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Mental and physical health and multidimensional problems among HIV outpatients in East Africa: a multicentre observational study.

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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 Higginson11) 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/


B ackground
B among ackground

  • 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?


Aim among

  • 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)


Results 1 n 1 337 worst problems on pos
Results #1 among N=1,337 Worst problems on POS


Results 2 n 1 337 associations with outcomes gee
Results among #2 N=1,337 Associations with outcomes (GEE)

NOTE: No significance gender, age


Conclusions
Conclusions among

  • 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)