Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study

BMC Infectious Diseases

Irene J Higginson²  Mackuline Atieno⁶  Nancy Gikaara⁶  Scott Moreland¹  Faith Mwangi-Powell³  Richard A Powell⁴  Eve Namisango⁶  Julia Downing⁶  Suzanne Penfold²  Victoria Simms⁵  Richard Harding² 

[1] Futures Group, MEASURE Evaluation, University of North Carolina, Chapel Hill, USA;King’s College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Bessemer Road, London SE5 9RJ, UK;Formerly APCA and Currently in USAID

[2] ASSIST, University Research Company, Nairobi, Kenya;Global Health and Knowledge Management Consultant, London, UK;London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK;African Palliative Care Association, Plot 850 Dr Gibbons Road, Kampala, Kampala, Uganda

关键词: Mental health;    Sub-Saharan Africa;    Self-report;    Quality of life;    HIV;   

Others  :  1122005
DOI  :  10.1186/s12879-014-0613-1

 received in 2014-08-04, accepted in 2014-11-04,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Harding et al.; licensee BioMed Central Ltd.

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