Caregiver versus self-reported activities of daily living among HIV-positive persons in Rakai, Uganda

Abstract

Assessment of an individual's functional status, as measured by activities of daily living (ADL), is an essential element in the diagnosis of HIV-associated neurocognitive disorders (HAND) but individuals with cognitive impairment may not accurately report ADL. We assessed agreement between self-and caregiver-reported ADL in HIV-positive persons. Antiretroviral therapy (ART)naïve HIV-positive persons (n=321) and HIV-negative controls (n=134) in Rakai, Uganda, completed neurocognitive tests and an ADL questionnaire. Co-resident relatives ("caregivers") were independently administered the ADL questionnaire to determine their perception of the participant's ADL. The relationship between neurocognitive impairment and participant-caregiver agreement was assessed using kappa statistics. Regression was used to estimate adjusted prevalence ratios (AdjPR) of participant-caregiver agreement on disability scores. Relative to HIVnegative adults, HIV-positive participants scoring at least 1 standard deviation (SD) below the norm on 2 or more neurocognitive tests were classified as having mild neurocognitive impairment and those scoring at least 2 SD below the norm on 2 or more neurocognitive tests were classified as having moderate-to-severe Mean age was 36 years (SD 8.9), and 53% of participants were male. The rate of ADL agreement between participants and caregivers was 77% for HIV-positive and 87% for HIV-negative participants (AdjPR= 0.89, 95% CI 0 .81-0 .97, p=0.01). Among HIV-positive participants, 41% had moderate neurocognitive impairment, 15% had severe neurocognitive impairment, and 44% were normal. For moderate neurocognitive impairment, the rate of ADL agreement was 69% and for severe neurocognitive impairment it was 66%. Compared to non-impaired HIV-positive participants (86% ADL agreement), ADL agreement was lower with moderate impairment (AdjPR=0.89, 95%CI 0 .81-0 .98, p=0.023) and severe impairment (AdjPR=0.77, 95%CI 0.63-0 . 95, p=0.014). Gender, education and CD4 count were not associated with ADL agreement.

El papel de las funciones ejecutivas en la calidad de vida en personas con VIH en situación de vulnerabilidad social

“…A este respecto se recuerda el subestudio en el que se comprobó como el grupo de PVIH en situación de vulnerabilidad social presentaba una sobreestimación de su funcionamiento en FE, por lo cual se constató la necesidad de utilizar una herramienta de evaluación de las FE por informantes con dicho grupo. Estos resultados concuerdan con los del estudio de Kisakye et al (2018), en el cual compararon a 321 PVIH con 134 personas no VIH en HAND y en AIVD, preguntando a los cuidadores de las PVIH sobre la AIVD de las PVIH, resultando que las PVIH con HAND presentaban un menor acuerdo con los informes de las AIVD de los cuidadores, que las PVIH sin HAND. Y finalmente, al evaluar las FE del grupo de PVIH en situación de vulnerabilidad social mediante una prueba de evaluación por informantes, se añade el posible sesgo de que han participado varios examinadores.…”