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Chaminuka AS, Prybutok G, Prybutok VR, Senn WD. Systematic Review: HIV, Aging, and Housing-A North American Perspective, 2012-2023. Healthcare (Basel) 2024; 12:992. [PMID: 38786403 PMCID: PMC11121341 DOI: 10.3390/healthcare12100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Advances in anti-retroviral therapy (ART) have decreased mortality rates and subsequently led to a rise in the number of HIV-positive people living longer. The housing experiences of this new population of interest-older adults (50 years and older) living with HIV-are under-researched. Understanding the housing experiences and unmet needs of older people with HIV can better provide comprehensive care services for them. This study's systematic review evaluated the peer-reviewed literature reporting housing access/insecurity/assistance/options, housing impact, and unmet needs of older individuals living with HIV in North America from 2012 to 2023. Furthermore, Latent Semantic Analysis (LSA), a text-mining technique, and Singular Value Decomposition (SVD) for text clustering were utilized to examine unstructured data from the abstracts selected from the review. The goal was to allow for a better understanding of the relationships between terms in the articles and the identification of emerging public health key themes affecting older adults living with HIV. The results of text clustering yielded two clusters focusing on (1) improvements to housing and healthcare services access and policies and (2) unmet needs-social support, mental health, finance, food, and sexuality insecurities. Topic modeling demonstrated four topics, which we themed to represent (1) a holistic care approach; (2) insecurities-food, financial, sexuality, and other basic needs; (3) access to housing and treatment/care; and (4) homelessness and HIV-related health outcomes. Stable housing, food, and healthcare services access and availability are critical elements to incorporating comprehensive, holistic healthcare for older adults living with HIV. The aging population requires high-priority policies for accessible and equitable healthcare. Clinicians and policymakers should address individual barriers, adopt a patient-centered approach, increase doctor visits, provide competency training, ensure long-term follow-up, involve families, and improve patient education in care management, contributing to HIV/AIDS geriatric care models.
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Affiliation(s)
- Arthur S. Chaminuka
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX 76205, USA;
| | - Gayle Prybutok
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX 76205, USA;
| | - Victor R. Prybutok
- G. Brint Ryan College of Business and Toulouse Graduate School, University of North Texas, Denton, TX 76205, USA
| | - William D. Senn
- Dr. Sam Pack College of Business, Tarleton State University, Stephenville, TX 76401, USA;
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Vu T, Quinn M, Womack J, Monin J. 'If I don't take care of me, then I can't be there for others:' a qualitative study of caregiving relationships among older women living with HIV. Aging Ment Health 2024:1-12. [PMID: 38327025 DOI: 10.1080/13607863.2024.2313729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The population of women ages 50 years and older living with HIV is increasing. Yet, little is known about the care networks that older women living with HIV (OWLH) use to manage their health. The goal of this study was to explore the caregiving and care receiving relationships among OWLH and how these relationships impact HIV management. METHODS OWLH aged 50 years and older were recruited from clinics and community-based organizations across the U.S. We conducted semi-structured, in-depth phone interviews and performed content and thematic analysis on transcripts. RESULTS Participants (N = 23) were on average 60 years old and had been living with HIV for an average of 23.7 years. Participants 1) relied on diverse care networks; 2) were caregivers for grandchildren and parents; 3) had pride and joy in being caregivers; and 4) were highly proactive in their own HIV management. Care networks promoted self-love and acceptance. However, concerns about aging with HIV were still highly prevalent. CONCLUSION Being a caregiver and care recipient are sources of meaning and strength to help OWLH manage HIV. Public health programs should consider engaging both OWLH and their care networks in healthcare discussions and educational efforts.
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Affiliation(s)
- Thi Vu
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Marielle Quinn
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Julie Womack
- Yale University School of Nursing, New Haven, CT, USA
| | - Joan Monin
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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3
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Gibson B, Rosser BA, Schneider J, Forshaw MJ. The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review. PLoS One 2023; 18:e0286198. [PMID: 37267292 DOI: 10.1371/journal.pone.0286198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.
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Affiliation(s)
- Benjamin Gibson
- School of Applied Social Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Benjamin A Rosser
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and, University of the West of England, Bristol, United Kingdom
| | - Mark J Forshaw
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Vajravelu S, O'Brien KK, Moll S, Solomon P. Exploring the disability experiences of South Asian Women living with HIV in Southern Ontario, Canada. Disabil Rehabil 2023; 45:434-440. [PMID: 35168465 DOI: 10.1080/09638288.2022.2037741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Given the steady rise in HIV incidence among South Asian women in Canada their health-related challenges and disability are not well understood. Our aim was to understand the "lived experiences" of disability among South Asian women living with HIV in Southern Ontario, Canada. METHODS We conducted a qualitative study using an interpretive phenomenological approach. We recruited immigrant South Asian women living with HIV in Ontario and conducted one-on-one semi structured interviews. Following the first interview, participants were invited to participate in a second interview. Interviews were audio recorded and transcribed verbatim. RESULTS Eight participants completed the first interview; six completed a second interview (14 interviews total). The mean age of participants was 47.1 years (standard deviation (sd) = 5.8) and mean length of time since HIV diagnosis was 15.1 years (sd = 6.7). We identified two overarching themes, "experiencing disability" and "experiencing discrimination". Apart from the physical and mental health impairments, the complex intersection of illness, gender, ethnicity, HIV-stigma and discrimination influenced disability experiences. CONCLUSION Understanding the disability experiences of marginalized women living with HIV through a phenomenological lens can help to facilitate the development of culturally safe treatment approaches and health care policies to lessen disability and improve their quality of life.Implications for rehabilitationDeveloping culturally safe treatment approaches may help to improve rehabilitation service provision for ethnically and culturally diverse populations.Rehabilitation professionals need to adopt a trauma-informed care when treating people living with HIV.Rehabilitation professionals should consider cultural safety by considering the role of religion, dependency, and gendered-power relations while treating South Asian women living with HIV.
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Affiliation(s)
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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6
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Han S, Zhang Y, Yang X, Li K, Zhang L, Shao Y, Ma J, Hu Y, Zhu Z, Zhang Y, Wang Z. Exploring core mental health symptoms among persons living with HIV: A network analysis. Front Psychiatry 2023; 14:1081867. [PMID: 36741117 PMCID: PMC9895861 DOI: 10.3389/fpsyt.2023.1081867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
CONTEXT Persons living with HIV (PLWH) commonly experience mental health symptoms. However, little is known about the core mental health symptoms and their relationships. OBJECTIVE This study aimed to evaluate the prevalence of various mental health symptoms and to explore their relationships in symptom networks among PLWH. METHODS From April to July 2022, we recruited 518 participants through convenience sampling in Beijing, China, for this cross-sectional study. Forty mental health symptoms, including six dimensions (somatization symptoms, negative affect, cognitive function, interpersonal communication, cognitive processes, and social adaptation), were assessed through paper-based or online questionnaires. Network analysis was performed in Python 3.6.0 to explore the core mental health symptoms and describe the relationships among symptoms and clusters. RESULTS Of the 40 mental health symptoms, the most common symptoms were fatigue (71.2%), trouble remembering things (65.6%), and uncertainty about the future (64.0%). In the single symptom network, sadness was the most central symptom across the three centrality indices (rS = 0.59, rC = 0.61, rB = 0.06), followed by feeling discouraged about the future (rS = 0.51, rC = 0.57, rB = 0.04) and feelings of worthlessness (rS = 0.54, rC = 0.53, rB = 0.05). In the symptom cluster network, negative affect was the most central symptom cluster across the three centrality indices (rS = 1, rC = 1, rB = 0.43). CONCLUSION Our study provides a new perspective on the role of each mental health symptom among PLWH. To alleviate the mental health symptoms of PLWH to the greatest extent possible and comprehensively improve their mental health, we suggest that psychological professionals pay more attention to pessimistic mood and cognitive processes in PLWH. Interventions that apply positive psychology skills and cognitive behavioral therapy may be necessary components for the mental health care of PLWH.
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Affiliation(s)
- Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Yizhu Zhang
- School of Nursing, Peking University, Beijing, China
| | - Xianxia Yang
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Ke Li
- Department of Emergency, Peking University First Hospital, Beijing, China
| | - Lili Zhang
- Department of Nursing, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Ying Shao
- Department of Infection, Beijing Youan Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jianhong Ma
- Department of Infection, Beijing Youan Hospital Affiliated With Capital Medical University, Beijing, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Yukun Zhang
- School of Nursing, Fudan University, Shanghai, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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van Koeveringe JM, Liaño Callahan E, George M, Russo TT, Seifu B, Spigt M. The challenge of dealing with non-AIDS comorbidities for people living with HIV: Perspectives and experiences of patients and healthcare providers. Glob Public Health 2023; 18:2185798. [PMID: 36915947 DOI: 10.1080/17441692.2023.2185798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
As the cohort of People Living with HIV (PLHIV) ages, so does the spectrum and burden of non-AIDS define HIV-associated conditions (NARC). PLHIV are likely to need different and increased healthcare services. It requires health systems to adapt to this disease trend and conform to a chronic care model, which respects the distinct needs of the ageing population. In this article, we explore the lived experiences of PLHIV and their healthcare providers in managing the challenges of dealing with NARC in Arba Minch, Southern Ethiopia. This study utilises interpretative substantive methods, encompassing qualitative interviews and Focus Group Discussions. The Normalisation Practice Theory (NPT) guided the semi-structured questions concerning routine screenings and current models of HIV care for ageing individuals. The main structural challenges in providing adequate geriatric care included: (i) the lack of awareness of the risk of NARCs; (ii) the absence of blended care; (iii) an HIV-centred approach exclusive of multidisciplinary care; and (iv) financial constraints. In an era with increasing NARCs, traditional HIV care models must adapt to the emerging challenges of a 'greying' and growing population.
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Affiliation(s)
| | - Elizabeth Liaño Callahan
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mala George
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Teklu Teshome Russo
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Biruk Seifu
- Department of Pharmacology, Arba Minch University, Arba Minch, Ethiopia
| | - Mark Spigt
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
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8
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Licchelli S, King A, Smith KJ. "It's Still in the Test Tube and Finding out How the Experiment Ends… ". A Qualitative Study on Health and Aging in Older Gay Males Living with HIV in England. J Int Assoc Provid AIDS Care 2023; 22:23259582221144448. [PMID: 36594233 PMCID: PMC9830087 DOI: 10.1177/23259582221144448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This paper highlights experiences and perceptions of older gay males living with Human Immunodeficiency Virus (HIV) in relation to age, sexual orientation, HIV status and how they perceive health. Participants were gay males aged 50 and over living in England, diagnosed with HIV for longer than 2 years. In total, 19 interviews were conducted between March 2020 and March 2021. Data were analysed using thematic analysis. Three major themes were generated: 1.) Health as holistic and as a balance; 2.) The impact of HIV on people's lives; 3.) The Intersectionality of stigma: a lifetime of discrimination. Participants highlighted the changing nature of the concept of health through their lifespan while the intersectionality of stigma in different contexts is examined considering the personal journey of living with HIV. The implications of health as a complex concept and intersectional stigma on the planning and delivering of care in this population are discussed.
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Affiliation(s)
| | - Andrew King
- Department of Sociology, 3660University of Surrey, Guildford, UK
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Xie M, Wang A, Wang K, Yu Y, Lin Z. Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study. BMC Geriatr 2022; 22:728. [PMID: 36058926 PMCID: PMC9442943 DOI: 10.1186/s12877-022-03411-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Debate has persisted regarding whether PLWH with longer HIV durations have lower levels of prevalence and severity of symptoms compared with their newly diagnosed counterparts. Whether and how the HIV duration impact the symptom distress among middle-aged and older PLWH has not been explored clearly. Methods The patients with HIV-infected aged more than 40 years old were included from seven designated medical institutions of seven regions in China. Outcome was the score of symptom distress. We used the multiple regression model to calculate adjusted Coefficient of Regression (β) with 95% CI in this study. Results Among 210 participants (mean age 50.8 years; 71.0% male; 68.1% at asymptomatic stage) in the study, the median number of symptoms was 5. Of all symptoms reported, the most distressed symptoms were sleep disturbance (33.33%), followed by memory loss (31.90%), fatigue (26.67%), slow reactions (22.86%), and vision blur (21.90%). All participants were divided into four groups according to HIV duration, and the median of total score of symptom ditress among all participants was 0.1(0.0,0.9). Difference of total scores and clusters’ scores of symptom distress among four HIV duration groups were statistically significant. 51 participants with 6–10 years HIV duration were more likely to be higher level of education, at asymptomatic stage and have higher CD4 + T cell count. After adjustment for gender, age, race, education, marital status, employment, family income, region, stage of disease and CD4 + T cell count, the score of symptom distress among participants with 6–10 years HIV duration had was higher with the extension of HIV duration. Specially in physical symptoms and psychological symptoms,participants with 6–10 years HIV duration reported the persisting worse burdensome. Conclusions HIV duration with 6–10 yearsmay be a key period that the medical team needs to pay special attention to among middle-aged and elderly PLWH. There is a need to provide medical and psychosocial services targeting middle-aged and elderly PLWH according to their changing symptom distress. Trial registration Clinicaltrials.gov: ChiCTR2100046225. Registered 11 May 2021.
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Affiliation(s)
- Meilian Xie
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Aiping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Kerong Wang
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yanping Yu
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhaoxia Lin
- Department of Quality Control, Beijing Ditan Hospital Capital Medical University, Beijing, China
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10
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Murzin K, Racz E, Behrens DM, Conway T, Da Silva G, Fitzpatrick E, Lindsay JD, Walmsley SL. "We can hardly even do it nowadays. So, what's going to happen in 5 years from now, 10 years from now?" The health and community care and support needs and preferences of older people living with HIV in Ontario, Canada: a qualitative study. J Int AIDS Soc 2022; 25 Suppl 4:e25978. [PMID: 36176028 PMCID: PMC9522634 DOI: 10.1002/jia2.25978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The population of people living with HIV (PLWH) is ageing consequent to effective treatment and a steady stream of new diagnoses among older adults. PLWH experience a greater burden of age‐related comorbidities and poorer social determinants of health compared to their HIV‐negative peers, yet comprehensive requisites for care and support as PLWH age remain poorly understood. Preferences And Needs for Ageing Care among HIV‐positive Elderly people in Ontario, Canada (PANACHE ON), explored the health and community care and social support needs and preferences of a diverse group of older PLWH (age 60+) and described life course experiences among older PLWH that shape these needs and preferences and whether they are met. Methods PANACHE ON was a qualitative community‐based participatory research study. In‐person focus groups using a semi‐structured interview guide were co‐facilitated by pairs of trained older PLWH from July to October 2019. Purposive sampling bolstered the inclusion of communities disproportionately affected by HIV in Ontario. Descriptive analysis was used to summarize demographic data; participatory data analysis was conducted by a subset of the research team, with transcripts double‐coded and analysed using NVIVO 12 Plus. Results A total of 73 PLWH participated, 66% identified as men. The mean age was 64 years (range 55–77) and median time living with HIV was 23 years (range 2–37). The current and anticipated needs of older PLWH, many of which were only partially met, included necessities such as food and housing, mobility and sensory aids, in‐home support, social and emotional support, transportation and information. Three experiences—trauma, stigma and uncertainty—intersected in the lives of many of our participants, shaping their needs for care and support, and impacting the ease with which these needs were met. Conclusions Unmet health and social needs and limited control over the availability and accessibility of ageing‐related care and support due to resource constraints or reduced capacity for self‐advocacy results in anxiety about the future among older PLWH, despite their well‐developed coping strategies and experience navigating systems of care. These study findings will inform the development of the first national needs assessment of older PLWH in Canada.
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Affiliation(s)
| | | | | | | | | | - Eimear Fitzpatrick
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Joanne D Lindsay
- Realize, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharon L Walmsley
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Wallace ZS, Cook C, Finkelstein-Fox L, Fu X, Castelino FV, Choi HK, Perugino C, Stone JH, Park ER, Hall DL. The Association of Illness-related Uncertainty With Mental Health in Systemic Autoimmune Rheumatic Diseases. J Rheumatol 2022; 49:1058-1066. [PMID: 35365580 PMCID: PMC9525460 DOI: 10.3899/jrheum.211084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with systemic autoimmune rheumatic diseases (SARDs) face illness-related uncertainty, but little is known about the psychological profiles and psychosocial and health needs associated with uncertainty among adults with SARDs. METHODS Patients from the Massachusetts General Hospital with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), IgG4-related disease (IgG4-RD), and systemic sclerosis (SSc) completed the Mishel Uncertainty in Illness Scale, 8-item Patient Health Questionnaire depression scale, 7-item General Anxiety Disorder scale, Sickness Impact Profile, and a survey of psychosocial needs. The associations of uncertainty and self-reported needs with depression, anxiety, and sickness impact were assessed. RESULTS One hundred thirty-two patients with AAV (n = 41, 31%), IgG4-RD (n = 61, 46%), or SSc (n = 30, 23%) participated. The mean age was 64 years, 52% were female, and 83% were White. Greater illness-related uncertainty was positively correlated with higher levels of depression (r = 0.43, P < 0.001), anxiety (r = 0.33, P < 0.001), and sickness impact (r = 0.28, P = 0.001). We observed variations in these measures across SARDs, such that uncertainty was more strongly associated with depression and sickness impact in AAV or SSc compared to IgG4-RD. The primary needs that patients endorsed were services for managing physical symptoms (53%), self-care (37%), and emotional concerns (24%), with greater needs strongly associated with greater illness-related uncertainty. CONCLUSION Among patients with SARDs, illness-related uncertainty is correlated with levels of depression, anxiety, and sickness impact, as well as psychosocial needs. Findings also implicate the need for targeted interventions to address uncertainty and needs among subgroups of patients with different illness profiles.
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Affiliation(s)
- Zachary S Wallace
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Claire Cook
- C. Cook, MPH, X. Fu, MS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute
| | - Lucy Finkelstein-Fox
- L. Finkelstein-Fox, PhD, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School
| | - Xiaoqing Fu
- C. Cook, MPH, X. Fu, MS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute
| | - Flavia V Castelino
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Hyon K Choi
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Cory Perugino
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - John H Stone
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Elyse R Park
- E.R. Park, PhD, D.L. Hall, PhD, Department of Psychiatry, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel L Hall
- E.R. Park, PhD, D.L. Hall, PhD, Department of Psychiatry, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School, Boston, Massachusetts, USA.
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12
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Brown DA, O’Brien KK, Harding R, Sedgwick PM, Nelson M, Boffito M, Lewko A. Prevalence, severity, and risk factors of disability among adults living with HIV accessing routine outpatient HIV care in London, United Kingdom (UK): A cross-sectional self-report study. PLoS One 2022; 17:e0267271. [PMID: 35551320 PMCID: PMC9098035 DOI: 10.1371/journal.pone.0267271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/05/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The study objectives were to measure disability prevalence and severity, and examine disability risk factors, among adults living with HIV in London, United Kingdom (UK). METHODS Self-reported questionnaires were administered: World Health Organization Disability Assessment Schedule 2.0 (WHODAS), HIV Disability Questionnaire (HDQ), Equality Act disability definition (EADD), and demographic questionnaire. We calculated proportion (95% Confidence Interval; CI) of "severe" and "moderate" disability measured using EADD and WHODAS scores ≥2 respectively. We measured disability severity with HDQ domain severity scores. We used demographic questionnaire responses to assess risk factors of "severe" and "moderate" disability using logistic regression analysis, and HDQ severity domain scores using linear regression analysis. RESULTS Of 201 participants, 176 (87.6%) identified as men, median age 47 years, and 194 (96.5%) virologically suppressed. Severe disability prevalence was 39.5% (n = 79/201), 95% CI [32.5%, 46.4%]. Moderate disability prevalence was 70.5% (n = 141/200), 95% CI [64.2%, 76.8%]. Uncertainty was the most severe HDQ disability domain. Late HIV diagnosis was a risk factor for severe disability [Odds Ratio (OR) 2.71; CI 1.25, 5.87]. Social determinants of health, economic inactivity [OR 2.79; CI 1.08, 7.21] and receiving benefits [OR 2.87; CI 1.05, 7.83], were risk factors for "severe" disability. Economic inactivity [OR 3.14; CI 1.00, 9.98] was a risk factor for "moderate" disability. Economic inactivity, receiving benefits, and having no fixed abode were risk factors (P≤0.05) for higher HDQ severity scores in physical, mental and emotional, difficulty with day-to-day activities, and challenges to social participation domains. Personal factors, identifying as a woman and being aged <50 years, were risk factors (P≤0.05) for higher HDQ severity scores in mental and emotional, uncertainty, and challenges with social participation domains. CONCLUSIONS People living with well-controlled HIV in London UK experienced multi-dimensional and episodic disability. Results help to better understand the prevalence, severity, and risk factors of disability experienced by adults living with HIV, identify areas to target interventions, and optimise health and functioning.
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Affiliation(s)
- Darren A. Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, United Kingdom
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitating, King’s College London, London, United Kingdom
| | - Philip M. Sedgwick
- Institute of Medical and Biomedical Education, St George’s, University of London, London, United Kingdom
| | - Mark Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Marta Boffito
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Agnieszka Lewko
- Centre for Allied Health, Kingston University and St George’s University of London, London, United Kingdom
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13
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Vader K, Chan Carusone S, Aubry R, Ahluwalia P, Murray C, Baxter L, Robinson G, Ibáñez-Carrasco F, Stewart A, Solomon P, O'Brien KK. Examining the Utility of the HIV Disability Questionnaire (HDQ) in Clinical Practice: Perspectives of People Living with HIV and Healthcare Providers. J Int Assoc Provid AIDS Care 2022; 21:23259582221079148. [PMID: 35175151 PMCID: PMC8859678 DOI: 10.1177/23259582221079148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Our aim was to examine the utility of the HIV Disability Questionnaire (HDQ), a patient-reported outcome measure for use in clinical practice from the perspectives of people living with HIV (PLWH) and healthcare providers. We conducted a qualitative descriptive study. Fifteen PLWH and five healthcare providers participated in an interview, of which ten PLWH participated in a follow-up focus group discussion. The HDQ has value in clinical practice, including its role in assessing disability, facilitating communication, tailoring treatments, and guiding referrals. Strengths of the HDQ included its comprehensiveness, relevance of domains, and importance of specific items. Concerns related to length of the HDQ, the potential for some items to trigger emotional response, and negative connotations with the term ‘disability.’ Recommendations for HDQ implementation included the importance of score interpretability, shortening the questionnaire, and tailoring administration to the individual. Results suggest the HDQ possesses clinical utility with PLWH and healthcare providers.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, 4257Queen's University, Kingston, ON, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | | | - Rachel Aubry
- Department of Physical Therapy, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | - Ann Stewart
- St. Michael's Academic Family Health Team, Toronto, ON, Canada.,Department of Family and Community Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada.,Rehabilitation Science Institute, 7938University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, 7938University of Toronto, Toronto, ON, Canada
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14
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Disability and self-care living strategies among adults living with HIV during the COVID-19 pandemic. AIDS Res Ther 2021; 18:87. [PMID: 34798881 PMCID: PMC8604195 DOI: 10.1186/s12981-021-00413-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Events associated with the COVID-19 pandemic, such as physical distancing, closure of community services, postponement of health appointments, and loss of employment can lead to social isolation, financial uncertainty, and interruption of antiretroviral adherence, resulting in additional health-related challenges (disability) experienced among adults living with chronic illness such as HIV. 'Living strategies' is a concept derived from the perspectives of people living with HIV, defined as behaviors, attitudes and beliefs adopted by people living with HIV to help deal with disability associated with HIV and multi-morbidity. Our aim was to describe disability among adults living with HIV and self-care living strategies used during the COVID-19 pandemic. METHODS Adults living with HIV in Toronto, Ontario, Canada, including some with pre-pandemic HIV Disability Questionnaire (HDQ) data, completed a cross-sectional web-based survey between June-August 2020. The survey included the HDQ and questions about self-care living strategy use during the pandemic. We compared disability (HDQ) scores prior to versus during the pandemic using paired t-tests. We reported the proportion of participants who engaged in various living strategies at least 'a few times a week' or 'everyday' during the pandemic. RESULTS Of the 63 respondents, 84% were men, median age 57 years, and 62% lived alone. During the pandemic the greatest disability severity was in the uncertainty [median 30; Interquartile range (IQR): 16, 43] and mental-emotional (25; IQR: 14, 41) domains. Among the 51 participants with pre-pandemic data, HDQ severity scores were significantly greater (worse) during the pandemic (vs prior) in all domains. Greatest change from prior to during the pandemic was in the mental-emotional domain for presence (17.7; p < 0.001), severity (11.4; p < 0.001), and episodic nature (9.3; p < 0.05) of disability. Most participants (> 60%) reported engaging a 'few times a week' or 'everyday' in self-care strategies associated with maintaining sense of control and adopting positive attitudes and beliefs. CONCLUSIONS People living with HIV reported high levels of uncertainty and mental-emotional health challenges during the pandemic. Disability increased across all HDQ dimensions, with the greatest worsening in the mental-emotional health domain. Results provide an understanding of disability and self-care strategy use during the COVID-19 pandemic.
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15
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Allen A, Zaviryukha I, Kiriazova T, Shenoi S, Rozanova J. The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine. QUALITATIVE HEALTH RESEARCH 2021; 31:2290-2303. [PMID: 34414837 PMCID: PMC8930274 DOI: 10.1177/10497323211026914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH's perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.
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Affiliation(s)
- Amy Allen
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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16
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O'Brien KK, Bayoumi AM, Carusone SC, Davis AM, Aubry R, Avery L, Solomon P, Erlandson KM, Bergin C, Harding R, Brown DA, Vera JH, Hanna S. Disability and Self-care Living Strategies Among Adults Living With HIV During the COVID-19 Pandemic. RESEARCH SQUARE 2021. [PMID: 34545356 PMCID: PMC8452102 DOI: 10.21203/rs.3.rs-868864/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BackgroundEvents associated with the COVID-19 pandemic, such as physical distancing, closure of community services, postponement of health appointments, and loss of employment can lead to social isolation, financial uncertainty, and interruption of antiretroviral adherence, resulting in additional health-related challenges (disability) experienced among adults living with chronic illness such as HIV. 'Living strategies' is a concept derived from the perspective of people living with HIV, defined as behaviors, attitudes and beliefs adopted by people living with HIV to help deal with disability associated with HIV and multi-morbidity. Our aim was to describe disability among adults living with HIV and self-care living strategies used during the COVID-19 pandemic. MethodsAdults living with HIV in Toronto, Ontario, Canada, including some with pre-pandemic HIV Disability Questionnaire (HDQ) data, completed a cross-sectional web-based survey between June-August 2020. The survey included the HDQ and questions about self-care living strategy use during the pandemic. We compared disability (HDQ) scores prior to versus during the pandemic using paired t-tests. We reported the proportion of participants who engaged in various living strategies at least 'a few times a week' or 'everyday' during the pandemic. ResultsOf the 63 respondents, 84% were men, median age 57 years, and 62% lived alone. During the pandemic the greatest disability severity was in the uncertainty (median 30; Interquartile range (IQR): 16, 43) and mental-emotional (25; IQR: 14, 41) domains. Among the 51 participants with pre-pandemic data, HDQ severity scores were significantly greater (worse) during the pandemic (vs prior) in all domains. Greatest change from prior to during the pandemic was in the mental-emotional domain for presence (17.7; p<0.001), severity (11.4; p<0.001), and episodic nature (9.3; p<0.05) of disability. Most participants (>60%) reported engaging a 'few times a week' or 'everyday' in self-care strategies associated with maintaining sense of control and adopting positive attitudes and beliefs. ConclusionsPeople living with HIV reported high levels of uncertainty and mental-emotional health challenges during the pandemic. Disability increased across all HDQ dimensions, with the greatest worsening in the mental-emotional health domain. Results provide an understanding of disability and self-care strategy use during the COVID-19 pandemic.
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17
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Brown DA, O'Brien KK. Conceptualising Long COVID as an episodic health condition. BMJ Glob Health 2021; 6:e007004. [PMID: 34551971 PMCID: PMC8460526 DOI: 10.1136/bmjgh-2021-007004] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 01/24/2023] Open
Affiliation(s)
- Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabiltation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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18
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Vader K, Carusone SC, Aubry R, Ahluwalia P, Murray C, Baxter L, Robinson G, Ibáñez-Carrasco F, Stewart A, Solomon P, O'Brien KK. Strengths and Challenges of Implementing Physiotherapy in an HIV Community-Based Care Setting: A Qualitative Study of Perspectives of People Living with HIV and Healthcare Providers. J Int Assoc Provid AIDS Care 2021; 20:23259582211005628. [PMID: 33779374 PMCID: PMC8010811 DOI: 10.1177/23259582211005628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The needs of people living with HIV (PLWH) who have access to antiretroviral therapy have shifted from hospital to community care; however, little is known about physiotherapy within HIV community-based care. Our aim was to understand strengths and challenges of implementing physiotherapy within an interprofessional HIV day health program in Toronto, Ontario, Canada. We conducted a qualitative descriptive study using semi-structured interviews. Data were analyzed using inductive content analysis. Fifteen PLWH and 5 healthcare providers participated. Strengths included improved access to physiotherapy and fulfilling an unmet need for rehabilitation; a tailored approach to physiotherapy; co-location improved communication, coordination, and engagement in care; and improved health outcomes for PLWH (i.e. function, psychosocial outcomes, and quality of life). Challenges related to managing expectations; variable attendance at visits; and managing complex and diverse needs of PLWH. Results may be transferable to other community-based care settings that provide care for PLWH and complex multi-morbidity.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Ann Stewart
- St. Michael's Academic Family Health Team, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
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19
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Baker V, Nkhoma K, Trevelion R, Roach A, Winston A, Sabin C, Bristowe K, Harding R. “I have failed to separate my HIV from this pain”: the challenge of managing chronic pain among people with HIV. AIDS Care 2021:1-9. [PMID: 33443450 DOI: 10.1080/09540121.2020.1869148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pain is a highly prevalent and burdensome symptom among people with HIV (PWH). This study aims to identify how the experience of living with HIV and chronic pain influences pain beliefs, health-seeking and pain management. Thirty-nine purposively sampled PWH with chronic pain (sample characteristics = 61% women, 79% Black, Asian and minority ethnic groups, 18% men who have sex with men, 45-54 median age category) participated in focus groups in London. Focus groups were co-facilitated with community members. Transcripts wereanalysed using a thematic approach. Findings revealed that HIV stigma, fractured care pathways, and general practitioners' lack of HIV training are barriers to supported pain management. Unaddressed pain results in poorer mental health and reduced quality of life, which has important clinical implications for HIV treatment adherence. Creating HIV-specific pain resources, activating social networks, and pain self-management techniques are potential solutions. Person-centred assessment and HIV training is needed to help clinicians identify PWH with chronic pain. Clear guidelines need to be developed to identify which health service providers are responsible for chronic pain management in PWH. This study generated a refined version of the Fear Avoidance Model that introduces a dimension of HIV-specific behaviours that impact PWHs seeking chronic pain management.
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Affiliation(s)
- V. Baker
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - K. Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | | | - A. Roach
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - A. Winston
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, England
| | - C. Sabin
- Faculty of Population Health Sciences, Department of Infection & Population Health, University College London, London, England
| | - K. Bristowe
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
| | - R. Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, England
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20
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O'Brien KK, Kietrys D, Galantino ML, Parrott JS, Davis T, Tran Q, Aubry R, Solomon P. Reliability and Validity of the HIV Disability Questionnaire (HDQ) with Adults Living with HIV in the United States. J Int Assoc Provid AIDS Care 2020; 18:2325958219888461. [PMID: 31769326 PMCID: PMC6880031 DOI: 10.1177/2325958219888461] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess measurement properties of the HIV Disability Questionnaire (HDQ) among adults with HIV in the United States. METHODS We administered the HDQ, World Health Organization Disability Assessment Schedule II (WHODAS 2.0), and a demographic questionnaire. For internal consistency reliability, we calculated Cronbach α and Kuder-Richardson-20 (KR-20) statistics for disability and episodic scores, respectively (≥0.80 acceptable). For test-retest reliability, we calculated intraclass correlation coefficients (>0.8 acceptable). For construct validity, we tested 15 a priori hypotheses assessing correlations between HDQ and WHODAS 2.0 scores. RESULTS Of the 128 participants, the majority were males (68%), median age 51 years, taking antiretroviral therapy (96%). Cronbach α ranged from 0.88 (social inclusion) to 0.93 (uncertainty). The KR-20 ranged from 0.86 (cognitive) to 0.96 (uncertainty). Intraclass correlation coefficients ranged from 0.88 (physical, cognitive, social inclusion) to 0.92 (mental-emotional). Of the 15 hypotheses, 13 (87%) were confirmed. CONCLUSIONS The HDQ demonstrates internal consistency reliability, test-retest reliability, and construct validity when administered to a sample of adults with HIV in the United States.
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Affiliation(s)
- Kelly Kathleen O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Science (RSI), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - David Kietrys
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Mary Lou Galantino
- Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, NJ, USA.,Perelman School of Medicine, Clinical Center for Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James Scott Parrott
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Tracy Davis
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Quang Tran
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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21
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O’Brien KK, Ibáñez-Carrasco F, Solomon P, Harding R, Brown D, Ahluwalia P, Chan Carusone S, Baxter L, Emlet C, Restall G, Casey A, Ahluwalia A, Quigley A, Terpstra AR, Ononiwu N. Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC). AIDS Res Ther 2020; 17:21. [PMID: 32429973 PMCID: PMC7236512 DOI: 10.1186/s12981-020-00280-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC's aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. METHODS We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. RESULTS Sixty-nine stakeholders from countries including Canada (n = 62; 90%), the United Kingdom (n = 5; 7%), United States (n = 1; 1%) and Australia (n = 1; 1%) attended the International Forum on HIV, Aging and Rehabilitation Research. Stakeholders represented community-based organizations (n = 20; 29%), academic institutions (n = 18; 26%), community or institutional healthcare organizations (n = 11; 16%), research or knowledge production organizations (n = 10; 14%), and organizations representing government or industry (n = 10; 14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: (1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; (2) prevalence, severity and impact of frailty; (3) community and social participation aging with HIV; (4) strategies for chronic disease management and healthy aging with HIV; (5) facilitators and barriers to access and engagement in, rehabilitation; (6) effectiveness of rehabilitation interventions for healthy aging with HIV; and (7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. CONCLUSIONS These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation (IHPME), 155 College Street, 4th Floor, Toronto, ON Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
| | | | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | - Richard Harding
- Cicely Saunders Institute, King’s College London, Bessemer Road, London, UK
| | - Darren Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Charles Emlet
- University of Washington, Tacoma, Social Work, 1900 Commerce Street, Tacoma, WA USA
| | - Gayle Restall
- College of Rehabilitation Sciences, University of Manitoba, R127 Rehab Building, Winnipeg, MB Canada
| | - Alan Casey
- Department of Physical Medicine and Rehabilitation, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB Canada
| | | | - Adria Quigley
- Faculty of Health, Dalhousie University, 5968 College Street, Room 316, Halifax, NS Canada
| | - Alex R. Terpstra
- Department of Psychology, 2136 West Mall, Room 2405, Vancouver, BC Canada
| | - Nkem Ononiwu
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
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22
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Abstract
Objective: The Rotterdam Healthy Aging Score (HAS) is a validated multidimensional index constructed from five health domains. We describe the HAS distribution in a cohort of HIV-positive adults and correlate it with health outcomes. Design: A cross-sectional pilot study of 101 adults aged at least 40 years, on suppressive antiretroviral therapy attending a tertiary HIV clinic in Toronto, Canada. Methods: Participants completed questionnaires to calculate their HAS (range 0–14). Demographics, HAS and sub-scores were compared by age and sex. The HAS was compared with results of the Fried Frailty Score, Short Performance Physical Battery score (SPPB) and measures of health utilization. Kruskal--Wallis Rank-Sum and Fisher's exact tests were used for all comparisons. Results: Median (IQR) age was 56 (50--62), 81 (80%) men and 50 (50%) born in Canada. Median (IQR) CD4+ cell count was 574 (417--794) cells/μl. Median (IQR) HAS was 12 (10--13) with 39 (39%) achieving a score more than 12 (considered healthy aging). Younger participants experienced more depression, whereas women had greater pain. The HAS score correlated with the Fried Frailty Score (P = 0.008) and trended with the SPPB Score (P = 0.077). Those with the poorest HAS scores were more likely to have been hospitalized in the preceding 6 months (P = 0.034). Conclusion: The HAS ranged from 5 to 14 in this cohort of older HIV adults with 39% attaining scores in the ‘healthy’ range. The HAS correlated with measures of physical performance and health utilization. Further validation of an objective outcome in HIV-positive patients will facilitate evaluation of interventional studies to improve healthy aging.
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O'Brien KK, Brown DA, Corbett C, Flanagan N, Solomon P, Vera JH, Aubry R, Harding R. AIDSImpact special issue - broadening the lens: recommendations from rehabilitation in chronic disease to advance healthy ageing with HIV. AIDS Care 2020; 32:65-73. [PMID: 32208741 DOI: 10.1080/09540121.2020.1739203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
People living with HIV are ageing with a combination of physical, mental and social health challenges, known as disability. Although rehabilitation can address disability, the field is still emerging. Our aim was to identify similar disability experiences across complex chronic conditions and establish recommendations for future rehabilitation research and practice to advance healthy ageing with HIV. We conducted a consultation with 77 stakeholders from the United Kingdom, Canada, and Ireland with expertise in the fields of rehabilitation and HIV, cancer, cardiovascular disease, renal disease, or chronic obstructive pulmonary disease who attended a one-day symposium. We used facilitated discussions to identify how rehabilitation issues in complex chronic disease translate to people ageing with HIV, and prioritised recommendations for future practice and research. Disability issues experienced across HIV and other complex chronic diseases included: (i) frailty, (ii) uncertainty and worrying about the future ageing with complex chronic disease, (iii) mental health, (iv) pain, and (v) stigma. We highlight six recommendations for clinical practice and research to advance healthy ageing with HIV. Opportunities for cross-collaboration exist with other more established areas of chronic disease management and rehabilitation. Recommendations can be used to inform future HIV clinical practice and research in this emerging field.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
| | - Darren A Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, Therapies Department, London, UK
| | | | - Nick Flanagan
- School of Health and Social Care, Teesside University, Middlesbrough, UK.,South Tyneside NHS Foundation Trust, Medical and Respiratory Physiotherapy, South Shields, UK
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Jaime H Vera
- Royal Sussex County Hospital, Brighton, UK.,Department of Global Health and Infection, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Richard Harding
- Cicely Saunders Institute, King's College London, London, UK.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
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24
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Solomon P, Bond V, Cameron C, Menon JA, Maimbolwa MC, Nixon SA. Types of episodic disability among people living with HIV in Zambia. AIDS Care 2019; 32:1277-1282. [PMID: 31698925 DOI: 10.1080/09540121.2019.1687836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HIV is increasingly recognized as a chronic illness which may result in episodic disability related to the effects of the virus, side effects of medication, co-morbidities and consequences of aging. Little is known about the episodic disability experiences of people living long-term with HIV in resource-limited countries, which is best understood by following people over time. This qualitative longitudinal study examined the episodic disability experiences and the applicability of four types of episodic disability among people living with HIV and on anti-retroviral therapy in Zambia. We interviewed 31 men and women living with HIV on 3 occasions at 6-month intervals (total of 93 interviews) examining the processes of change over time. We used disability models to inform the interviews exploring impairments/symptoms, activity limitations and participation restrictions. Longitudinal analyses of transcribed interviews confirmed the applicability of four types over time: stable, increasing disability, decreasing disability and significant fluctuations. Analyses highlighted the extent to which determinants of health contributed to the disability experienced. The use of disability models revealed the importance of environmental and social influences on disability and quality of life. The indicators of the type of episodic disability could be used clinically to help understand the nature and potential triggers of the episodes.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Virginia Bond
- Global and Health Development Department, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,School of Medicine, Zambart, Lusaka, Zambia
| | - Cathy Cameron
- International Centre for Disability and Rehabilitation, Toronto, Canada
| | - J Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | | | - Stephanie A Nixon
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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25
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Abstract
Palm Springs, CA, is a retirement community with the highest prevalence of gay men living with HIV older than 50 years in the United States. Through a community-academic partnership, we explored the major health issues, resiliencies, and priority research topics related to HIV and aging. We conducted five community facilitated focus groups with different stakeholders, including two focus groups with older adults living with HIV, one with their caregivers, one with HIV-focused community-based organizations, and a joint focus group with researchers and HIV care providers. Using the rigorous and accelerated data reduction technique, five major themes emerged, which included long-term side effects of medication, social determinants of health, mental health, resiliencies, and involving community in research. These data are important for developing effective interventions, conducting useful and impactful research, and providing health care providers with the tools and knowledge to provide optimal care.
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26
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The Experience of Growing Old While Living With HIV in Spain: A Phenomenological Study. J Assoc Nurses AIDS Care 2019; 30:111-118. [PMID: 30586088 DOI: 10.1097/jnc.0000000000000032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
HIV infection has transformed from a deadly disease into a chronic infection with low mortality. Using descriptive phenomenology, this study was designed to describe the lived experience of aging among persons living with HIV in Spain. Twenty-four participants ages 50 years or older were interviewed. Data were analyzed using Colaizzi's method. Aging with HIV made participants aware of the process of growing old, a stage of life they never expected to reach. They acknowledged the physical changes their bodies were undergoing, mostly due to the HIV and as a consequence of antiretroviral therapy. Most participants had financial problems and felt lonely. The participants highlighted how others had positively and negatively influenced their lives and, finally, how they learned to cope and then to accept living with HIV infection, be ready to help peers, and fight against discrimination. More research is needed to reduce loneliness, evaluate the impact of financial problems on health, and identify barriers and facilitators for adaptation, coping, and resilience in persons living with HIV ages 50 years or older.
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27
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Marg LZ, Heidari O, Taylor J, Marbley C, Scheibel S, Hagan R, Messaoudi I, Mendoza N, Brown B. A Multidimensional Assessment of Successful Aging Among Older People Living with HIV in Palm Springs, California. AIDS Res Hum Retroviruses 2019; 35:1174-1180. [PMID: 31441322 DOI: 10.1089/aid.2019.0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We assessed successful aging among older people living with HIV (PLWH) compared with older people without HIV. One hundred ten older men and women in Palm Springs, California completed a self-administered 28-question survey, which collected data on physiological and psychosocial factors related to successfully aging with HIV, including demographics, HIV status, sexual activity, health and well-being, experiences of stigma or discrimination, feelings of isolation, receipt of disability benefits, work and volunteer participation, and presence of comorbid infectious diseases, noninfectious diseases, and geriatric syndromes. Most participants were male (96.4%), non-Hispanic white (84.5%), college educated (61.7%), and ranged in age from 55 to 87 years (median = 64 years). Respondents with HIV were significantly older than those without HIV (p = .04). The overall prevalence of two or more comorbid conditions across the sample was 59.1%. PLWH were more likely to report depression (p = .008). PLWH were also significantly more likely to report having a current sex partner living with HIV (p < .001) and receiving disability benefits than people without HIV (41.9% vs. 6.3%). Among PLWH, there was a significant relationship between not working or volunteering and feelings of isolation (p = .005). For people without HIV, we found a significant relationship between feelings of isolation and not living with someone (p < .001), but there was no such relationship among PLWH-possibly reflecting the strength of the support network for PLWH in Palm Springs. Our findings suggest that older PLWH experience successful aging to a similar degree compared with their peers without HIV. However, depression and social isolation remain highly salient issues that threaten successful aging and with which PLWH must contend.
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Affiliation(s)
- Logan Z. Marg
- Department of Sociology, University of California, Riverside, Riverside, California
| | - Omeid Heidari
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Jeff Taylor
- HIV+Aging Research Project-Palm Springs, Palm Springs, California
| | | | | | - Rod Hagan
- Borrego Health, Cathedral City, California
| | - Ilhem Messaoudi
- School of Biological Sciences, University of California, Irvine, Irvine, California
| | - Norma Mendoza
- School of Biological Sciences, University of California, Irvine, Irvine, California
| | - Brandon Brown
- School of Medicine, University of California, Riverside, Riverside, California
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28
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Solomon P, O'Brien KK, Nixon S, Letts L, Baxter L, Gervais N. Trajectories of Episodic Disability in People Aging with HIV: A Longitudinal Qualitative Study. J Int Assoc Provid AIDS Care 2019; 17:2325958218759210. [PMID: 29464973 PMCID: PMC6748469 DOI: 10.1177/2325958218759210] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
People living with HIV may experience disability which is episodic in nature, characterized by periods of wellness and illness. The purpose of this longitudinal qualitative study was to understand how the episodic nature of HIV and the associated uncertainty shape the disability experience of older adults living with HIV over time. Fourteen men and 10 women who were HIV positive and over 50 years (mean age: 57 years; range: 50-73) participated in 4 interviews over 20 months. Longitudinal analyses of the transcribed interviews identified 4 phenotypes of episodic disability over time: decreasing, increasing, stable, or significant fluctuations. Although all participants experienced uncertainty, acceptance and optimism were hallmarks of those whose phenotypes were stable or improved over time. Understanding a person's episodic trajectory may help to tailor interventions to promote stability, mitigate an upward trajectory of increasing disability, and increase the time between episodes of illness.
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Affiliation(s)
- Patricia Solomon
- 1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Stephanie Nixon
- 2 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lori Letts
- 1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Larry Baxter
- 3 Community HIV Volunteer, Halifax, Nova Scotia, Canada
| | - Nicole Gervais
- 1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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29
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O'Brien KK, Dagenais M, Solomon P, Worthington C, Chan Carusone S, Ibáñez-Carrasco F, Hanna S, Gahagan J, Baxter L, Robinson G, Gayle P, James D, Yates T. Use of Living Strategies among Adults Aging with HIV in Canada: Comparison by Age-Group Using Data from the HIV, Health and Rehabilitation Survey. J Int Assoc Provid AIDS Care 2019; 17:2325958218774041. [PMID: 29745310 PMCID: PMC6748490 DOI: 10.1177/2325958218774041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To examine the type and frequency of living strategies used by adults living with HIV. Methods: We conducted a cross-sectional web-based survey that included 51 living strategies: maintaining sense of control, attitudes and beliefs, blocking HIV out of the mind, and social interaction. We examined the frequency of use and compared the proportion of respondents who engaged in strategies across 3 age-groups (<40 years, 40-49 years, and ≥50 years). Results: Of the 935 participants, the majority were men (79%) and most (≥60%) engaged “most” or “all of the time” in healthy lifestyle strategies and maintained a positive outlook living with HIV. Compared to younger participants, a higher proportion of older adults (≥50 years) engaged “most” or “all the time” in strategies that involved maintaining control over health and adopting positive attitudes and outlook living with HIV. Conclusions: Findings can help to inform the role of self-management to enhance successful aging with HIV.
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Affiliation(s)
- Kelly Kathleen O'Brien
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,2 Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada.,3 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Matthieu Dagenais
- 2 Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- 4 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Worthington
- 5 School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | | | - Francisco Ibáñez-Carrasco
- 7 Centre for Urban Health Studies, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Steven Hanna
- 8 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jacqueline Gahagan
- 9 Faculty of Health, School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Larry Baxter
- 10 Community Member, Halifax, Nova Scotia, Canada
| | | | - Patriic Gayle
- 12 Gay Men's Health Collective (GMHC), London, United Kingdom
| | - Dawn James
- 13 Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada
| | - Tammy Yates
- 14 Realize, formerly the Canadian Working Group on HIV and Rehabilitation, Toronto, Ontario, Canada
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30
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Solomon P, O'Brien KK, McGuff R, Sankey M. Living strategies for disability in men ageing with HIV in Ontario, Canada: a longitudinal qualitative study. BMJ Open 2019; 9:e031262. [PMID: 31481379 PMCID: PMC6731853 DOI: 10.1136/bmjopen-2019-031262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the living strategies used by older men living with HIV to deal with the episodic nature of disability and associated uncertainty, over time. DESIGN Qualitative longitudinal study in which men living with HIV were interviewed on four occasions over 20 months. SETTING Men were recruited from HIV community organisations in Canada. PARTICIPANTS 14 men with a median age of 57.5 years and median time since diagnosis of 21.5 years. RESULTS Five themes depict the living strategies used to deal with the episodic nature of disability and uncertainty over time. Actively engaging in problem-solving by prioritising and modifying activities and avoiding stress, advocating for support, being positive and future oriented, engaging in healthy pursuits and providing social support to others helped men to mitigate their disability. By following participants over time, we were able to gather insights into triggers of episodes of disability, and perceptions of the success of implementing their living strategies and avoiding uncertainty. CONCLUSIONS Participants used living strategies to deal with uncertainty and mitigate episodes of disability over time. This study supports the importance of programmes that promote self-management for older men living with HIV through helping them identify triggers of disability, set realistic goals and problem-solve. These may help build self-efficacy, increase sense of control, and decrease feelings of uncertainty and episodes of disability.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Rebecca McGuff
- School of Rehabilitation Science, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Michelle Sankey
- School of Rehabilitation Science, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
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31
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Brown DA, Simmons B, Boffito M, Aubry R, Nwokolo N, Harding R, O’Brien KK. Evaluation of the psychometric properties of the HIV Disability Questionnaire among adults living with HIV in the United Kingdom: A cross-sectional self-report measurement study. PLoS One 2019; 14:e0213222. [PMID: 31291243 PMCID: PMC6619602 DOI: 10.1371/journal.pone.0213222] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/06/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of the HIV Disability Questionnaire (HDQ) among people living with HIV (PLHIV) in London, United Kingdom (UK). METHODS This is a cross-sectional measurement study. We recruited and administered the self-reported HDQ, seven criterion measures, and a demographic questionnaire with adults living with HIV accessing HIV care. We determined median and interquartile ranges (IQR) for disability presence, severity and episodic scores (range 0-100). We calculated Cronbach's alpha (α) Kuder-Richardson-20 (KR-20) statistics for disability and episodic scores respectively (internal consistency reliability), smallest detectable change (SDC) for each HDQ severity item and domain (precision), and tested 36 a priori hypotheses assessing correlations between HDQ and criterion scores (construct validity). RESULTS Of N = 243 participants, all were male, median age 40 years, 94% currently taking antiretroviral therapy, and 22% living with ≥2 concurrent health conditions. Median HDQ domain scores ranged from 0 (IQR: 0,7) (difficulties with day-to-day activities domain) to 27 (IQR: 14, 41) (uncertainty domain). Cronbach's alpha for the HDQ severity scale ranged from 0.85 (95% Confidence Interval (CI): 0.80-0.90) in the cognitive domain to 0.93 (95%CI: 0.91-0.94) in the mental-emotional domain. The KR-20 statistic for the HDQ episodic scale ranged from 0.74 (95%CI: 0.66-0.83) in the cognitive domain to 0.91 (95%CI: 0.89-0.94) in the uncertainty domain. SDC ranged from 7.3-15.0 points on the HDQ severity scale for difficulties with day-to-day activities and cognitive symptoms domains, respectively. The majority of the construct validity hypotheses (n = 30/36, 83%) were confirmed. CONCLUSIONS The HDQ possesses internal consistency reliability and construct validity with varied precision when administered to males living with HIV in London, UK. Clinicians and researchers may use the HDQ to measure the nature and extent of disability experienced by PLHIV in the UK, and to inform HIV service provision to address the health-related challenges among PLHIV.
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Affiliation(s)
- Darren A. Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, Therapies Department, London United Kingdom
| | - Bryony Simmons
- Imperial College London, Faculty of Medicine, Department of Medicine, London, United Kingdom
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, Department of HIV Medicine, London, United Kingdom
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
| | - Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
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32
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O’Brien KK, Hanna S, Solomon P, Worthington C, Ibáñez-Carrasco F, Chan Carusone S, Nixon S, Merritt B, Gahagan J, Baxter L, Gayle P, Robinson G, Baltzer Turje R, Tattle S, Yates T. Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey. BMC Infect Dis 2019; 19:594. [PMID: 31286891 PMCID: PMC6615082 DOI: 10.1186/s12879-019-4203-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as 'disability'. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV. METHODS We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2-0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis. RESULTS Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001). CONCLUSIONS Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, Ontario Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, Ontario Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario Canada
| | - Steven Hanna
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, British Columbia, Canada
| | - Francisco Ibáñez-Carrasco
- Centre for Urban Health Solutions (CUHS), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | | | - Stephanie Nixon
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, Ontario Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, Ontario Canada
| | - Brenda Merritt
- School of Health & Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia Canada
| | - Jacqueline Gahagan
- School of Health & Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia Canada
| | | | - Patriic Gayle
- Gay Men’s Health Collective (GMHC), Three Flying Piglets, London, UK
| | | | | | - Stephen Tattle
- Realize, formerly the Canadian Working Group on HIV and Rehabilitation, Toronto, Canada
| | - Tammy Yates
- Realize, formerly the Canadian Working Group on HIV and Rehabilitation, Toronto, Canada
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33
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O'Brien KK, Bergin C, Solomon P, O'Dea S, Forde C, Vajravelu S. Cross-cultural applicability of the episodic disability framework with adults living with HIV in Ireland: a qualitative study. Disabil Rehabil 2019; 43:229-240. [PMID: 31161816 DOI: 10.1080/09638288.2019.1621395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: To explore the cross-cultural applicability of the Episodic Disability Framework with people living with HIV in Ireland.Methods: We conducted a qualitative descriptive study using semi-structured interviews. We recruited adults with HIV from a hospital clinic and community-based organization in Dublin, Ireland. We asked participants to describe their health-related challenges, the extent to which these challenges were episodic in nature, and the impact on their overall health. We analyzed data using content analytical techniques.Results: Of the 12 participants (9 men; 3 women), with a median time since HIV diagnosis of 12 years, 83% had an undetectable viral load. Participants described multi-dimensional and episodic health challenges that spanned disability dimensions in the Episodic Disability Framework including: physical, cognitive, and mental-emotional symptoms and impairments, challenges to social inclusion, and uncertainty or worrying about future health with HIV. Contextual factors that exacerbated disability included stigma and fear of HIV disclosure whereas living strategies (lifestyle, positive outlook, resiliency) and social support (family, friends, health services and providers) mitigated disability.Conclusions: The Episodic Disability Framework is pertinent to adults living with HIV in Ireland. Contextual factors are critical for understanding cross-cultural distinctions of the disability experience across varying political, economic, socio-cultural, and environmental contexts and should be considered by rehabilitation professionals to address disability for people with HIV.Implications for rehabilitationThe Episodic Disability Framework, originally derived and validated from perspectives of adults living with HIV in Canada, is pertinent to people living with HIV in Ireland.The Episodic Disability Framework can be used to describe disability experienced by people living with HIV, and to better understand the contextual factors that may exacerbate or alleviate dimensions of disability over time.Contextual factors are critical for understanding cross-cultural distinctions of the disability experience across varying political, economic, sociocultural, and environmental contexts, and should be considered by rehabilitation professionals to better address disability for people with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Colm Bergin
- Department of Genito Urinary Medicine and Infectious Diseases Clinic, St James's Hospital, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Siobhan O'Dea
- Department of Genito Urinary Medicine and Infectious Diseases Clinic, St James's Hospital, Dublin, Ireland
| | - Cuisle Forde
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Vance DE, Blake BJ, Brennan-Ing M, DeMarco RF, Fazeli PL, Relf MV. Revisiting Successful Aging With HIV Through a Revised Biopsychosocial Model: An Update of the Literature. J Assoc Nurses AIDS Care 2019; 30:5-14. [PMID: 30586079 DOI: 10.1097/jnc.0000000000000029] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The concept of successful aging was recognized only recently by HIV researchers because people living with HIV (PLWH) in the early epidemic were not expected to survive. With the introduction of antiretrovirals that block viral replication, PLWH are now aging with HIV. Given the complex nature of HIV within the social, economic, and political climates in which it occurs, a holistic model of successful aging is needed to guide researchers and clinicians. Several overarching models exist, but must be updated for rapidly advancing HIV and aging research agendas. We provide an updated, adapted, and integrated biopsychosocial model of successful aging with HIV based on the principles of Baltes and Baltes (1998) on 8 essential components of successful aging: (a) length of life, (b) biological health, (c) mental health, (d) cognitive efficiency, (e) social competence, (f) productivity, (g) personal control, and (h) life satisfaction. Clinical practice and research implications are highlighted.
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Greene ML, Tan JY, Weiser SD, Christopoulos K, Shiels M, O’Hollaren A, Mureithi E, Meissner L, Havlir D, Gandhi M. Patient and provider perceptions of a comprehensive care program for HIV-positive adults over 50 years of age: The formation of the Golden Compass HIV and aging care program in San Francisco. PLoS One 2018; 13:e0208486. [PMID: 30517193 PMCID: PMC6281256 DOI: 10.1371/journal.pone.0208486] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 11/19/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE People living with HIV (PLWH) are living longer and developing comorbidities and aging-related syndromes. New care models are needed to address the combined burden and complexity of HIV and its comorbidities in this group. The goal of this study is to describe qualitative data from patients and providers that informed the development of a comprehensive care model for older PLWH. METHODS Patient and provider perspectives on the clinical care and service needs of patients living and aging with HIV were explored via surveys and focus groups at a safety net HIV clinic in San Francisco. We surveyed 77 patients and 26 providers and conducted separate focus groups of older patients living with HIV (n = 31) and staff (n = 20). Transcripts were analyzed using thematic analysis. Themes for a care program were additionally explored using findings from the literature on HIV and aging. FINDINGS Themes from surveys and focus groups emphasized (a) the need for knowledge expertise in HIV and aging, (b) focus on medical conditions and determinants of health of particular import (e.g. marginal housing) among older PLWH, (c) co-locating specialty services (e.g. cardiology, geriatrics) with primary care, and (d) addressing social isolation. Findings informed the design of a comprehensive, multidisciplinary care model for PLWH called the Golden Compass program composed of four "points": Heart and Mind (North), Bones and Strength (East), Network and Navigation (South), and Dental, Hearing, and Vision (West). CONCLUSION Based on patient and clinic staff perspectives from surveys and focus groups, we designed a multidisciplinary program of integrated primary and specialty care, as well as housing and social support, to address the needs of older PLWH within a safety-net infrastructure. Golden Compass launched in 2017 for PLWH older than 50 years. Future research to evaluate the effectiveness of this care program in improving patient outcomes and satisfaction is ongoing.
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Affiliation(s)
- Meredith L. Greene
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Judy Y. Tan
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Katerina Christopoulos
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Mary Shiels
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Allison O’Hollaren
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Eva Mureithi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Loren Meissner
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Diane Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
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‘The own’ and ‘the wise’ as social support for older people living with HIV in the United Kingdom. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractAs the HIV population ages, how the ageing and HIV experiences intersect to shape the lives of older people living with HIV (PLWH) becomes an increasingly pressing question. This multi-method study investigated social support, mental health and quality of life among 100 older PLWH in the United Kingdom. Drawing on data from three focus groups and 74 life-history interviews with older (aged 50+) White men who have sex with men (MSM), and Black African and White heterosexual men and women, living with HIV, we explore participants’ distinctions between, evaluations of and access to sources of social support. Participants distinguished between support from the HIV-negative (Goffman's ‘the own’) and experientially based support from other PLWH (Goffman's ‘the wise’), and viewed the former, while valuable, as needing to be supplemented by the latter. Furthermore, access to experientially based support varied across participant groups, whose communities had different histories with HIV/AIDS and thus different degrees of knowledge about HIV and avenues for connecting to other PLWH. Thus, social support among older PLWH cannot be neatly divided into ‘formal’ and ‘informal’ domains, or fully appreciated by applying traditional social support measures, including, in the context of health conditions, ‘peer support’ created through formal service organisations. Rather, older PLWH's own distinctions and evaluations better illuminate the complexities of social support in the context of ageing with HIV.
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Solomon P, O’Brien KK, Nixon S, Letts L, Baxter L, Gervais N. Qualitative longitudinal study of episodic disability experiences of older women living with HIV in Ontario, Canada. BMJ Open 2018; 8:e021507. [PMID: 29678993 PMCID: PMC5914902 DOI: 10.1136/bmjopen-2018-021507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To examine the episodic disability experiences of older women living with HIV over time. DESIGN Qualitative longitudinal study, conducting semistructured in-depth interviews on four occasions over a 20-month time frame. Inductive thematic analyses were conducted cross-sectionally and longitudinally. SETTING Participants were recruited from HIV community organisations in Canada. PARTICIPANTS 10 women aged 50 years or older living with HIV for more than 6 years. RESULTS Two major themes related to the episodic nature of the women's disability. Women were living with multiple and complex sources of uncertainty over time including: unpredictable health challenges, worrying about cognition, unreliable weather, fearing stigma and the effects of disclosure, maintaining housing and adequate finances, and fulfilling gendered and family roles. Women describe strategies to deal with uncertainty over time including withdrawing and limiting activities and participation and engaging in meaningful activities. CONCLUSIONS This longitudinal study highlighted the disabling effects of HIV over time in which unpredictable fluctuations in illness and health resulted in uncertainty and worrying about the future. Environmental factors, such as stigma and weather, may put older women living with HIV at a greater risk for social isolation. Strategies to promote dealing with uncertainty and building resilience are warranted.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Nixon
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Larry Baxter
- Community HIV Volunteer, Halifax, Nova Scotia, Canada
| | - Nicole Gervais
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Akhtar NF, Garcha RK, Solomon P. Experiences of women aging with the human immunodeficiency virus: A qualitative study. The Canadian Journal of Occupational Therapy 2018; 84:253-261. [DOI: 10.1177/0008417417722574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vader K, Simonik A, Ellis D, Kesbian D, Leung P, Jachyra P, Carusone SC, O'Brien KK. Perceptions of ‘physical activity’ and ‘exercise’ among people living with HIV: A qualitative study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.11.473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kyle Vader
- Department of Physical Therapy, University of Toronto, Canada
| | - Alya Simonik
- Department of Physical Therapy, University of Toronto, Canada
| | - Denine Ellis
- Department of Physical Therapy, University of Toronto, Canada
| | - Dirouhi Kesbian
- Department of Physical Therapy, University of Toronto, Canada
| | - Priscilla Leung
- Department of Physical Therapy, University of Toronto, Canada
| | - Patrick Jachyra
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | | | - Kelly K O'Brien
- Department of Physical Therapy; Rehabilitation Sciences Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
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Stevens ME, Parsons JA, Read SE, Nixon SA. The conceptualization of stigma within a rehabilitation framework using HIV as an example. Disabil Rehabil 2017; 41:235-243. [PMID: 28978242 DOI: 10.1080/09638288.2017.1385099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Stigma theory is concerned with inclusion and opportunities that influence well-being. Rehabilitation is also concerned with social inclusion and well-being. This is a central concern in one of the leading rehabilitation theories, the World Health Organization's International Classification of Functioning, Disability and Health. Despite these shared concerns, the relationship between the fields of stigma and rehabilitation has not been well theorized to date. Using human immunodeficiency virus (HIV) as an example, this article presents an analysis of three ways that stigma may be conceptualized within the context of the International Classification of Functioning, Disability and Health. Three broad spheres of stigma are described: enacted, self, and structural stigma. These three forms of stigma are then aligned in unique ways with three particular constructs of the International Classification of Functioning, Disability and Health: participation restrictions, environmental, and personal contextual factors. This conceptualization illustrates how rehabilitation professionals and other practitioners, policy makers and researchers can better understand the dynamic and nuanced forms of stigma and how they relate to rehabilitation. Implications for rehabilitation This article enables rehabilitation professionals to better understand stigma as it relates to rehabilitation and human immunodeficiency virus. Rehabilitation professionals have the important job of allies and advocates for persons experiencing restrictions in these domains as a result of stigma.
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Affiliation(s)
- Marianne E Stevens
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b International Centre for Disability and Rehabilitation , University of Toronto , Toronto , Canada
| | - Janet A Parsons
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , Canada.,d Applied Health Research Centre , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
| | - Stanley E Read
- e Division of Infectious Diseases , The Hospital for Sick Children , Toronto , Canada.,f Department of Pediatrics , University of Toronto , Toronto , Canada
| | - Stephanie A Nixon
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b International Centre for Disability and Rehabilitation , University of Toronto , Toronto , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , Canada
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Nguyen AL, McNeil CJ, Han SD, Rhodes SD. Risk and protective factors for health-related quality of life among persons aging with HIV. AIDS Care 2017; 30:518-522. [PMID: 28944679 DOI: 10.1080/09540121.2017.1381333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
For persons living with HIV, health-related quality of life (HRQOL) may be threatened by physical and mental conditions but may be protected by positive psychological traits. We performed an exploratory look at the risk and protective factors for HRQOL in older adults living with HIV. Cross-sectional analyses of baseline data from the Rush Center of Excellence on Disparities in HIV and Aging (CEDHA), a community-based cohort of persons ages ≥50 living with HIV (n = 176) were performed. Analyses examined the relationship between risk/protective factors and two outcomes (i.e., self-reported health status [SRHS] and the healthy days index [HDI]). Having good/excellent health was associated with being a non-smoker (p = 0.002), greater purpose in life (p = 0.006), higher education (p = 0.007), fewer depressive symptoms (p = 0.004), fewer disabilities (p = 0.000), and less loneliness (p = 0.002) in bivariate analyses. Males (p = 0.03) and African Americans/Blacks (p = 0.03) reported higher HDI. Fewer depressive symptoms (p = 0.000), disabilities (p = 0.002), adverse life events (p = 0.0103), and loneliness (p = 0.000) were associated with higher HDI in bivariate analyses. In a logistic regression model, greater purpose in life, fewer disabilities, and being a non-smoker were associated with better SRHS after adjusting for covariates. For African Americans/Blacks, having fewer depressive symptoms and disabilities were associated with higher HDI after adjusting for covariates. Disabilities, depression, smoking status, race/ethnicity, and purpose in life were significantly associated with HRQOL. Findings support the need for research to examine the influence of cultural interpretations of life quality and focus on promoting physical function, smoking cessation, and psychological wellness in persons aging with HIV.
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Affiliation(s)
- Annie L Nguyen
- a Department of Family Medicine, Keck School of Medicine , University of Southern California , Alhambra , CA , USA
| | - Candice J McNeil
- b Department of Internal Medicine, Section on Infectious Diseases , Wake Forest University Health Sciences , Winston-Salem , NC , USA
| | - S Duke Han
- c Department of Family Medicine, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Scott D Rhodes
- b Department of Internal Medicine, Section on Infectious Diseases , Wake Forest University Health Sciences , Winston-Salem , NC , USA.,d Department of Social Sciences and Health Policy, Section on Infectious Diseases , Wake Forest University Health Sciences , Winston-Salem , NC , USA
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Solomon P, Letts L, O'Brien KK, Nixon S, Baxter L, Gervais N. 'I'm still here, I'm still alive': Understanding successful aging in the context of HIV. Int J STD AIDS 2017; 29:172-177. [PMID: 28728526 DOI: 10.1177/0956462417721439] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
As people living with HIV (PLWH) live longer, increased understanding of individuals' values and perceptions of successful aging can assist health providers in working with PLWH to set meaningful goals as they age. The purpose of this qualitative study was to understand how PLWH define successful aging and their perceptions of contributors to successful aging. Fourteen men and ten women over the age of 50 years (mean age 57 years; mean time since diagnosis 18 years) participated in individual interviews. Interviews were analyzed using directed content analysis. Six themes emerged: accepting limitations, staying positive, maintaining social supports, taking responsibility, living a healthy lifestyle, and engaging in meaningful activities. The participants emphasized individual control. This highlights the importance of working with PLWH to understand their values and aspirations, and create patient-centered goals. From a research perspective this reinforces calls to include the subjective experiences of older adults in developing successful aging criteria.
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Affiliation(s)
- Patricia Solomon
- 1 School of Rehabilitation Sciences, 3710 McMaster University , Hamilton, Canada
| | - Lori Letts
- 1 School of Rehabilitation Sciences, 3710 McMaster University , Hamilton, Canada
| | - Kelly K O'Brien
- 2 Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Stephanie Nixon
- 2 Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Nicole Gervais
- 1 School of Rehabilitation Sciences, 3710 McMaster University , Hamilton, Canada
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Mental Health Experiences of Older Adults Living with HIV: Uncertainty, Stigma, and Approaches to Resilience. Can J Aging 2017; 36:125-140. [PMID: 28349859 DOI: 10.1017/s0714980817000022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study describes the mental health experiences of older adults living with HIV in Ottawa. Eleven participants aged 52 to 67 completed in-depth personal interviews. Mental health concerns pervaded the lives of these older adults. We identified three central themes common to the participants' stories: uncertainty, stigma, and resilience. For some of these participants, uncertainty impacting mental health centred on unexpected survival; interpretation of one's symptoms; and medical uncertainty. Participants' experiences of stigma included discrimination in health care interactions; misinformation; feeling stigmatized due to aspects of their physical appearance; compounded stigma; and anticipated stigma. Participants reported using several coping strategies, which we frame as individual approaches to resilience. These strategies include reducing the space that HIV takes up in one's life; making lifestyle changes to accommodate one's illness; and engaging with social support. These findings inform understandings of services for people aging with HIV who may experience mental health concerns.
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A growing need - HIV education in long-term care. Geriatr Nurs 2017; 38:199-206. [PMID: 28169038 DOI: 10.1016/j.gerinurse.2016.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 10/02/2016] [Accepted: 10/27/2016] [Indexed: 01/15/2023]
Abstract
As people living with HIV (PLHIV) age, knowledge of HIV and the associated care of those aging with HIV will become an increasingly important component of education for long-term care (LTC) providers. This descriptive study piloted two different approaches to distribute narrative-based HIV educational videos. Four LTC facilities were assigned to receive the videos to implement 'as usual' or to receive the videos in addition to blended learning sessions where the videos were shown with facilitated discussion with a nurse educator and a PLHIV. In LTC facilities where external educators were provided, a larger proportion of staff watched the videos. However, increases in staff comfort level providing care to PLHIV were comparable between both groups. Narratives of PLHIV, administrator engagement and coordination of online education were identified as facilitators to improving HIV knowledge and compassion in LTC, while fear of HIV transmission and limited time for education, especially when not mandated or identified as immediately applicable, were identified as barriers. From our findings, HIV-related stigma still exists in LTC and these videos may be a strategy for disseminating basic knowledge about HIV transmission and sensitizing staff to the experience of living with HIV.
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McGowan JA, Sherr L, Rodger AJ, Fisher M, Miners A, Anderson J, Johnson MA, Elford J, Collins S, Hart G, Phillips AN, Speakman A, Lampe FC. Age, time living with diagnosed HIV infection, and self-rated health. HIV Med 2017; 18:89-103. [PMID: 27385511 PMCID: PMC5245118 DOI: 10.1111/hiv.12398] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 12/05/2022]
Abstract
OBJECTIVES An increasing proportion of people living with HIV are older adults, who may require specialized care. Adverse physical and psychological effects of HIV infection may be greatest among older people or those who have lived longer with HIV. METHODS The ASTRA study is a cross-sectional questionnaire study of 3258 HIV-diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from UK clinics in 2011-2012. Associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms (scores ≥ 10 on PHQ-9 and GAD-7, respectively), and health-related functional problems (problems on at least one of three domains of the Euroqol 5D-3L)) were assessed, adjusting for time with diagnosed HIV infection, gender/sexual orientation and ethnicity. RESULTS The age distribution of participants was: < 30 years, 5%; 30-39 years, 23%; 40-49 years, 43%; 50-59 years, 22%; and ≥ 60 years, 7%. Overall prevalences were: physical symptom distress, 56%; depression symptoms, 27%; anxiety symptoms, 22%; functional problems, 38%. No trend was found in the prevalence of physical symptom distress with age [adjusted odds ratio (OR) for trend across age groups, 0.96; 95% confidence interval (CI) 0.89, 1.04; P = 0.36]. The prevalence of depression and anxiety symptoms decreased with age [adjusted OR 0.86 (95% CI 0.79, 0.94; P = 0.001) and adjusted OR 0.85 (95% CI 0.77, 0.94; P = 0.001), respectively], while that of functional problems increased (adjusted OR 1.28; 95% CI 1.17, 1.39; P < 0.001). In contrast, a longer time with diagnosed HIV infection was strongly and independently associated with a higher prevalence of symptom distress, depression symptoms, anxiety symptoms, and functional problems (P < 0.001 for trends, adjusted analysis). CONCLUSIONS Among people living with HIV, although health-related functional problems were more common with older age, physical symptom distress was not, and mental health was more favourable. These results suggest that a longer time with diagnosed HIV infection, rather than age, is the dominating factor contributing to psychological morbidity and lower quality of life.
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Affiliation(s)
- JA McGowan
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - L Sherr
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - AJ Rodger
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - M Fisher
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - A Miners
- London School of Hygiene and Tropical MedicineLondonUK
| | - J Anderson
- Homerton University Hospital NHS Foundation TrustLondonUK
| | - MA Johnson
- Royal Free London NHS Foundation TrustLondonUK
| | - J Elford
- School of Health SciencesCity UniversityLondonUK
| | | | - G Hart
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - AN Phillips
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - A Speakman
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | - FC Lampe
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
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Sharmin R, Jung B, Shimmell L, Solomon P. Benefits and challenges of role-emerging placements of student occupational therapists in HIV service organisations. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.12.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background and aims: Recognising the importance of occupational therapy for people with Human Immunodeficiency Virus (HIV) has led to the possibility of promoting and integrating services in HIV service organisations through role-emerging placements for student occupational therapists. The objective of this study was to investigate the benefits and challenges of role-emerging placements of student occupational therapists in HIV service organisations. Methods: This study employed qualitative methods to understand the perspectives of student occupational therapists, HIV service organisation staff, an occupational therapy preceptor, and people with HIV following 8-week role-emerging placements of student occupational therapists in HIV service organisations. Transcribed interviews were analysed using content analysis to identify themes. Findings: Results highlighted the following benefits: 1) Reinforcing professional skills; 2) Developing competency in providing rehabilitation services for people with HIV; 3) Shining a light on the role of occupational therapy; and 4) Empowering HIV service organisations. Challenges included: 1) Starting the groundwork; and 2) Building relationships. Conclusion: The placements of student occupational therapists in HIV service organisations can foster the integration of occupational therapy services in these organisations to maintain the optimum community responses. Findings also demonstrated the value that role-emerging placements have in increasing the competencies of the student occupational therapists as future rehabilitation professionals.
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Affiliation(s)
- Rabeya Sharmin
- Graduate student, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Bonny Jung
- Associate professor, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Lorie Shimmell
- Director of clinical education (occupational therapy), assistant professor, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Patricia Solomon
- Professor and associate dean, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Hu H, Yao X, Xie X, Wu X, Zheng C, Xia W, Ma S. Prognostic value of preoperative NLR, dNLR, PLR and CRP in surgical renal cell carcinoma patients. World J Urol 2016; 35:261-270. [PMID: 27255479 DOI: 10.1007/s00345-016-1864-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/23/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Emerging evidences indicate that inflammation plays a crucial role in carcinogenesis and tumor progression. Inflammatory response biomarkers are recognized as promising prognostic factors for improving predictive accuracy in renal cell carcinoma (RCC). We aimed to evaluate the prognostic significance of preoperative neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR) and serum C-reactive protein (CRP) in RCC. METHODS 484 surgical RCC patients were enrolled from 2006 to 2010 in this study. Receiver operating curve (ROC) was applied to assess the optimal cutoff levels for four biomarkers, and the prognostic values were determined by Kaplan-Meier curve, univariate and multivariate COX regression models. The predictive accuracy was evaluated by concordance index (c-index). RESULTS The median follow-up duration after surgical resection was 36 months. The optimal cutoff levels were 2.78 for NLR, 2.05 for dNLR, 185 for PLR and 5.1 for CRP by ROC curves analysis. Elevated NLR, dNLR, PLR and CRP were significantly correlated with worse overall survival (OS). Multivariate analysis showed that elevated NLR was an independent risk factor for OS, and NLR was superior to dNLR, PLR and CRP based on hazard ratio (HR 2.10, 95 % CI 1.21-3.64, P = 0.008). Additionally, the nomogram could more effectively work in predicting OS (c-index: 0.749) in surgical RCC patients. CONCLUSION Pre-operation NLR can be considered as a potential prognostic biomarker in patients with RCC who underwent surgical resection.
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Affiliation(s)
- Hong Hu
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China
| | - Xiajuan Yao
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China
| | - Xiangcheng Xie
- Department of Nephrology, Hangzhou First People's Hospital, Hangzhou Hospital Affiliated to Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Xia Wu
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China
| | - Chuanming Zheng
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhengjiang, China
| | - Wenkai Xia
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China.
| | - Shenglin Ma
- Department of Oncology, Hangzhou First People's Hospital, Hangzhou Hospital Affiliated to Nanjing Medical University, 261 Huansha Road, Hangzhou, 310006, Zhejiang, China.
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Abstract
Living with human immunodeficiency virus (HIV) in the industrialised world has for over a decade been conceptualised as living with a chronic illness. People living with HIV now are amongst the first to live and age with the virus. Drawing on a qualitative longitudinal study in a low-incidence area in a low-incidence country, this paper investigates the nuanced ways that people negotiate this condition. While it has been argued that HIV is a condition like any other chronic disease, our thematic analysis reveals some similarities and particularities around living with the condition. In comparing themselves to others with the condition, high levels of diversity of experience were identified that extended well beyond length of time from diagnosis. In comparing their illness with other illnesses, the location, for example, of their specialist service within a clinic for those with acute sexually transmitted diseases was identified as problematic. The work involved in maintaining a coherent sense of self in the face of existing and shifting challenges as a result of their infection was a second strong theme. The final theme involved flux and flex work in the ways people sought to gain and maintain control over various aspects of their lives. All of these experiences are mediated by place; that is the experience is not the same as that of those who live where there is a much higher incidence of infection. The work involved in negotiating this condition in low-incidence environments deserves more attention, but aspects of these findings are significant in higher incidence contexts as well; in particular, passivity in face of infection as one ages and the potential for medication refusal as a means of maintaining control over life and death.
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Affiliation(s)
- Lee Thompson
- a Department of Population Health , University of Otago , Christchurch , New Zealand
| | - Gillian Abel
- a Department of Population Health , University of Otago , Christchurch , New Zealand
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Simonik A, Vader K, Ellis D, Kesbian D, Leung P, Jachyra P, Chan Carusone S, O'Brien KK. Are you ready? Exploring readiness to engage in exercise among people living with HIV and multimorbidity in Toronto, Canada: a qualitative study. BMJ Open 2016; 6:e010029. [PMID: 26956163 PMCID: PMC4785327 DOI: 10.1136/bmjopen-2015-010029] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our aim was to explore readiness to engage in exercise among people living with HIV and multimorbidity. DESIGN We conducted a descriptive qualitative study using face-to-face semistructured interviews with adults living with HIV. SETTING We recruited adults (18 years or older) who self-identified as living with HIV and 2 or more additional health-related conditions from a specialty hospital in Toronto, Canada. PARTICIPANTS 14 participants with a median age of 50 years and median number of 9 concurrent health-related conditions participated in the study. The majority of participants were men (64%) with an undetectable viral load (71%). OUTCOME MEASURES We asked participants to describe their readiness to engage in exercise and explored how contextual factors influenced their readiness. We analysed interview transcripts using thematic analysis. RESULTS We developed a framework to describe readiness to engage in exercise and the interplay of factors and their influence on readiness among adults with HIV and multimorbidity. Readiness was described as a diverse, dynamic and fluctuating spectrum ranging from not thinking about exercise to routinely engaging in daily exercise. Readiness was influenced by the complex and episodic nature of HIV and multimorbidity comprised of physical impairments, mental health challenges and uncertainty from HIV and concurrent health conditions. This key factor created a context within which 4 additional subfactors (social supports, perceptions and beliefs, past experience with exercise, and accessibility) may further hinder or facilitate an individual's position along the spectrum of readiness to exercise. CONCLUSIONS Readiness to engage in exercise among people living with HIV is a dynamic and fluctuating construct that may be influenced by the episodic nature of HIV and multimorbidity and 4 subfactors. Strategies to facilitate readiness to exercise should consider the interplay of these factors in order to enhance physical activity and subsequently improve health outcomes of people with HIV and multimorbidity.
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Affiliation(s)
- Alya Simonik
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Vader
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Denine Ellis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dirouhi Kesbian
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Leung
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Jachyra
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
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50
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High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy. J Behav Med 2016; 39:453-64. [PMID: 26733010 DOI: 10.1007/s10865-015-9710-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m(2) heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.
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