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King’s College London

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WHO Collaborating Centre for
Palliative Care & Older People
Mental and physical health and
multidimensional problems among
HIV outpatients in East Africa: a
multicentre observational study
Richard Harding1, Victoria Simms1, Suzanne Penfold1, Eve Namisango2,
Tony Powell2, Faith Mwangi-Powell2, Julia Downing2, Scott Moreland3,
Irene J Higginson1
1) King’s College London, Cicely Saunders Institute. 2) African Palliative Care Association, Uganda. 3) MEASURE Evaluation, USA.
Cicely Saunders Institute
Department of Palliative Care, Policy & Rehabilitation
King’s College London
http://www.csi.kcl.ac.uk/
Background
• Problems (physical, psychological, social, spiritual) persist:
– from diagnosis (Simms 2011), alongside ART (Lowther 2014)
– Yet most investigation is in advanced disease (Harding 2012/13/14)
• WHO defines “health” as “complete physical, psychological
and social wellbeing”
• WHO recommends assessment and management of these
problems throughout disease trajectory
• PEPFAR funding has decreased mortality (Bendavid 2009)
and vertical transmission (Reynolds 2008)
• Is optimal benefit from PROM perspective being achieved?
www.csi.kcl.ac.uk
Aim
• To measure patient wellbeing using PROMS
among HIV outpatients at 12 PEPFAR-funded
facilities in Kenya & Uganda, and to determine
associations with patent problems
– MOS-HIV (Quality of life)
– POS (physical/psychological/social/spiritual
problems)
www.csi.kcl.ac.uk
Results #1
N=1,337 Worst problems on POS
0-1 None/mild
2-3 Moderate
4-5 Severe
Help/advice to plan
20.7%
27.7%
51.6%
Sharing feelings
26.3%
30.2%
43.5%
At peace
43.3%
35.6%
21.1%
Worry
52.1%
34.9%
13.0%
Life worthwhile
62.6%
25.1%
12.3%
Pain
42.1%
48.2%
9.7%
Symptoms
57.7%
38.1%
4.2%
www.csi.kcl.ac.uk
Results #2 N=1,337
Associations with outcomes (GEE)
Mental health
B
Wealth
0.93
Z
p
Physical health
95% CIs
4.47 <0.001 0.52-1.34
B
1.16
Z
p
4.76 <0.001
Total POS score
95% CIs
B
Z
p
95% CIs
0.68-1.64
quintile
Functional
-6.06 to
-5.36 -14.85 <0.001
status
-8.56
-4.65
Has a carer
-9.44 to
<0.001
-2.47 to
-2.07 -10.23 <0.001
19.13
-7.69
-2.12 -2.38 0.017
-3.87 to
-1.68
-0.37
CD4 count
1.60
5.97 <0.001
1.08-2.13
Education
0.70
3.78
<0.001
0.34-1.07
Using ART
0.94
3.10
0.002
0.34-1.53
NOTE: No significance gender, age
www.csi.kcl.ac.uk
Conclusions
• We risk reducing HIV services to “test & treat”
• Simple assessment and care protocols are feasible
and urgently required
• As greater numbers live with HIV long-term, we must
ensure this is an optimal QoL
• Psychosocial needs are greatest
• Pain is also endured
• ART is central but not the complete answer
• These problems are shown to affect key outcomes
of QoL, adherence, switching, suicidal ideation,
virological rebound (Harding JIAS 2014)
• We CAN improve these outcomes (TOPCare trial
WEPE219)
www.csi.kcl.ac.uk
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