Abstract
ObjectivesWe aimed to determine for the first time the prevalence and severity of multidimensional problems in a population newly diagnosed with HIV at outpatient clinics in Africa.MethodsRecently diagnosed patients (within previous 14 days) were consecutively recruited at 11 HIV clinics in Kenya and Uganda. Participants completed a validated questionnaire, the African Palliative Outcome Scale (POS), with three underpinning factors. Ordinal logistic regression was used to evaluate risk factors for prevalence and severity of physical, psychological, interpersonal and existential problems.ResultsThere were 438 participants (62% female, 30% with restricted physical function). The most prevalent problems were lack of help and advice (47% reported none in the previous 3 days) and difficulty sharing feelings. Patients with limited physical function reported more physical/psychological (OR = 3.22) and existential problems (OR = 1.54) but fewer interpersonal problems (OR = 0.50). All outcomes were independent of CD4 count or ART eligibility.ConclusionsPatients at all disease stages report widespread and burdensome multidimensional problems at HIV diagnosis. Newly diagnosed patients should receive assessment and care for these problems. Effective management of problems at diagnosis may help to remove barriers to retention in care.
Highlights
A very high proportion of people newly diagnosed with HIV lose contact with health care services and do not initiate antiretroviral therapy (ART) at the most appropriate time, leading to increased mortality and morbidity[1]
Existential and spiritual concerns following HIV diagnosis are evident in qualitative studies[30], and for patients with advanced HIV in South Africa and Uganda, meaning in life is a higher priority than physical comfort or activity[14]
Clinical recommendations following from these findings are that newly diagnosed outpatients should receive assessment, screening and care for physical symptoms and psychological, spiritual and social problems within days of HIV diagnosis
Summary
A very high proportion of people newly diagnosed with HIV lose contact with health care services and do not initiate antiretroviral therapy (ART) at the most appropriate time, leading to increased mortality and morbidity[1]. Unaddressed social, emotional and informational needs at the time of HIV diagnosis are thought to be a cause of avoidant coping strategies such as denial[3]. Common physical and psychological symptoms (pain, vomiting, fatigue, confusion and hopelessness) are reported as impediments to ART adherence[5,6]. A multidimensional approach to patient assessment at diagnosis which incorporates physical, psychological, emotional, social and informational elements would enable early management of these problems, which could help to remove some of the barriers that prevent patients from remaining in care[4]
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