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 InstituteDepartment of Palliative Care, Policy & RehabilitationKing’s College Londonhttp://www.csi.kcl.ac.uk/

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• 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?

Background

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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)

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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%

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Results #2 N=1,337 Associations with outcomes (GEE)

  Mental health Physical health Total POS score

  B Z p 95% CIs B Z p 95% CIs B Z p 95% CIs

Wealth

quintile

0.93 4.47 <0.001 0.52-1.34 1.16 4.76 <0.001 0.68-1.64        

Functional

status -5.36 -14.85 <0.001-6.06 to

-4.65-8.56

-

19.13<0.001

-9.44 to

-7.69-2.07 -10.23 <0.001

-2.47 to

-1.68

Has a carer         -2.12 -2.38 0.017 -3.87 to

-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

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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)