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 Harding 1 , Victoria Simms 1 , Suzanne Penfold 1 , Eve Namisango 2 , Tony Powell 2 , Faith Mwangi-Powell 2 , Julia Downing 2 , Scott Moreland 3 , Irene J Higginson 1 1) 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/
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WHO Collaborating Centre for Palliative Care & Older People Mental and physical health and multidimensional problems among HIV outpatients in East Africa:
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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/
www.csi.kcl.ac.uk
• 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)
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