London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England.
King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England.
BMC Infect Dis. 2019 Mar 12;19(1):248. doi: 10.1186/s12879-019-3855-0.
Evidence on patient-reported outcomes of newly diagnosed HIV patients is scarce, and largely cross-sectional. This prospective cohort study describes the prevalence of, and changes in, patient-reported outcomes in the three months after HIV diagnosis, in 11 HIV outpatient centres in Kenya and Uganda.
Adults were recruited within 14 days of result, completing self-report measures four times at monthly intervals. Multilevel mixed-effects linear regression (quality of life continuous outcomes) and ordinal logistic regression (symptoms and concerns categorical outcomes) modelled change over time, with repeated observations grouped within individuals adjusted for demographic/clinical characteristics, and multiple imputation for missing data.
438 adults were enrolled and 234 (53·4%) initiated ART. Improvement was found for MOS-HIV physical health (from 46·3 [95% CI 45·1-47·3], to 53·7 [95% CI 52.8-54·6], p < 0.001), and mental health (from 46·4 [95% CI 45·5-47·3] to 54·5 [95% CI 53·7-55·4], p < 0.001). POS subscale 'interpersonal problems' improved but remained burdensome (OR = 0·91, 95% CI = 0·87-0·94, p < 0.001; 22·7% reported severe problems at final time point). The scores for the existential POS subscale (OR = 0·95, 95% CI = 0.90-1·00, p = 0.056) and physical/psychological problems POS subscale (OR = 0·97, 95% CI = 0.92-1·02, p = 0.259) did not improve. Participants who initiated ART had worsening physical/psychological (OR = 0·64, 95% CI = 0·41-0·99, p = 0·045) and interpersonal problems (OR = 0·64, 95% CI = 0·42-0·96, p = 0·033).
Although some self-reported outcomes improve over time, burden of interpersonal problems remains substantial and existential concerns do not improve.
关于新诊断 HIV 患者的患者报告结局的证据很少，而且主要是横断面研究。本前瞻性队列研究描述了在肯尼亚和乌干达的 11 个 HIV 门诊中心，在 HIV 诊断后三个月内患者报告结局的发生率和变化。
成年人在结果出现后 14 天内被招募，每月间隔四次完成自我报告测量。使用多水平混合效应线性回归（生活质量连续结局）和有序逻辑回归（症状和关注点分类结局）来模拟随时间的变化，将个体内的重复观察结果进行分组，并根据人口统计学/临床特征进行调整，对于缺失数据进行多重插补。
共纳入 438 名成年人，其中 234 名（53.4%）开始接受 ART 治疗。发现 MOS-HIV 身体健康（从 46.3[95%CI 45.1-47.3]）和心理健康（从 46.4[95%CI 45.5-47.3]）都有所改善，分别达到 53.7[95%CI 52.8-54.6]，p<0.001）。POS 子量表“人际问题”有所改善，但仍有负担（OR=0.91，95%CI=0.87-0.94，p<0.001；22.7%在最后时间点报告严重问题）。存在主义 POS 子量表（OR=0.95，95%CI=0.90-1.00，p=0.056）和身体/心理问题 POS 子量表（OR=0.97，95%CI=0.92-1.02，p=0.259）的评分没有改善。开始接受 ART 治疗的参与者的身体/心理（OR=0.64，95%CI=0.41-0.99，p=0.045）和人际问题（OR=0.64，95%CI=0.42-0.96，p=0.033）恶化。
尽管一些自我报告的结果随时间改善，但人际问题的负担仍然很大，存在主义问题没有改善。
