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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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  1. 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/

  2. 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?

  3. 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)

  4. Results #1 N=1,337 Worst problems on POS

  5. Results #2 N=1,337 Associations with outcomes (GEE) NOTE: No significance gender, age

  6. 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)

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