health.
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Affiliation(s)
- Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa M Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, CA, USA
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Mwangala PN, Mabrouk A, Wagner R, Newton CRJC, Abubakar AA. Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review. BMJ Open 2021; 11:e052810. [PMID: 34551953 PMCID: PMC8461287 DOI: 10.1136/bmjopen-2021-052810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes. DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA The following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included. DATA EXTRACTION AND SYNTHESIS We extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies. RESULTS A total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%-59%), cognitive impairments (4%-61%) and frailty (3%-15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent. CONCLUSIONS This review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors. PROSPERO REGISTRATION NUMBER CRD42020145791.
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Affiliation(s)
- Patrick Nzivo Mwangala
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Adam Mabrouk
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ryan Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parkton, Gauteng, South Africa
| | - Charles R J C Newton
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina A Abubakar
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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Belay YB, Ali EE, Sander B, Gebretekle GB. Health-related quality of life of patients with HIV/AIDS at a tertiary care teaching hospital in Ethiopia. Health Qual Life Outcomes 2021; 19:24. [PMID: 33468153 PMCID: PMC7816449 DOI: 10.1186/s12955-021-01670-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients’ health-related quality of life (HRQoL) and health state utility values are critical inputs in the clinical and economic evaluation of treatments for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). However, information on health state utility values is lacking in the context of Ethiopia. Here, we aimed to assess HRQoL and determine health state utility values and factors that influence the values among HIV/AIDS patients in Ethiopia.
Methods A cross-sectional study was conducted among 511 HIV/AIDS patients at Tikur Anbessa Specialized Hospital in Ethiopia. Patients aged 18 years or older were eligible for the interview and those who were mentally unstable and with hearing impairment were excluded from the study. We performed face-to-face interviews using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) in combination with EuroQol-Visual Analog Scales (EQ-VAS). Level-specific disutility coefficients obtained from the general population were used for computing utility values. Patients’ health profiles were described using percentages and different statistical analysis were conducted to determine factors associated with the EQ-5D index and EQ-VAS scores.
Results A total of 511 patients participated in the study. A higher proportion of patients reported slight or more severe problems on the anxiety/depression (55.2%) and pain/discomfort (51.3%) dimensions. The overall median utility value of HIV/AIDS patients was 0.94 (IQR = 0.87, 1) from the EQ-5D index and 80% (IQR = 70%, 90%) from the EQ-VAS scores. Demographic characteristics including age, occupational status, and household monthly income significantly affected patient’s utility values. Moreover, statistically significant (p < 0.001) differences were seen between the EQ-5D index values of patients with different CD4 count intervals. Furthermore, number of medicines that the patients were taking at the time of the study and comorbidities were significantly associated with the EQ-5D utility index and EQ-VAS score, p < 0.001. Conclusions The anxiety/depression and pain/ discomfort dimensions were identified to have critical influence in reducing the HRQoL of adult HIV/AIDS patients in the context of Ethiopia. The study is also the first to use the EQ-5D-5L tool to identify health state utility values for Ethiopian adult HIV/AIDS patients. Future economic evaluations of HIV/AIDS interventions are encouraged to employ the identified utility values.
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Affiliation(s)
- Yared Belete Belay
- School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia.
| | - Eskinder Eshetu Ali
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Gebremedhin Beedemariam Gebretekle
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
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Abboah-Offei M, Bristowe K, Harding R. Are patient outcomes improved by models of professionally-led community HIV management which aim to be person-centred? A systematic review of the evidence. AIDS Care 2020; 33:1107-1117. [PMID: 32741201 DOI: 10.1080/09540121.2020.1798865] [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: 10/23/2022]
Abstract
UNAIDS advocates person-centred care (PCC) for people living with HIV/AIDS (PLWHA) to improve outcomes and wellbeing. We appraised the evidence of person-centred models of community HIV care delivered or led by trained healthcare professionals and its impact on care outcomes. A systematic review was conducted in line with PRISMA guidance. Six electronic databases (CINAHL, Embase, PubMed, Medline, PsycINFO and Web of Science) were searched from January 1980 to April 2019. We included primary studies of any design of PCC models; for adults aged ≥15 years; that were delivered or led by trained HCP. Data were extracted including study location, design, quality, outcomes measured and effectiveness. Five out of 1393 studies met the inclusion criteria, of which four were from a high-income country and one a lower-middle income country. Of the PCC components (physical, psychological, social and spiritual wellbeing) delivered alongside HIV clinical management, one study delivered 2, two studies delivered 3 and two studies delivered all 4 components. This review highlights the lack of outcome evidence for person-centred HIV care, and of concurrent focus on all domains of concern for PLWHA within interventions. Clear articulation of the meaning, practice of PCC and implementation strategies are needed to meet policy recommendations.
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Affiliation(s)
- M Abboah-Offei
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - K Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - R Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
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Ghodrati S, Shahabinezhad Z, SeyedAlinaghi S. Association Between Immunologic and Virologic Functioning and Health-Related Quality of Life Among People Living with HIV, Tehran, Iran. Infect Disord Drug Targets 2020; 19:297-303. [PMID: 30574855 DOI: 10.2174/1871526519666181221123932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/11/2018] [Accepted: 12/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND With recent progress in the treatment of people living with HIV (PLWH) and their increased rate of survival, health-related quality of life (HRQoL) has become an important issue. OBJECTIVE In the present study, we aimed to investigate the association of current CD4 cell count, baseline CD4 cell count, nadir CD4 cell count, and plasma viral load with health-related quality of life in PLWH. METHODS Participants were 67 PLWH who were under the treatment of antiretroviral therapy (ART) in Imam Khomeini Hospital of Tehran, Iran in 2016. Participants were divided into the two groups with high and low levels of current CD4 cell count, baseline CD4 cell count, nadir CD4 cell count and plasma viral load. We used independent sample t-test for data analysis using SPSS 22 software. RESULTS Our results demonstrated that for current CD4 cell count, the group differences were significant for total scores of HRQoL (P=0.028), also in the components of physical functioning (P=0.032), role limitation due to physical health problems (P=0.006), and role limitation due to emotional problems (P=0.009). Our data analysis showed that for baseline CD4 cell count (P=0.62), nadir CD4 cell count (P=0.29), and viral load group (P=0.78), the differences were not significant for HRQoL. CONCLUSION Knowing the association between current CD4 count and health-related quality of life, adherence to ART might be a motivator for PLWH to enhance their health-related quality of life.
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Affiliation(s)
- Saeed Ghodrati
- Shahid Beheshti University, Institute for Cognitive and Brain Sciences, Tehran, Iran
| | | | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Abboah-Offei M, Bristowe K, Koffman J, Vanderpuye-Donton NA, Ansa G, Abas M, Higginson I, Harding R. How can we achieve person-centred care for people living with HIV/AIDS? A qualitative interview study with healthcare professionals and patients in Ghana. AIDS Care 2019; 32:1479-1488. [PMID: 31795741 DOI: 10.1080/09540121.2019.1698708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although person-centred care (PCC) has been identified as a means to achieve the 90-90-90 targets, limited research has considered PCC in low- or middle-income settings. We aimed to explore what constitutes PCC from the perspectives of PLWHA and healthcare professionals (HCP) in Ghana. We conducted 39 semi-structured qualitative interviews with PLWHA and HCP in two community clinics in Ghana, West Africa. Interviews were analysed deductively using thematic analysis, and sampling continued until thematic saturation was achieved. Twenty-four PLWHA (median age 42.5, 50% female) and 15 HCP (median age 34, 53% female) were interviewed. Three interconnected themes emerged across PLWHA and HCP: (1) care structures not built around the person, (2) priority outcomes and components of PCC and (3) re-engineering HIV care to be more person-centred. A conceptual model showing the overlap between PLWHA and HCP's perspectives of PCC and a framework to inform PCC delivery have been developed from these findings. Our data revealed that PLWHA want PCC to improve care outcomes, well-being and quality of life. Further testing of this model is required to inform PCC delivery for PLWHA in low- and middle-income countries.
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Affiliation(s)
- Mary Abboah-Offei
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | | | - Gloria Ansa
- University Health Services, University of Ghana Hospital, Accra, Ghana
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience King's College, London, UK
| | - Irene Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
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Kall M, Marcellin F, Harding R, Lazarus JV, Carrieri P. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV 2019; 7:e59-e68. [PMID: 31776101 DOI: 10.1016/s2352-3018(19)30345-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Quality of life has been proposed as the fourth 90 to complement the UNAIDS 90-90-90 targets to monitor the global HIV response, highlighting a need to address the holistic needs of people living with HIV beyond viral suppression. This proposal has instigated a wider discussion about the use of patient-reported outcomes (PROs) to improve the treatment and care of an ageing HIV population with increasing comorbidities and a disproportionate burden of social problems. PROs can provide a first-hand assessment of the impact of HIV treatment and care on patients' quality of life, including symptoms. The field of PRO measures is rapidly expanding but still no gold standard exists, raising concerns about tool selection. Challenges also remain in the collection, interpretation, and use of PRO data to improve the performance of the health system. An emerging concern is how to adapt PROs to different sociocultural and geographical settings.
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Affiliation(s)
- Meaghan Kall
- HIV/STI Department, National Infection Service, Public Health England, London, UK.
| | - Fabienne Marcellin
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, Cicely Saunders Institute, Kings College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Patrizia Carrieri
- Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institution Française Publique de Recherche, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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Nkhoma K, Ahmed A, Alli Z, Sherr L, Harding R. Does sexual behaviour of people with HIV reflect antiretroviral therapy as a preventive strategy? A cross-sectional study among outpatients in Kenya. BMC Public Health 2019; 19:1254. [PMID: 31510974 PMCID: PMC6739960 DOI: 10.1186/s12889-019-7581-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organisation (WHO) advocates early initiation of HIV treatment as a prevention strategy among people living with HIV. There is strong evidence for the effectiveness of antiretroviral therapy (ART) as a preventive tool for HIV transmission. We aimed to determine the sexual behaviour of HIV outpatients and assess if it reflects the current preventive strategy for HIV transmission. Methods We conducted a cross-sectional study among adult (aged at least 18 years) patients with confirmed HIV diagnosis, and aware of their diagnosis, attending HIV outpatient care in Kenya. Data were gathered through self-report (using validated questionnaires) and file extraction. Multivariate logistic regression assessed the association between sexual risk taking behaviour controlling for gender, HIV clinical stage, HIV treatment status, Tuberculosis (TB) treatment status, and CD4 count. Results We recruited n = 400 participants (n = 280[70%] female gender). The mean age was 39.4 (SD = 9.9) years. The mean CD4 count was 393.7 (SD = 238.2) and ranged from 2 to 1470 cells/mm3. N = 61 (15.64%) were on TB treatment. The majority (n = 366, 91.5%) were on ART. Just over half (n = 202, 50.5%) reported having a sexual partner. Of these n = 33 (16.1%) reported having unprotected sexual intercourse with a person of unknown HIV status in the previous 3 months. Multivariate analysis showed that participants not on ART (HIV treatment) were more likely to report unprotected sexual intercourse compared to those who were on ART (odds ratio .25, 95% CI .09 to .69; P = 0.007). Participants at early stage of HIV infection (stages 1/2) were more likely to report unprotected sexual intercourse compared to participants at advanced HIV infection (stages 3/4) (odds ratio .34, 95% CI .13 to .92; P = 0.035). Males participants were more likely to be involved in sexual risk taking behaviours compared to female participants (odds ratio .36, 95% CI .16 to .82; P = 0.015). TB treatment status, and CD4 count were not significantly associated with sexual risk taking. Conclusion Participants not on ART have more unprotected sexual intercourse than those who are on ART. This calls for the need to scale up coverage and early ART initiation in order to reduce transmission of HIV.
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Affiliation(s)
- Kennedy Nkhoma
- Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Denmark Hill Campus, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | | | - Zipporah Alli
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - Richard Harding
- Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Denmark Hill Campus, King's College London, Bessemer Road, London, SE5 9PJ, UK
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Simms V, Downing J, Namisango E, Powell RA, Mwangi-Powell F, Higginson IJ, Harding R. Change in multidimensional problems and quality of life over three months after HIV diagnosis: a multicentre longitudinal study in Kenya and Uganda. BMC Infect Dis 2019; 19:248. [PMID: 30871509 PMCID: PMC6419372 DOI: 10.1186/s12879-019-3855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Evidence on patient-reported outcomes of newly diagnosed HIV patients is scarce, and largely cross-sectional. This prospective cohort study describes the prevalence of, and changes in, patient-reported outcomes in the three months after HIV diagnosis, in 11 HIV outpatient centres in Kenya and Uganda. Methods Adults were recruited within 14 days of result, completing self-report measures four times at monthly intervals. Multilevel mixed-effects linear regression (quality of life continuous outcomes) and ordinal logistic regression (symptoms and concerns categorical outcomes) modelled change over time, with repeated observations grouped within individuals adjusted for demographic/clinical characteristics, and multiple imputation for missing data. Results 438 adults were enrolled and 234 (53·4%) initiated ART. Improvement was found for MOS-HIV physical health (from 46·3 [95% CI 45·1–47·3], to 53·7 [95% CI 52.8–54·6], p < 0.001), and mental health (from 46·4 [95% CI 45·5–47·3] to 54·5 [95% CI 53·7–55·4], p < 0.001). POS subscale ‘interpersonal problems’ improved but remained burdensome (OR = 0·91, 95% CI = 0·87–0·94, p < 0.001; 22·7% reported severe problems at final time point). The scores for the existential POS subscale (OR = 0·95, 95% CI = 0.90–1·00, p = 0.056) and physical/psychological problems POS subscale (OR = 0·97, 95% CI = 0.92–1·02, p = 0.259) did not improve. Participants who initiated ART had worsening physical/psychological (OR = 0·64, 95% CI = 0·41–0·99, p = 0·045) and interpersonal problems (OR = 0·64, 95% CI = 0·42–0·96, p = 0·033). Conclusion Although some self-reported outcomes improve over time, burden of interpersonal problems remains substantial and existential concerns do not improve.
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Affiliation(s)
- Victoria Simms
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England
| | - Julia Downing
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
| | - Eve Namisango
- African Palliative Care Association, P. O. Box 72518, Plot 95, Dr Gibbons Road, Makindye Kampala, Uganda
| | | | | | - Irene J Higginson
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
| | - Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England.
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11
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Lowther K, Harding R, Simms V, Ahmed A, Ali Z, Gikaara N, Sherr L, Kariuki H, Higginson IJ, Selman LE. Active ingredients of a person-centred intervention for people on HIV treatment: analysis of mixed methods trial data. BMC Infect Dis 2018; 18:27. [PMID: 29316883 PMCID: PMC5761128 DOI: 10.1186/s12879-017-2900-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/10/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A new model of care is required to meet the changing needs of people living with HIV (PLWH), particularly in low and middle-income countries, where prevalence is highest. We evaluated a palliative care intervention for PLWH in Mombasa, Kenya. Although we found no effect on pain (primary outcome), there was a positive effect on mental health (secondary outcome) in the intervention group. To inform replication and implementation, we have determined the active ingredients of the intervention and their mechanisms of action. METHODS We conducted a randomised controlled trial (RCT) with qualitative exit interviews in HIV clinic attenders. The intervention was delivered over 5 months, with a minimum of 7 clinical contacts. Longitudinal quantitative data on components of care received were analysed using area under the curve and logistic regression. Qualitative data were analysed using inductive and deductive thematic analysis. RESULTS Quantitative data analysis identified that intervention patients received more weak opioid, laxatives, discussion about spiritual worries, emotional support from staff for themselves and their families, time to talk about worries, discussion about future and planning ahead. Qualitative data analysis found that patients reported that having time to talk, appropriate pain medication and effective health education was of therapeutic value for their psychological well-being. Integration of mixed method findings suggest that positive effect in quantitative measures of mental health and well-being are attributable to the active ingredients of: appropriate medication, effective health education and counselling, and having time to talk in clinical encounters. Mechanisms of action include symptom relief, improved understanding of illness and treatment, and support focused on articulated concerns. CONCLUSIONS Routine care must provide opportunities and means for existing clinical staff to make routine appointments more person-centred. This approach enabled staff to identify and manage multidimensional problems and provide tailored health education and counselling. TRIAL REGISTRATION ClinicalTrials.gov ( NCT01608802 ). Registered 12th May 2012.
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Affiliation(s)
- Keira Lowther
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, SdE59PJ, London, UK. .,Dartington Service Design Lab, Lower Hood Barn, Dartington, Totnes, TQ9 6AB, UK.
| | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, SdE59PJ, London, UK
| | - Victoria Simms
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Aabid Ahmed
- Bomu Hospital, Off Airport Road, P.O. BOX 95683, Mombasa, Soweto, Kenya
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, P.O Box 20854, Nairobi, 00202, Kenya
| | - Nancy Gikaara
- Kenya Hospices and Palliative Care Association, P.O Box 20854, Nairobi, 00202, Kenya
| | - Lorraine Sherr
- Dept of Infection and Population Health, University College London, Rowland Hill Street, London, NW32PF, UK
| | - Hellen Kariuki
- Department of Medical Physiology, University of Nairobi, Chiromo Campus, PO BOX 30197 (00100), Nairobi, Kenya
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, SdE59PJ, London, UK
| | - Lucy Ellen Selman
- Bristol Randomised Controlled Trials Collaboration, School of Social and Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK
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Wakeham K, Harding R, Levin J, Parkes-Ratanshi R, Kamali A, Lalloo DG. The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study. BMC Palliat Care 2017; 17:8. [PMID: 28705181 PMCID: PMC5508714 DOI: 10.1186/s12904-017-0215-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda. METHODS HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures. RESULTS During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more. CONCLUSION Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes. TRIAL REGISTRATION CRYPTOPRO [ISRCTN 76481529 ], November 2004.
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Affiliation(s)
- Katie Wakeham
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. .,Liverpool School of Tropical Medicine, Liverpool, UK. .,Sussex Cancer Centre, Brighton and Sussex University Hospital, Eastern Road, Brighton, BN2 5DA, UK.
| | - Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Jonathan Levin
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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14
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Evidence-Based Programming of HIV Care and Support: Is the Psychosocial "Optional"? J Acquir Immune Defic Syndr 2016; 70:e176-7. [PMID: 26049282 DOI: 10.1097/qai.0000000000000713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mwesigire DM, Martin F, Seeley J, Katamba A. Relationship between CD4 count and quality of life over time among HIV patients in Uganda: a cohort study. Health Qual Life Outcomes 2015; 13:144. [PMID: 26370702 PMCID: PMC4570610 DOI: 10.1186/s12955-015-0332-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunological markers (CD4 count) are used in developing countries to decide on initiation of antiretroviral therapy and monitor HIV/AIDS disease progression. HIV is an incurable chronic illness, making quality of life paramount. The direct relationship between quality of life and CD4 count is unclear. The purpose of this study is to determine the relationship between change in CD4 count and quality of life measures in a Ugandan cohort of people living with HIV. METHODS We prospectively assessed quality of life among 1274 HIV patients attending an HIV clinic within a national referral hospital over a period of 6 months. Quality of life was measured using an objective measure, the Medical Outcomes Study HIV health survey summarized as Physical Health Score and Mental Health Score and a subjective measure, the Global Person Generated Index. Generalized estimating equations were used to analyze the data. The primary predictor variable was change in CD4 count, and the outcome was quality of life scores. We controlled for sociodemographic characteristics, clinical factors and behavioral factors. Twenty in-depth interviews were conducted to assess patient perception of quality of life and factors influencing quality of life. RESULTS Of the 1274 patients enrolled 1159 had CD4 count at baseline and six months and 586 (51%) received antiretroviral therapy. There was no association found between change in CD4 count and quality of life scores at univariate and multivariate analysis among the study participants whether on or not on antiretroviral therapy. Participants perceived quality of life as happiness and well-being, influenced by economic status, psychosocial factors, and health status. CONCLUSIONS Clinicians and policy makers cannot rely on change in immunological markers to predict quality of life in this era of initiating antiretroviral therapy among relatively healthy patients. In addition to monitoring immunological markers, socioeconomic and psychosocial factors should be underscored in management of HIV patients.
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Affiliation(s)
| | - Faith Martin
- Department of Psychology, University of Bath, Bath, United Kingdom.
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda.
| | - Achilles Katamba
- Department of Medicine, Makerere College of Health Sciences, PO Box 7072, Kampala, Uganda.
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Lowther K, Selman L, Simms V, Gikaara N, Ahmed A, Ali Z, Kariuki H, Sherr L, Higginson IJ, Harding R. Nurse-led palliative care for HIV-positive patients taking antiretroviral therapy in Kenya: a randomised controlled trial. Lancet HIV 2015; 2:e328-34. [PMID: 26423375 DOI: 10.1016/s2352-3018(15)00111-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with HIV accessing antiretroviral therapy (ART) have persistent physical, psychological, social, and spiritual problems, which are associated with poor quality of life and treatment outcomes. We assessed the effectiveness of a nurse-led palliative care intervention on patient-reported outcomes. METHODS We did this randomised controlled trial at a clinic in Kenya for adults with HIV, established on ART, and reporting moderate-to-severe pain or symptoms. We randomly assigned participants (1:1) either to a palliative care intervention (including assessments of physical, emotional, and spiritual wellbeing and quality of life) given six times over 4 months, or to usual care. Participants and investigators were not masked to allocation. The primary outcome was pain (scored on the African Palliative Care Association's African Palliative Outcome Scale). This trial is registered with ClinicalTrials.gov, number NCT01608802. FINDINGS We screened 2070 patients, of whom we enrolled 120: 60 allocated to each group. In the control group, median pain score improved from 1·0 (IQR 0·0-2·0) at baseline to 5·0 (3·0-5·0) at 4 months; in the intervention group, it improved from 1·0 (0·0-2·0) at baseline to 4·5 (3·0-5·0) at 4 months. Compared with standard care, the intervention had no significant effect on pain (coefficient -0·01, 95% CI -0·36 to 0·34, p=0·95). INTERPRETATION A nurse-led palliative care intervention was not effective in reducing pain. However, person-centred assessment and care delivered by staff who have received additional training had positive effects on self-reported mental health related quality of life and psychosocial wellbeing. FUNDING Diana Princess of Wales Memorial Fund.
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Affiliation(s)
- Keira Lowther
- Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Lucy Selman
- Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Victoria Simms
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nancy Gikaara
- Kenyan Hospice Palliative Care Association, Nairobi, Kenya
| | | | - Zipporah Ali
- Kenyan Hospice Palliative Care Association, Nairobi, Kenya
| | - Hellen Kariuki
- Department of Medical Physiology, University of Nairobi, Nairobi, Kenya
| | - Lorraine Sherr
- Department of Infection and Population Health, University College London, London, UK
| | - Irene J Higginson
- Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Richard Harding
- Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
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