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Sagaon-Teyssier L, Vilotitch A, Mora M, Maradan G, Guagliardo V, Suzan-Monti M, Dray-Spira R, Spire B. A generalized additive model to disentangle age and diagnosis-specific cohort effects in psychological and behavioral outcomes in people living with HIV: the French cross-sectional ANRS-VESPA2 survey. BMC Public Health 2019; 19:590. [PMID: 31101129 PMCID: PMC6525437 DOI: 10.1186/s12889-019-6905-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/29/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Unlike their younger counterparts, some of today's older HIV patients were diagnosed before the advent of highly active antiretroviral therapy (HAART). The psychosocial and behavioral outcomes of people living with HIV (PLWH) have been widely studied, and associated factors are well known. However, their evolution both in terms of age and diagnosis-specific cohort effects is not well understood. METHODS Data from the ANRS-VESPA2 cross-sectional survey, representative of French PLWH, were used to investigate whether psychosocial and behavioral outcomes such as quality of life, need for support and HIV status disclosure, evolve under both the influence of patients' age and diagnosis-specific cohort effects. A semi-parametric generalized additive model (GAM) was employed. The physical and mental components of health-related quality of life, the need for material and moral support, and HIV-status disclosure, constituted our outcomes. RESULTS Non-linear diagnosis-specific cohort effects were found for physical and mental QoL and HIV-status disclosure. Overall, physical QoL was better in recently diagnosed patients than in those diagnosed in the early 1980s. An increasing influence of diagnosis-specific cohort effects between 1983 and 1995 was observed. No cohort effects were noticeable between 1996 and 2000, while an increasing influence was apparent for patients diagnosed with HIV from 2000 to 2011 (year of study). For mental QoL, the only increase was observed in participants diagnosed with HIV between 1983 and 2000. The relationship between diagnosis-specific cohort effects and HIV status disclosure was negative overall: participants diagnosed after 2000 were much less likely to disclose than those diagnosed before 1995. The effect of age was significantly associated with all outcomes, with a non-linear influence on mental QoL and with the need for material/moral support. CONCLUSIONS Psychosocial and behavioral outcomes are complex processes which can be explained in different ways by a combination of the clinical and social contexts which PLWH are exposed to at the time of diagnosis, and by developmental characteristics. A greater understanding of these processes could inform healthcare policy-making for specific HIV generations and different HIV age groups.
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Affiliation(s)
- Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France. .,ORS PACA, Southeastern Health Regional Observatory, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France.
| | - Antoine Vilotitch
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France.,ORS PACA, Southeastern Health Regional Observatory, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France.,ORS PACA, Southeastern Health Regional Observatory, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France
| | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France.,ORS PACA, Southeastern Health Regional Observatory, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France
| | - Valérie Guagliardo
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France.,ORS PACA, Southeastern Health Regional Observatory, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France.,ORS PACA, Southeastern Health Regional Observatory, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France
| | - Rosemary Dray-Spira
- INSERM, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, 56, Boulevard Vincent Auriol - CS 81393 - 75646, F-75013, Paris Cedex 13, France.,Pierre Louis Institute of Epidemiology and Public Health, Team Research in social epidemiology, Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, 56, Boulevard Vincent Auriol - CS 81393 - 75646, F-75013, Paris Cedex 13, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France.,ORS PACA, Southeastern Health Regional Observatory, 27 Bd Jean Moulin, 13385, Marseille Cedex 5, France
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