Reduced HIV symptoms and improved health‐related quality of life correlate with better access to care for HIV‐1 infected women: the ELLA study

Baran, Robert W.; Mulcahy, Fiona; Krznaric, Ivanka; Monforte, Antonella d’Arminio; Самарина, А. В.; He, Xiaoyun; Cassetti, Isabel; Madruga, José Valdez; Zachry, Woodie M.; Wyk, Jean van; Martínez, Marisol

doi:10.7448/ias.17.4.19616

Cited by 10 publications

(5 citation statements)

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“…Symptom burden impacts adherence to cART and health outcomes along the HIV disease care continuum (Baran et al, 2014; Gay et al, 2011; Kempf et al, 2009; Mugavero, Amico, Horn, & Thompson, 2013). During clinic visits and while addressing adherence to cART, providers should be particularly sensitive to identifying and managing symptoms that are causing patient distress, regardless of the source of the symptoms.…”

Section: Discussionmentioning

confidence: 99%

Identifying Symptom Patterns in People Living With HIV Disease

Wilson¹,

Azuero²,

Vance³

et al. 2016

Journal of the Association of Nurses in AIDS Care

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Symptoms guide disease management, and patients frequently report HIV-related symptoms, but HIV symptom patterns reported by patients have not been described in the era of improved antiretroviral treatment. The objectives of our study were to investigate the prevalence and burden of symptoms in people living with HIV and attending an outpatient clinic. The prevalence, burden, and bothersomeness of symptoms reported by patients in routine clinic visits during 2011 were assessed using the 20-item HIV Symptom Index. Principal component analysis was used to identify symptom clusters and relationships between groups using appropriate statistic techniques. Two main clusters were identified. The most prevalent and bothersome symptoms were muscle aches/joint pain, fatigue, and poor sleep. A third of patients had seven or more symptoms, including the most burdensome symptoms. Even with improved antiretroviral drug side-effect profiles, symptom prevalence and burden, independent of HIV viral load and CD4+ T cell count, are high.

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Section: Discussionmentioning

confidence: 99%

Identifying Symptom Patterns in People Living With HIV Disease

Wilson¹,

Azuero²,

Vance³

et al. 2016

Journal of the Association of Nurses in AIDS Care

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“…The previous meta-analysis did not examine the association of PTSD and fine motor skills (Scott et al 2015). Although HIV+ women may have a presumed vulnerability because of their medical status, HIV+ women in the WIHS and in the community have had greater access to medical care and social services compared with at-risk HIV− women (Baran et al 2014). It is possible that greater access to care may mitigate against particular cognitive declines and mental health conditions including PTSD.…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic stress is associated with verbal learning, memory, and psychomotor speed in HIV-infected and HIV-uninfected women

et al. 2015

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The prevalence of post-traumatic stress disorder (PTSD) is higher among HIV-infected (HIV+) women compared with HIV-uninfected (HIV−) women, and deficits in episodic memory are a common feature of both PTSD and HIV infection. We investigated the association between a probable PTSD diagnosis using the PTSD Checklist-Civilian (PCL-C) version and verbal learning and memory using the Hopkins Verbal Learning Test in 1004 HIV+ and 496 at-risk HIV− women. HIV infection was not associated with a probable PTSD diagnosis (17 % HIV+, 16 % HIV−; p=0.49) but was associated with lower verbal learning (p<0.01) and memory scores (p<0.01). Irrespective of HIV status, a probable PTSD diagnosis was associated with poorer performance in verbal learning (p<0.01) and memory (p<0.01) and psychomotor speed (p<0.001). The particular pattern of cognitive correlates of probable PTSD varied depending on exposure to sexual abuse and/or violence, with exposure to either being associated with a greater number of cognitive domains and a worse cognitive profile. A statistical interaction between HIV serostatus and PTSD was observed on the fine motor skills domain (p= 0.03). Among women with probable PTSD, HIV− women performed worse than HIV+ women on fine motor skills (p=0.01), but among women without probable PTSD, there was no significant difference in performance between the groups (p= 0.59). These findings underscore the importance of considering mental health factors as correlates to cognitive deficits in women with HIV.

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“…22 Some studies have used qualitative methods and psychometric measures to try and understand why patients do not engage with care. HIV stigma is found to be a significant barrier [32][33][34][35] and health beliefs may also deter people from attending for care. 36 A qualitative study on non-attendance of HIV clinics in Scotland highlighted issues of mental health, isolation, stigma, poverty and complex social circumstances as contributing to disengagement from care.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

Howarth

Apea

Michie

et al. 2017

Health Serv Deliv Res

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BackgroundAntiretroviral therapy (ART) benefits individuals living with human immunodeficiency virus (HIV) through reduced morbidity and mortality, and brings public health gains through a reduction in HIV transmission. People living with human immunodeficiency virus (PLWH) need to know their HIV status and engage in HIV care in order for these individual and public health benefits to be realised.ObjectiveTo explore, describe and understand HIV outpatient attendance in PLWH, in order to develop cost-effective interventions to optimise engagement in care.DesignA mixed-methods study incorporating secondary analysis of data from the UK Collaborative HIV Cohort (UK CHIC) study and primary data collection.MethodsPhase 1 – an engagement-in-care (EIC) algorithm was developed to categorise patients as in care or out of care for each month of follow-up. The algorithm was used in group-based trajectory analysis to examine patterns of attendance over time and of the association between the proportion of months in care before ART initiation and post-ART mortality and laboratory test costs. Phase 2 – a cross-sectional survey was conducted among patients attending seven London HIV clinics. Regular attenders (all appointments attended in past year), irregular attenders (one or more appointments missed in past year) and non-attenders (recent absence of ≥ 1 year) were recruited. A ‘retention risk tool’ was developed to identify those at risk of disengaging from care. Individual in-depth interviews and focus groups were conducted with PLWH. Phase 3 – key informant interviews were conducted with HIV service providers. Interventions were developed from the findings of phases 2 and 3.ResultsPlots from group-based trajectory analysis indicated that four trajectories best fitted the data. Higher EIC is associated with reduced mortality but the association between EIC before starting ART, and post-ART mortality [relative hazard (RH) per 10% increase in EIC 0.29, 95% confidence interval (CI) 0.18 to 0.47] was attenuated after adjustment for fixed covariates and post-ART cluster of differentiation 4 counts and viral loads (RH 0.74, 95% CI 0.42 to 1.30). Small differences were found in pre-ART EIC and the costs of post-ART lab tests. The final model for the retention risk tool included age at diagnosis, having children, recreational drug use, drug/alcohol dependency, insufficient money for basic needs and use of public transport to get to the clinic. Quantitative and qualitative data showed that a range of psychological, social and economic issues were associated with disengagement from care. The negative impact of stigma on attendance was highlighted. Interventions were proposed that support a holistic approach to care including peer support, address stigma by holding clinics in alternative locations and involve training staff to encourage attendance.ConclusionsThe study shows the adverse health impacts of disengaging from HIV care and demonstrates the importance of the wider health and social context in managing HIV effectively. Although phase 1 analysis was based on UK data, phases 2 and 3 were limited to London. The interventions proposed are supported by the data but their cost-effectiveness requires testing. Future research is needed to evaluate the interventions, to validate our retention risk tool across populations and settings, and to fully analyse the economic costs of disengaging from HIV care.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The UK CHIC study is funded by the Medical Research Council UK (grant numbers G0000199, G0600337, G0900274 and M004236).

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Reduced HIV symptoms and improved health‐related quality of life correlate with better access to care for HIV‐1 infected women: the ELLA study

Cited by 10 publications

References 0 publications

Identifying Symptom Patterns in People Living With HIV Disease

Identifying Symptom Patterns in People Living With HIV Disease

Post-traumatic stress is associated with verbal learning, memory, and psychomotor speed in HIV-infected and HIV-uninfected women

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

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