Multidimensional Patient-Reported Problems within Two Weeks of HIV Diagnosis in East Africa: A Multicentre Observational Study

Victoria Simms; Nancy Gikaara; Grace Munene; Mackuline Atieno; Jeniffer Kataike; Clare Nsubuga; Geoffrey Banga; Eve Namisango; Suzanne Penfold; Peter Fayers; Richard A. Powell; Irene J. Higginson; Richard Harding

doi:10.1371/journal.pone.0057203

Multidimensional Patient-Reported Problems within Two Weeks of HIV Diagnosis in East Africa: A Multicentre Observational Study

Victoria Simms^* (Corresponding Author), Nancy Gikaara, Grace Munene, Mackuline Atieno, Jeniffer Kataike, Clare Nsubuga, Geoffrey Banga, Eve Namisango, Suzanne Penfold, Peter Fayers, Richard A. Powell, Irene J. Higginson, Richard Harding

^*Corresponding author for this work

Applied Health Sciences

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Abstract

Objectives: We aimed to determine for the first time the prevalence and severity of multidimensional problems in a population newly diagnosed with HIV at outpatient clinics in Africa.

Methods: Recently diagnosed patients (within previous 14 days) were consecutively recruited at 11 HIV clinics in Kenya and Uganda. Participants completed a validated questionnaire, the African Palliative Outcome Scale (POS), with three underpinning factors. Ordinal logistic regression was used to evaluate risk factors for prevalence and severity of physical, psychological, interpersonal and existential problems.

Results: There were 438 participants (62% female, 30% with restricted physical function). The most prevalent problems were lack of help and advice (47% reported none in the previous 3 days) and difficulty sharing feelings. Patients with limited physical function reported more physical/psychological (OR = 3.22) and existential problems (OR = 1.54) but fewer interpersonal problems (OR = 0.50). All outcomes were independent of CD4 count or ART eligibility.

Conclusions: Patients at all disease stages report widespread and burdensome multidimensional problems at HIV diagnosis. Newly diagnosed patients should receive assessment and care for these problems. Effective management of problems at diagnosis may help to remove barriers to retention in care.

Original language	English
Article number	e57203
Number of pages	5
Journal	PloS ONE
Volume	8
Issue number	2
DOIs	https://doi.org/10.1371/journal.pone.0057203
Publication status	Published - 19 Feb 2013

Bibliographical note

Acknowledgments
Keira Lowther read and commented on the manuscript. The authors are grateful for the guidance provided by the United States Government (USG) Palliative Care Technical Working Group and to the Kenyan and Ugandan USG Country Teams. Finally we are grateful to the staff and patients at the participating facilities.
Author Contributions
Conceived and designed the experiments: VS IJH RH. Performed the experiments: NG GM MA JK CN GB EN RAP. Analyzed the data: VS PF SP. Wrote the paper: VS.

Funding: The project was funded by USAID (www.usaid.gov) through Cooperative Agreement GPO-A-00-03-00003-00, under the authority provided to the University of North Carolina. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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10.1371/journal.pone.0057203Licence: CC BY

Multidimensional Patient-Reported Problems within Two Weeks of HIV Diagnosis in East Africa
© 2013 Simms et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/
Final published version, 139 KBLicence: CC BY

Cite this

Simms, V., Gikaara, N., Munene, G., Atieno, M., Kataike, J., Nsubuga, C., Banga, G., Namisango, E., Penfold, S., Fayers, P., Powell, R. A., Higginson, I. J., & Harding, R. (2013). Multidimensional Patient-Reported Problems within Two Weeks of HIV Diagnosis in East Africa: A Multicentre Observational Study. PloS ONE, 8(2), Article e57203. https://doi.org/10.1371/journal.pone.0057203

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abstract = "Objectives: We aimed to determine for the first time the prevalence and severity of multidimensional problems in a population newly diagnosed with HIV at outpatient clinics in Africa. Methods: Recently diagnosed patients (within previous 14 days) were consecutively recruited at 11 HIV clinics in Kenya and Uganda. Participants completed a validated questionnaire, the African Palliative Outcome Scale (POS), with three underpinning factors. Ordinal logistic regression was used to evaluate risk factors for prevalence and severity of physical, psychological, interpersonal and existential problems. Results: There were 438 participants (62% female, 30% with restricted physical function). The most prevalent problems were lack of help and advice (47% reported none in the previous 3 days) and difficulty sharing feelings. Patients with limited physical function reported more physical/psychological (OR = 3.22) and existential problems (OR = 1.54) but fewer interpersonal problems (OR = 0.50). All outcomes were independent of CD4 count or ART eligibility. Conclusions: Patients at all disease stages report widespread and burdensome multidimensional problems at HIV diagnosis. Newly diagnosed patients should receive assessment and care for these problems. Effective management of problems at diagnosis may help to remove barriers to retention in care.",

author = "Victoria Simms and Nancy Gikaara and Grace Munene and Mackuline Atieno and Jeniffer Kataike and Clare Nsubuga and Geoffrey Banga and Eve Namisango and Suzanne Penfold and Peter Fayers and Powell, {Richard A.} and Higginson, {Irene J.} and Richard Harding",

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AU - Gikaara, Nancy

AU - Munene, Grace

AU - Atieno, Mackuline

AU - Kataike, Jeniffer

AU - Nsubuga, Clare

AU - Banga, Geoffrey

AU - Namisango, Eve

AU - Penfold, Suzanne

AU - Fayers, Peter

AU - Powell, Richard A.

AU - Higginson, Irene J.

AU - Harding, Richard

N1 - Acknowledgments Keira Lowther read and commented on the manuscript. The authors are grateful for the guidance provided by the United States Government (USG) Palliative Care Technical Working Group and to the Kenyan and Ugandan USG Country Teams. Finally we are grateful to the staff and patients at the participating facilities. Author Contributions Conceived and designed the experiments: VS IJH RH. Performed the experiments: NG GM MA JK CN GB EN RAP. Analyzed the data: VS PF SP. Wrote the paper: VS. Funding: The project was funded by USAID (www.usaid.gov) through Cooperative Agreement GPO-A-00-03-00003-00, under the authority provided to the University of North Carolina. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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N2 - Objectives: We aimed to determine for the first time the prevalence and severity of multidimensional problems in a population newly diagnosed with HIV at outpatient clinics in Africa. Methods: Recently diagnosed patients (within previous 14 days) were consecutively recruited at 11 HIV clinics in Kenya and Uganda. Participants completed a validated questionnaire, the African Palliative Outcome Scale (POS), with three underpinning factors. Ordinal logistic regression was used to evaluate risk factors for prevalence and severity of physical, psychological, interpersonal and existential problems. Results: There were 438 participants (62% female, 30% with restricted physical function). The most prevalent problems were lack of help and advice (47% reported none in the previous 3 days) and difficulty sharing feelings. Patients with limited physical function reported more physical/psychological (OR = 3.22) and existential problems (OR = 1.54) but fewer interpersonal problems (OR = 0.50). All outcomes were independent of CD4 count or ART eligibility. Conclusions: Patients at all disease stages report widespread and burdensome multidimensional problems at HIV diagnosis. Newly diagnosed patients should receive assessment and care for these problems. Effective management of problems at diagnosis may help to remove barriers to retention in care.

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Multidimensional Patient-Reported Problems within Two Weeks of HIV Diagnosis in East Africa: A Multicentre Observational Study

Abstract

Bibliographical note

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