Maintaining wellbeing for South Africans receiving ART: The burden of pain and symptoms is greater with longer ART exposure

Farrant, Lindsay; Gwyther, Liz; Dinat, Natalya; Mmoledi, Keletso; Hatta, Ntombi; Harding, Richard

doi:10.7196/samj.7461

Cited by 18 publications

(14 citation statements)

References 27 publications

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“…However, given prior global evidence that ART is not associated with self-report symptom burden [ 26 , 34 ], it was appropriate to include those both currently taking ART and those who are not, and to determine proportions of these groups in each cluster. Thirdly, given the unpredictable nature of HIV disease, it is unclear how stable this symptom clustering is over time, particularly as burden may become greater with long time on treatment [ 35 ], Fourth, given that we needed to apply the standard exclusion criterion of cognitive impairment (to avoid any potential bias through mixed self and proxy report), and we excluded those with cancer to make a more readily interpretable cluster structure, further study is required. Fifth, as CD4 counts were often missing (which is a problem reported in a similar study in outpatient settings) [ 28 ]) data on the physical functional status of the respondents were used as a proxy indicator of the disease progression.…”

Section: Discussionmentioning

confidence: 99%

Symptom Clusters in People Living with HIV Attending Five Palliative Care Facilities in Two Sub-Saharan African Countries: A Hierarchical Cluster Analysis

et al. 2015

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BackgroundSymptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries.MethodsData from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward’s method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X2 tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores.ResultsAmong the sample (N=217) the mean age was 36.5 (SD 9.0), 73.2% were female, and 49.1% were on antiretroviral therapy (ART). The cluster analysis produced five symptom clusters identified as: 1) dermatological; 2) generalised anxiety and elimination; 3) social and image; 4) persistently present; and 5) a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001); being on ART (highest proportions for clusters two and three, p=0.012); global distress (F=26.8, p<0.001), physical distress (F=36.3, p<0.001) and psychological distress subscale (F=21.8, p<0.001) (all subscales worst for cluster one, best for cluster four).ConclusionsThe greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to test cluster stability and identify common symptom trajectories is recommended.

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Section: Discussionmentioning

confidence: 99%

Symptom Clusters in People Living with HIV Attending Five Palliative Care Facilities in Two Sub-Saharan African Countries: A Hierarchical Cluster Analysis

et al. 2015

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“…There is a commensurate shift to a focus on the health-related needs of people living with HIV (PLHIV), including the management of comorbidities and disabilities, but also the livelihood changes that come with a life on ART (Deeks, Lewin, & Havlir, 2013; Hanass-Hancock, Myezwa, Nixon, & Gibbs, 2015;Hanass-Hancock & Nixon, 2009;Nixon, Hanass-Hancock, Whiteside, & Barnett, 2011;Russel et al, 2007). These shifts are highlighted in an emerging body of literature exploring these challenges and livelihood changes (Banks, Zuurmon, Ferrana, & Kuper, 2015;Booysen, Van Rensburg, Bachmann, Louwagie, & Fairall, 2007;Brandt, 2009;Deeks et al, 2013;Farrant et al, 2014;Hanass-Hancock, Myezwa, Nixon, et al, 2015;HanassHancock, Regondi, Van Egeraat, & Nixon, 2013;Myezwa, Buchalla, Jelsma, & Stewart, 2011;Sherr, Clucas, Harding, Sibley, & Catalan, 2011). We have only just begun to understand the long-term impact of ART on health and livelihood after a decade of widespread access to treatment in southern Africa.…”

Section: Introductionmentioning

confidence: 96%

Determinants of livelihood in the era of widespread access to ART

Hanass-Hancock

Misselhorn²,

Carpenter³

et al. 2016

AIDS Care

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We have only just begun to understand the long-term impact of living with chronic HIV on health and livelihood after a decade of widespread access to treatment in southern Africa. This paper explores health and well-being, disability, and livelihood dynamics among people living with HIV (PLHIV) in a public healthcare setting in South Africa. We undertook a cross-sectional survey among a cohort of 1042 people on ART and explored associations between socio-demographic characteristics, treatment adherence, measures of disability (functional and activity limitations), livelihood resources (capitals) and outcomes, including food security, and exposure to livelihood shocks. A range of dynamic relationships relevant for decision-makers is evident. Age, gender, and marital status all had significant associations with levels of livelihood capitals and outcomes. Those who had been on ART for longer periods of time also had significantly higher aggregate livelihood capital. This was particularly driven by social and financial capital. Livelihoods are built within specific social and health contexts. Of particular importance is that the resources drawn on to build a livelihood differ significantly between men and women, and that different forms of disability also have gender-specific pathways in influencing livelihood and livelihood outcomes. Our results support the need for a gender-sensitive approach to supporting the well-being and livelihoods of PLHIV. Of equal importance is an approach that considers more comprehensively the new experiences of comorbidities and disabilities that may occur with a long life on ART.

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“…This finding is supported by other studies done in the US, London and South Africa. 10 , 18 , 20 , 35 This could be due to the fact that WHO clinical disease stage is an important indicator of disease progression indicating the presence of opportunistic infection that leads to experience of pain. 36 In this study, having chronic comorbid condition was also found to be another determinant factor of pain among HIV-infected patients.…”

Section: Discussionmentioning

confidence: 99%

“…Pain has been associated with age, 15 female sex, lower educational status, 16 single marital status, 17 history of smoking, 10 lower CD4 count, 10 , 15 , 18 , 19 longer duration of HIV infection and treatment with antiretroviral medications, including longer duration of antiretroviral treatment (ART), 20 particularly protein inhibitor-based regimens, 21 use of ART, 19 advanced disease stage and the number of health comorbidities. 13 , 22…”

Section: Introductionmentioning

confidence: 99%

High prevalence of pain among adult HIV-infected patients at University of Gondar Hospital, Northwest Ethiopia

Azagew¹,

Woreta²,

Tilahun³

et al. 2017

JPR

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BackgroundHIV/AIDS are pressing global health problems. Pain is a common symptom reported by patients living with HIV/AIDS. The exact cause of pain in HIV patients has not been thoroughly described, but it may, due to a symptom of HIV itself, result from opportunistic infections, as a side effect of antiretroviral drugs, concurrent neoplasia or other causes. In addition, pain perception of HIV-infected patients is highly variable and may vary based on cultural context and patient demographics. In Ethiopia, there is insufficient evidence on the prevalence and factors associated with HIV-related pain.MethodsA cross-sectional study was conducted among 422 adult HIV-infected patients at Gondar University Hospital antiretroviral care clinic from March 1 to May 1, 2016. Systematic random sampling was used to select study participants. A pretested interviewer-administered questionnaire and a standardized medical record data abstraction tool were used to collect data. A short form brief pain inventory tool was used to measure the outcome. Bivariate and multivariate logistic regression models were fitted to identify factors associated with pain among adult HIV patients.ResultsThe prevalence of pain was found to be 51.2% (95% CI: 46.4%–55.9%). Headache (17.9%), abdominal pain (15.6%), and backache (13.3%) were the most common symptoms of study participants. Being female (adjusted odds ratio [aOR]=1.8, 95% CI: 1.1–2.9); regular alcohol intake (aOR=3.3, 95% CI: 1.5–7.2); baseline World Health Organization clinical disease stage: II (aOR=2.5, 95% CI: 1.2–4.9), III (aOR=2, 95%, CI: 1.1–3.6), and IV (aOR=2.4, 95% CI: 1.1–5.3); and the presence of a chronic comorbid condition (aOR=5.9, 95% CI: 2.1–16.7) were significantly associated with pain.ConclusionAdult HIV patients in this sample reported a high level of chronic pain. Healthcare providers should better implement a routine pain assessment among HIV-positive patients to alleviate their suffering.

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Maintaining wellbeing for South Africans receiving ART: The burden of pain and symptoms is greater with longer ART exposure

Cited by 18 publications

References 27 publications

Symptom Clusters in People Living with HIV Attending Five Palliative Care Facilities in Two Sub-Saharan African Countries: A Hierarchical Cluster Analysis

Symptom Clusters in People Living with HIV Attending Five Palliative Care Facilities in Two Sub-Saharan African Countries: A Hierarchical Cluster Analysis

Determinants of livelihood in the era of widespread access to ART

High prevalence of pain among adult HIV-infected patients at University of Gondar Hospital, Northwest Ethiopia

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