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Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study
BACKGROUND: Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities. METHODS:...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240824/ https://www.ncbi.nlm.nih.gov/pubmed/25403371 http://dx.doi.org/10.1186/s12879-014-0613-1 |
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author | Harding, Richard Simms, Victoria Penfold, Suzanne Downing, Julia Namisango, Eve Powell, Richard A Mwangi-Powell, Faith Moreland, Scott Gikaara, Nancy Atieno, Mackuline Higginson, Irene J |
author_facet | Harding, Richard Simms, Victoria Penfold, Suzanne Downing, Julia Namisango, Eve Powell, Richard A Mwangi-Powell, Faith Moreland, Scott Gikaara, Nancy Atieno, Mackuline Higginson, Irene J |
author_sort | Harding, Richard |
collection | PubMed |
description | BACKGROUND: Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities. METHODS: In a multicentre 2 country cross-sectional study, adults attending 12 facilities in Kenya and Uganda gave self-reported data on quality of life (physical and mental wellbeing dimensions), functional and a measure of multidimensional problems (physical, psychological, social and spiritual). RESULTS: Among the 1,337 participants, multidimensional problems were more common in psychological, spiritual and social domains than in physical. In multivariable analysis using GEE to adjust for facility effect, the mental health subscale of quality of life was lower for people with limited functional status (B = -5.27, 95% CI -5.99, 1. -4.56 p < 0.001) and higher for wealthier people (B = 0.91, 95% CI 0.48, 1.33, p < 0.001). The physical health subscale of quality of life was lower for those with limited functional status (B = -8.58, 95% CI -9.46 to -7.70, p < 0.001) and those who had a caregiver present (B = -1.97, 95% CI -3.72 to -0.23, p = 0.027), higher for wealthier people (B = 1.14, 95% CI 0.65, 1.64, p < 0.001), and positively associated with CD4 count (B = 1.61, 95% CI 1.08-2.14, p < 0.001). Multidimensional problems were more burdensome for people with limited functional status (B = -2.06, 95% CI -2.46 to -1.66, p < 0.001), and less burdensome with more education (B = 0.63, 95% CI 0.25-1.00, p = 0.001) or ART use (B = 0.94, 95% CI 0.34-1.53, p = 0.002). CONCLUSIONS: Multidimensional problems are highly prevalent, and worse with declining function. Importantly, ART use does not appear to be protective for self-reported physical and mental dimensions of quality of life. Assessment and management of self-reported wellbeing must form part of HIV care and treatment services to ensure maximum benefit from ART investment. |
format | Online Article Text |
id | pubmed-4240824 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42408242014-11-23 Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study Harding, Richard Simms, Victoria Penfold, Suzanne Downing, Julia Namisango, Eve Powell, Richard A Mwangi-Powell, Faith Moreland, Scott Gikaara, Nancy Atieno, Mackuline Higginson, Irene J BMC Infect Dis Research Article BACKGROUND: Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities. METHODS: In a multicentre 2 country cross-sectional study, adults attending 12 facilities in Kenya and Uganda gave self-reported data on quality of life (physical and mental wellbeing dimensions), functional and a measure of multidimensional problems (physical, psychological, social and spiritual). RESULTS: Among the 1,337 participants, multidimensional problems were more common in psychological, spiritual and social domains than in physical. In multivariable analysis using GEE to adjust for facility effect, the mental health subscale of quality of life was lower for people with limited functional status (B = -5.27, 95% CI -5.99, 1. -4.56 p < 0.001) and higher for wealthier people (B = 0.91, 95% CI 0.48, 1.33, p < 0.001). The physical health subscale of quality of life was lower for those with limited functional status (B = -8.58, 95% CI -9.46 to -7.70, p < 0.001) and those who had a caregiver present (B = -1.97, 95% CI -3.72 to -0.23, p = 0.027), higher for wealthier people (B = 1.14, 95% CI 0.65, 1.64, p < 0.001), and positively associated with CD4 count (B = 1.61, 95% CI 1.08-2.14, p < 0.001). Multidimensional problems were more burdensome for people with limited functional status (B = -2.06, 95% CI -2.46 to -1.66, p < 0.001), and less burdensome with more education (B = 0.63, 95% CI 0.25-1.00, p = 0.001) or ART use (B = 0.94, 95% CI 0.34-1.53, p = 0.002). CONCLUSIONS: Multidimensional problems are highly prevalent, and worse with declining function. Importantly, ART use does not appear to be protective for self-reported physical and mental dimensions of quality of life. Assessment and management of self-reported wellbeing must form part of HIV care and treatment services to ensure maximum benefit from ART investment. BioMed Central 2014-11-18 /pmc/articles/PMC4240824/ /pubmed/25403371 http://dx.doi.org/10.1186/s12879-014-0613-1 Text en © Harding et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Harding, Richard Simms, Victoria Penfold, Suzanne Downing, Julia Namisango, Eve Powell, Richard A Mwangi-Powell, Faith Moreland, Scott Gikaara, Nancy Atieno, Mackuline Higginson, Irene J Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study |
title | Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study |
title_full | Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study |
title_fullStr | Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study |
title_full_unstemmed | Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study |
title_short | Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study |
title_sort | quality of life and wellbeing among hiv outpatients in east africa: a multicentre observational study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240824/ https://www.ncbi.nlm.nih.gov/pubmed/25403371 http://dx.doi.org/10.1186/s12879-014-0613-1 |
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