Harding Richard, Simms Victoria, Penfold Suzanne, Downing Julia, Namisango Eve, Powell Richard A, Mwangi-Powell Faith, Moreland Scott, Gikaara Nancy, Atieno Mackuline, Higginson Irene J
BMC Infect Dis. 2014 Nov 18;14:613. doi: 10.1186/s12879-014-0613-1.
Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities.
In a multicentre 2 country cross-sectional study, adults attending 12 facilities in Kenya and Uganda gave self-reported data on quality of life (physical and mental wellbeing dimensions), functional and a measure of multidimensional problems (physical, psychological, social and spiritual).
Among the 1,337 participants, multidimensional problems were more common in psychological, spiritual and social domains than in physical. In multivariable analysis using GEE to adjust for facility effect, the mental health subscale of quality of life was lower for people with limited functional status (B = -5.27, 95% CI -5.99, 1. -4.56 p < 0.001) and higher for wealthier people (B = 0.91, 95% CI 0.48, 1.33, p < 0.001). The physical health subscale of quality of life was lower for those with limited functional status (B = -8.58, 95% CI -9.46 to -7.70, p < 0.001) and those who had a caregiver present (B = -1.97, 95% CI -3.72 to -0.23, p = 0.027), higher for wealthier people (B = 1.14, 95% CI 0.65, 1.64, p < 0.001), and positively associated with CD4 count (B = 1.61, 95% CI 1.08-2.14, p < 0.001). Multidimensional problems were more burdensome for people with limited functional status (B = -2.06, 95% CI -2.46 to -1.66, p < 0.001), and less burdensome with more education (B = 0.63, 95% CI 0.25-1.00, p = 0.001) or ART use (B = 0.94, 95% CI 0.34-1.53, p = 0.002).
Multidimensional problems are highly prevalent, and worse with declining function. Importantly, ART use does not appear to be protective for self-reported physical and mental dimensions of quality of life. Assessment and management of self-reported wellbeing must form part of HIV care and treatment services to ensure maximum benefit from ART investment.
全球卫生投资已降低了艾滋病病毒的死亡率和传播率。然而，在抗逆转录病毒治疗（ART）推广的同时，患者报告的结果却鲜为人知。本研究旨在使用患者报告结局量表（PROMS）来衡量由美国总统艾滋病紧急救援计划（PEPFAR）资助的医疗机构中门诊患者的健康状况。
在一项涉及两个国家的多中心横断面研究中，肯尼亚和乌干达12家医疗机构的成年患者自行报告了生活质量（生理和心理健康维度）、功能以及多维问题（生理、心理、社会和精神方面）的相关数据。
在1337名参与者中，多维问题在心理、精神和社会领域比在生理领域更为常见。在使用广义估计方程（GEE）对机构效应进行校正的多变量分析中，功能状态有限的人群生活质量的心理健康子量表得分较低（B = -5.27，95%置信区间 -5.99，-4.56，p < 0.001），而较富裕人群得分较高（B = 0.91，95%置信区间0.48，1.33，p < 0.001）。功能状态有限的人群生活质量的身体健康子量表得分较低（B = -8.58，95%置信区间 -9.46至 -7.70，p < 0.001），有护理人员陪伴的人群得分也较低（B = -1.97，95%置信区间 -3.72至 -0.23，p = 0.027），较富裕人群得分较高（B = 1.14，95%置信区间0.65，1.64，p < 0.001），且与CD4细胞计数呈正相关（B = 1.61，95%置信区间1.08 - 2.14，p < 0.001）。多维问题对功能状态有限的人群负担更重（B = -2.06，95%置信区间 -2.46至 -1.66，p < 0.001），而受教育程度越高（B = 0.63，95%置信区间0.25 - 1.00，p = 0.001）或使用抗逆转录病毒治疗（B = 0.94，95%置信区间0.34 - 1.53，p = 0.002）负担则较轻。
多维问题非常普遍，且功能下降时情况更糟。重要的是，抗逆转录病毒治疗的使用似乎对患者报告的生活质量的生理和心理维度并无保护作用。对患者报告的健康状况的评估和管理必须成为艾滋病毒护理和治疗服务的一部分，以确保从抗逆转录病毒治疗投资中获得最大益处。
