PSYCHOLOGICAL BURDEN AND THE IMPACT ON

Transcription

1 PSYCHOLOGICAL BURDEN AND THE IMPACT ON ENGAGEMENT WITH CARE AMONG ETHNICALLY DIVERSE OLDER WOMEN WITH HIV 4 th April 2019 Danielle Solomon 1, Shema Tariq 1, Jon Alldis 1, Fiona Burns 1, Richard Gilson 1, Caroline Sabin 1, Lorraine Sherr 1, Fiona Pettit 2, Rageshri Dhairyawan 3 1 UCL Institute for Global Health; 2 Positively UK; 3 Barts Health NHS Trust

2 Number of women accessing HIV care by age group, < Source: Personal communication, Zheng Yin (Centre for Infectious Disease Surveillance and Control, Public Health England)

3 Psychosocial factors and health outcomes in older women Female gender linked to poorer health- related quality of life in older people 1 Lower socioeconomic status linked to poorer health outcomes in older women 2 Black, Asian and Minority Ethnic (BAME) status linked to poorer mental health- related quality of life in older women 3 Source: 1.Coley et al. (2017); 2. Gardiner et al. (2016); 3. Avis et al. (2018)

4 Psychosocial factors and health outcomes in HIV Women living with HIV more likely to experience depressive symptoms than men living with HIV 1 Depressive symptoms linked to poorer HIV related outcomes among women 2 45% of women living with HIV in the UK live below the poverty line 3 Lower socioeconomic status associated with poorer HIV- related outcomes 4 Source: 1. Lipsitz et al. (1994); 2. Ickovicks et al. (2001) ; 3. Sophia Forum/Terrence Higgins Trust (2018); 4. Burch et al. (2016)

5 AIMS Among older women living with HIV, to explore the association between: 1. Ethnicity and socioeconomic factors 2. Ethnicity and mental health 3. Mental health and HIV- related outcomes

6 METHODS: PRIME Study Design

7 METHODS: Current analysis Quantitative questionnaire and clinical data Analysis restricted to women of White UK, Black African and Black Caribbean ethnicity (N=724) Poor mental health: PHQ- 4 (score 6), reported history of depression and current use of antidepressants Social isolation: modified Duke- UNC Functional Social Support Scale (score >12)

8 METHODS: Current analysis Engagement in HIV care: Suboptimal adherence: less than complete adherence in last 7 days Suboptimal attendance: any appointments missed in last 12 months Detectable HIV VL: clinically reported as >50 or self- reported as detectable Chi squared tests to identify associations between outcome and exposure variables Confounders: variables associated with outcome AND exposure (p<0.2) and not on causal pathway Multivariable logistic regression to obtain adjusted odds ratios (AORs)

9 RESULTS: Baseline characteristics of PRIME participants (N=869) Total,n (%) Median age 49.5 (IQR 45 59) Ethnicity Black African White UK Black Caribbean Other 607 (71.6) 71 (8.4) 46 (5.4) 117 (13.9) Born outside of the UK 728 (85.3) Median years since migration (if not born in the UK) 19 (IQR 3 43) Secure immigration status British citizen Indefinite leave to remain EU Citizen Insecureimmigration status Refugee / seeking asylum Right to stay for a fixed amount of time Visa No papers to be in the UK 603 (91.6) 526 (63.2) 179 (21.5) 58 (7.0) 70 (8.4) 31 (3.7) 21 (2.5) 13 (1.6) 5 (0.6)

10 RESULTS: Association between ethnicity & education and socioeconomic status 100% 80% White UK Black African Black Caribbean 60% 40% 20% 0% University education Employed Enough money for basic Total: 44.8% Total: 67.7% needs Total: 59.5%

11 RESULTS: Ethnicity and education/socioeconomic status multivariable analysis White UK AOR* Black African AOR (95% CI) University education ( ) Employed ( ) Basic needs met all/most of the time 3 ( ) Black Caribbean AOR (95% CI) 0.95 ( ) 0.93 ( ) 0.31 ( ) *Adjusted odds ratio 1 Adjusted for alcohol consumption, smoking, recreational drug use 2 Adjusted for alcohol consumption, smoking 3 Adjusted for recreational drug use

12 RESULTS: Association between ethnicity and mental health 60% White UK Black African Black Caribbean 40% 20% 0% Social isolation Ever diagnosed with depression Currently using antidepressants Psychological distress (PHQ- 4 6), Total: 39.0% Total: 30.4% Total: 28.7% Total: 23.7%

13 RESULTS: Ethnicity and education/socioeconomic status multivariable analysis White UK AOR Black African AOR (95% CI) Social isolation (CI ) Ever diagnosed with depression Currently using antidepressants Psychological distress (PHQ 6) (CI ) (CI ) (CI ) Black Caribbean AOR (95% CI) 2.69 (CI ) 0.80 (CI ) 0.61 (CI ) 4.81 (CI ) Adjusted for alcohol consumption, smoking, recreational drug use

14 RESULTS: Association between psychological distress and HIV outcomes None/mild distress Moderate/severe distress Detectable viral load Missed appointments Suboptimal adherence 0% 5% 10% 15% 20% 25% 30% 35%

15 RESULTS: Psychosocial distress and HIV outcomes multivariable analysis None/mild distress AOR Moderate/severe distress AOR (95% CI) Missed HIV clinic appointments 1 ( ) Sub- optimal ART adherence ( ) Detectable HIV viral load ( ) 1 Adjusted for ethnicity, employment, income, alcohol consumption, smoking, recreational drug use 2 Adjusted for ethnicity, employment and income

16 CONCLUSIONS High levels of poverty, psychological distress and social isolation especially amongst Black African (BA) and Black Caribbean (BC) women BA and BC women more likely to experience psychological distress but less likely to have ever been diagnosed with depression Psychological distress associated with poorer engagement in HIV care

17 CONCLUSIONS Awareness of the psychosocial needs of midlife women living with HIV is important for holistic HIV care These needs may be more pronounced in women living with HIV from BAME communities Clinicians need be proactive about recognition of psychosocial needs, aware of support mechanisms - including psychology, peer support and advice around benefits and be proactive about referral

18 ACKNOWLEDGEMENTS National Institute of Health Research (NIHR) Teams at PRIME Study sites Our participants for their generous sharing of time and experiences