Amsterdam 2015
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| Abstract #2327 - No health without mental health | ||||
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Session: 40.3: No health without mental health (Parallel) on Thursday @ 16.30-18.00 in C103 Chaired by Mark Tomlinson, Tomas Campbell Authors: Presenting Author: Dr Victoria Simms - London School of Hygiene and Tropical Medicine, United Kingdom |
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| Aim: Few studies have prospectively investigated needs and quality of life at the time of HIV diagnosis. This paper aimed to describe multidimensional problems and health related quality of life in the three months following HIV diagnosis and entry into care for outpatient adults in East Africa, using a prospective cohort. | ||||
| Method / Issue: In Uganda and Kenya, participants were recruited within 14 days of testing positive for HIV at 11 outpatient facilities. These facilities provided multidimensional care, including symptom management, social support, counselling and antiretroviral therapy. Participants were aged 18 and over, and gave informed consent to participate. Data were collected as part of a service evaluation. Participants completed the validated 35-item MOS-HIV and APCA African Palliative Outcome Scale (POS) four times at monthly intervals. The POS was analysed as 3 factors: physical/psychological, interpersonal and existential. Physical health (PHS) and mental health (MHS) summary scores were calculated from the MOS-HIV. Multilevel mixed-effects linear regression (for the continuous MOS-HIV summary scores) or ordinal logistic regression (for the categorical POS factors) were used to fit models, with repeated observations grouped within individuals, and a 5% significance level. Time since HIV diagnosis was fitted as a continuous variable, measured in weeks. | ||||
| Results / Comments: 438 participants were enrolled. 62% were female mean age was 36 for men, 31 for women. 322 (73.5%) completed 4 clinic visits within 20 weeks of diagnosis. 234 (53.4%) initiated ART during the study period. In multivariate analysis, improved MHS was associated with full physical function, older age, use of ART, residence in Kenya and time. Improved PHS was associated with full physical function, less poverty and time. Improved physical/psychological problems was associated with full physical function, less poverty, use of ART and residence in Kenya. Improved interpersonal problems was associated with more poverty, use of ART and time. Improved existential problems was associated with full physical function and residence in Kenya, and weakly with time. | ||||
| Discussion: The period immediately after diagnosis is the time when crucial decisions about care must be made and adherence habits established. Loss from care and risk of mortality are highest in the first three months. This study sheds light on patients’ needs during this important time. Multidimensional problems decrease and health related quality of life improves in the three months following diagnosis, but the burden especially of interpersonal problems remains high. Holistic care is required to manage this unmet need. Priority groups include pre-ART patients, poorer people and people with disabilities. | ||||
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