Barcelona 2013
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| Abstract #127 - Psychological state | ||||
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Session: 6.6: Psychological state (Parallel) on Monday @ 11.00-13.00 in Auditorio Chaired by Barbara Hedge, Susannah Allison Authors: Presenting Author: Dr Richard Harding - Kings College London , United Kingdom |
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| Additional Authors: | ||||
| Aim: Palliative care is indicated throughout the HIV disease trajectory. However, there is a lack of evidence to determine what aspects of generalist palliative care should be provided | ||||
| Method / Issue: Consecutive HIV positive adult outpatients were recruited at 12 PEPFAR-funded sites across Kenya and Uganda, facilities selected from a random sample stratified by size. Patients gave self-report responses to the MOS-HIV and the APCA African POS. Following descriptive analysis, multivariable regression models were constructed. Multilevel fixed-effects linear regression was used to analyse whether scores were associated with personal characteristics, adjusting for facility clustering. Population-averaged models were fitted using GEE to adjust for the effect of facility. | ||||
| Results / Comments: 1,336 individuals participated, majority female (53.8%). On the POS severe problems were most common for the items need for help/advice and difficulty sharing feelings. In seven facilities, more than half of participants had severe problems with obtaining help/advice. Using GEE, mental health was lower for people with limited functional status (B=-5.36 95% CI -6.06 to -4.65, p<0.001) and slightly higher for wealthier people (B=0.93, 95% CI 0.52, 1.34, p<0.001). Physical health was lower for those with limited functional status (B=-8.56 95%CI -9.44 to -7.69 p<0.001) or those who had a carergiver present (B=-2.12 95% CI 0.68 to 1.64 p<0.001), higher for wealthier people (B=1.16 95% CI 0.68-1.64 p<0.001), and positively associated with CD4 count (B=1.60 95% CI 1.08-2.13 p<0.001). Palliative care problems were more burdensome for people with limited functional status (B=-2.07 95% CI -2.47 to -1.68 p<0.001), less burdensome for those with more education (B=0.70 95% CI0.34 to 1.07 p<0.001) or those using ART (B=0.94 95% CI 0.34 to 1.53 p=0.002). | ||||
| Discussion: Patients report a high need to share their feelings and to receive help and advice. These are simple interventions that need not be costly but may pose challenges in a context of stigma and high patient load. Patients with limited physical function require greater care, and although ART use is associated with lower levels of total palliative care need, physical and mental health problems were not lower. Inequalities in terms of wealth and education persist. Simple integration of core palliative care skills must be designed in line with specific population needs and must be feasible in outpatient contexts. | ||||
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