Dr Richard Harding. King s College London. BHIVA AUTUMN CONFERENCE 2014 Including CHIVA Parallel Sessions
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1 BHIVA AUTUMN CONFERENCE 2014 Including CHIVA Parallel Sessions Dr Richard Harding King s College London 9-10 October 2014, Queen Elizabeth II Conference Centre, London
2 BHIVA AUTUMN CONFERENCE 2014 Including CHIA Parallel Sessions Dr Richard Harding King s College London COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Dr. Richard HardingRichard Harding Statement None Date October October 2014, Queen Elizabeth II Conference Centre, London
3 More than pills: what do people living with HIV need to live a long and healthy life? Health-Related Quality of Life Dr Richard Harding Faculty of Life Sciences and Medicine King s College London
4 Conceptual approaches: health & quality of life Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity WHO 1948 HRQOL is an assessment of how the individual's wellbeing may be affected over time by a disease, disability or disorder CDC Patient-oriented care: Spiritual problems From the life of the virus to the life of the host Physical problems Emotional problems Social problems
5 Needs & problems following HIV diagnosis Country N Time since diagnosis Problem Prevalence Group Tanzania months Depressive symptoms 43% India weeks Fatigue 96% USA 174 India weeks 4-6 weeks E Africa weeks Anxiety disorder 17% Death wish 20% Sharing feelings 32% Pregnant women No exclusion Aged Heterosexual Heterosexual Simms, Higginson, Harding J Pain Symptom Manage 2012
6 Systematic review: psychosocial symptoms among HIV positive patients on ART Lowther, Higginson & Harding, Int J Nursing Studies 2014
7
8 Comparison of anxiety prevalence with other populations with chronic illness Population Anxiety prevalence HIV positive patients on ART (this review) 45% Patients with diabetes 14%[1] Patients with cancer 15%-23%[1] Patients with heart disease 10%-50%[1] 1. Clarke, D.M. and K.C. Currie, Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust, (7 Suppl): p. S54-60
9 Quality of Life EUROQol 5-D n=778 N % Quality of life A Mobility 1: I have no problems walking about : I have some problems walking about : I am confined to bed Quality of life B Self-care 1: I have no problems with self-care : I have some problems with self care : I am unable to wash or dress myself Quality of life C Usual activities 1: I have no problems performing my usual activities : I have some problems with performing usual activities : I am unable to perform my usual activities
10 Results 3: Quality of Life EUROQol 5-D N % Quality of Life D- Pain/discomfort 1: I have no pain or discomfort : I have moderate pain or discomfort : I have extreme pain or discomfort Quality of Life E- Anxiety/ Depression 1: I am not anxious or depressed : I am moderately anxious or depressed : I am extremely anxious or depressed
11 EUROQol VAS n=778 Scale N % Quality of life F General health
12 EUROQoL: Multivariable analysis, what is associated with VAS score? EUROQOL dimensions: Mobility (95% CI) (-8.25, -.24) for some problems compared to no problems, p =.038*, Usual activities B (95% CI) (-10.54, 3.41) and (-20.85, -3.63) for some problems and unable to perform compared to no problems, p <0.001*** Pain/discomfort B (95% CI) (-7.24, -1.11) and (-16.67, 3.96) for moderate and extreme compared to no problems, p <.001*** Anxiety/depression B (95% CI) (-10.90, -5.26) and (-18.32, -8.01) for moderate and extreme compared to no problems, p <.001*** Treatment optimism B (95% CI) 4.83 (1.77, 7.89) for optimistic compared to not optimistic, p =.008** Sexual partner having a sexual partner B (95% CI) 3.58 (.42, 6.74) p =.035* NOT SIG Self care, employment, Education, UK born, age, relationship, gender/sexuality, ethnicity, sexual risk, STI, disclosure, ART, CD4, viral load Variance 45% explained
13 Positive futures : what is needed to achieve quality of life? Key themes to open ended question: Better clinical care/medications More understanding from the HIV doctors. i.e. side effects and mental illness Improved clinical services/mental health Maintain general health More energy! Illness=worse depression positive outlook Personal skills I need to rebuild my confidence and self esteem need to find a way mental structure to move forward in every area of life Harding & Molloy AIDS Care 2007
14 Study 1: UK 10 most prevalent (physical) n=778 Symptom 7 day prev Level of distress (% whole sample) Not at all Little bit Somewhat Quite a bit Very much Lack energy 70.8% 10.8% 19.8% 12.3% 12.1% 10.8% Drowsy/ tired 67.5% 10.7% 19.8% 9.8% 12.3% 10% Difficulty sleeping Difficulty concentrating 61.8% 13.5% 10.9% 9.5% 12.1% 10.9% 60.7% 16.6% 15.2% 10.3% 9.1% 5.5% Diarrhoea 53.6% 17.6% 12.6% 7.5% 7.5% 5.4% Sexual activity 53.5% 15.7% 8.1% 6.6% 7.1% 12.2% Pain 53.2% 18.0% 12.0% 5.9% 8.6% 5.4%
15 Study 1: UK 10 most prevalent (psychological) 7 day period prev Intensity Rarely Occasionally Frequently Constantly Worried 69.9% 8.4% 25.4% 21.5% 9.1% Sad 66.3% 11.8% 26.9% 16.7% 6.2% Feeling irritable 56.6% 10.4% 22.4% 16.3% 4.2% Harding et al BMJ STI 2010
16 Adult HIV symptom datasets UK n= 347 Gay men Uganda n= 200 newly diagnosed London n=778 outpatients Argentina n=200 outpatients 5 sites Uganda & South Africa n= 224 advanced pts Kenya n=378 outpatients SOWETO n= 385 ART outpatients
17 Key messages Pain & symptom burden assoc with: Risk Harding et al BMJ STI 2010 Poor adherence Harding et al AIDS & Behavior 2012 Viral rebound Lampe et al JAIDS 2010 Poorer QoL Harding et al AIDS Care 2011 Suicidal ideation 31% Sherr et al AIDS 2008 ART Discontinuation/change Sherr et al HIV Med 2011 Older gay men stigma accounts 39% QoL variance Slater et al J Assoc Nurses AIDS Care 2014 Prayer & meditation used to improve subjective wellbeing Ridge 2008 Sociology Health & Illness ART does improves quality of life (Bucciardini 2014) QoL critical challenge to HIV medicine Buscher JAMA 2010 Few intervention studies in person-centered care Harding Lancet Infect Dis 2012
18 Can we improve QoL alongside ART? 1. Develop PROM with sound psychometric properties Harding HQLO Study determining main problems* n=1328 outpatients BMC Public Health RCT training existing clinical staff in patient-centred care with structured assessment, care plan and mentorship BMC Infectious Disease 2012 Clinicaltrials.gov NCT Sig improvements in: QoL (phys p=0.06, psych p=0.015) Psych morbidity (p=0.035) Sharing feelings (p=0.005)* Help & advice (p=0.002)* TOPCare team, BOMU Hospital, Mombasa
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