Quality of life in HIV-positive persons in Mexico

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Quality of life among persons living with HIV who receive clinical care at a healthcare institution in Tijuana, Mexico

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Quality of life in HIV-positive persons in Mexico

  1. 1. Quality of life in persons living with  HIV in a healthcare institution of  Tijuana, Mexico Jhonis Quintero1, David Goodman1,  José Burgos1, Fátima Muñoz1, María  Ibarra2, María Zuñiga1, 2 Sixth Annual CFAR International HIV/AIDS Research Day September 18, 2012Affiliation: 1 University of California San Diego, 2 ISSSTECALI, Tijuana, MexicoFunding: AIDS International Training in Research Grant (1D43TW008633‐01)
  2. 2. INTRODUCTION• Health‐related quality of life (HRQoL)  multidimensional concept. – Physical and social functioning, mental health, pain  and energy (Briongos et al, 2011).• HIV chronic disease, HRQoL important health indicator (Valencia et al, 2010).
  3. 3. BACKGROUND• HIV prevalence in Mexico 0.3 %. – HIV prevalence in Tijuana 3 times the national  average in the general population (Brouwer et al, 2006).• No previous studies exploring HRQoL among HIV patients in México. Studies HRQoL (mean, SD) using MOS‐HIV* Briongos et al, 2011 (Spain) PHSa 52.3 (8.8) MHSb 49.3 (9.9) Perez et al, 2005 (Spain) PHSa 50 (10.6) MHSb 50 (9.6) Miners, et al, 2004 (London) PHSa 41.8 (13.2) MHSb 43.2 (12.2) *MOS‐HIV: Medical Outcomes Study HIV Health Survey aPHS: Physical Health Score. bMHS: Mental Health Score
  4. 4. OBJECTIVES• Explore HRQoL in patients receiving HIV care in a government health care institution in Tijuana Mexico.• Determine the association between sociodemographic and clinical variables with HRQoL.
  5. 5. METHODS• Cross‐sectional study.• Target population: HIV infected adult patients receiving care in a government hospital in Tijuana, Mexico (ISSSTECALI).• Recruitment period: Nov 2010 ‐ June 2011.
  6. 6. • Medical Services Institute for B.C.  State workers.• 4.16 % of state health beneficiaries.  bajacalifornia.gob.mx. 2009
  7. 7. Summary of MOS‐HIV Survey Concepts Dimensions METHODSExplanation Physical Functioning Physical activities (eating, dressing, bathing) • Total 54 patients were selected. Role Functioning Problems with work or daily activities • Approaching: consultation with medical doctor. Pain No‐severe painGeneral Health Perceptions instrument: personal health • Investigation Views Disease‐specific Medical Outcomes Study HIV social activities Social Functioning Limitations Health Survey (MOS‐HIV) instrument (Wu et al).Tired/energetic Energy • Sociodemographic Nervous, depressed/calm, peaceful, happy Mental Health data was collected using a Health Distress standardized questionnaire. Despair, discouraged, afraid due health Cognitive Functioning Concentrating, reasoning, remembering • Clinical variables were obtained through electronic record of hospital. could hardly be worse/better Quality of life Life bad/good, Adapted from MOS‐HIV Health Survey, Users manual. Wu. 1996‐99
  8. 8. MOS‐HIV Dimensions General  Energy Health Social Fn Cognitive Fn Pain Physical Health Fn Mental distress Health Role Fn QoL Physical Health Mental Health SummarySummary (PHS) score (MHS) score Revicki, Sorensen and Wu, 1998
  9. 9. ANALYSIS• Descriptive statistics: Means, standard deviation (SD), proportions.• Student‐t test, ANOVA were used to identify associations between sociodemographic and clinical variables with PHS and MHS (dependent variables).• Multivariate linear regression model. – Variables attaining p<0.20 in univariate analysis were considered in the final model. – Backward stepwise linear regression; variables with significance p<0.05 were retained.• Data were analyzed using SPSS v20.0 (IBM).
  10. 10. ENROLLMENT 62 eligible participants 3 decline to participate 5 could not be found 54 participants were included in the analysis
  11. 11. Clinical characteristics  Sociodemographic characteristics N (%) N (%) Characteristic drug use History injection 5 (9.2) Years since HIV Diagnosis (mean, SD) Gender (male) 45 (83.3) 6.5 (4.5) Years on antirretroviral tratment (ART) (mean, SD) Age (mean, SD) 44.0 (9.4) 4.9 (4.0) All Comorbilities 29 (53.9) Marital status  ART regimen Single 29 (53.7) First line (Mexico*) 45 (83.3) Married 19 (35.2) Not first line 8 (14.8) Common law relationship 4 (7.4) No treatment 1 (1.9) Widowed 2 (3.7) T CD4+ Lymphocyte count (mean, SD) 720.5 (599.4) Sexual orientation <200 cells/μm3 2 (3.7) Heterosexual 30 (55.6) 200‐499 cells/μm3 18 (33.3) Homosexual 20 (37.0) >500 cells/μm3 34 (63.0) Bisexual Viral load, log (mean, SD) 4 (7.4) 2.0 (0.9) Education Viral load, categories Primary school <40 copies/ml 19 (35.2) 39 (72.2) High school 41‐1000 copies/ml 13 (24.1) 8 (14.8)*CENSIDA Guideline 2012 University >1000 copies/ml 22 (40.7) 7 (13.0)
  12. 12. Mean Scores for the MOS‐HIVDomains Mean Median SDPhysical Health Summary Score  56.6 57.2 5.7Mental Health Summary Score  56.9 58.2 13.1DimensionsPain 88.3 100 19.4Physical Functioning 87.2 90 13.5Role Functioning 89.3 100 20.1General Health Perceptions 78.7 80 17.4Social Functioning 92.4 100 19.9Energy 77.0 80 15.1Mental Health 77.6 80 16.5Health Distress 82.2 80 18.3Cognitive Functioning 80.0 80 19.6Quality of Life 84.1 80 14.7
  13. 13. Univariate Analysis for Sociodemographic Variables  Category N  PHS p MHS p valor (%) (Mean, SD) valor (Mean , SD)Gender Female 9 59.1 (3.0) .15 55.7 (5.1) .65 Male 45 56.1 (6.09 57.1 (8.7)Age 18‐44 y 30 56.0 (6.5) .39 57.0 (9.1) .90 > 45 y 24 57.3 (4.49 56.7 (7.3)Marital  status Single 29 55.6 (6.9) .55 54.9 (5.6) .04 Married 19 58.0 (4.2) 59.4 (5.6) Widowed 2 55.9 (1.1) 48.8 (4.7) Common law relationship 4 57.3 (0.8) 63.7 (2.7)Sexual orientation Heterosexual 30 57.9 (3.7) <.001 58.1 (5.8) <.001 Homosexual 20 56.7 (5.0) 58.0 (7.2) Bisexual 4 46.2 (10.9) 41.7 (14.6)
  14. 14. Univariate Analysis for Clinical Variables Category N  PHS p MHS p (%) (Mean, SD) valor (Mean, SD) valorART regimen First line (Mexico) 45 56.6 (5.7) .61 56.0 (1.3) .22 Not first line 8 57.3 (5.9) 61.5 (6.0) No treatment 1 51.2 58.8Comorbilities Yes 29 55.4 (6.7) .11 54.7 (9.7) .03 No 25 57.9 (3.8) 59.4 (5.3)T CD4+ Lymphocyte count <200 cells/μm3 2 45.0 (16.6) <.01 43.1 (29.8) .04 200‐499 cells/μm3 18 56.5 (4.9) 56.3 (5.9) >500 cells/μm3 34 57.3 (7.3) 58.0 (7.2)Viral load <40 copies/ml 39 57.6 (4.5) .10 54.1 (9.1) .1440‐1000 copies/ml 8 54.1 (9.1) 51.7 (13.5)>1000 copies/ml 4 53.8 (5.9) 56.5 (6.8)
  15. 15. Final multivariate linear regression models Linear regression for Physical Health summary score Variable B SE IC95% PSexual orientation a ‐4.2 1.0 ‐6.3, ‐2.0 <.001Years since diagnosis 0.4 0.2 0.1, 0.7 .01Viral load (log) ‐2.6 0.7 ‐4.1, ‐1.1 .001Intercept 65.5 2.1 61.3, 69.7 Linear Regression for Mental Health summary score Variable B SE IC95% PSexual orientation a ‐5.3 1.5 ‐8.4, ‐2.2 .001ART regimen b 3.6 1.3 1.0, 6.2 .007T CD4+ Lymphocytesc 4.4 1.7 0.9, 7.8 .014Intercept 45.9 6.0 33.9, 57.9 aSexualorientation: Heterosexual (reference), homosexual, bisexual BART regimen: First line (reference), not first line according to Mexican guidelines CT CD4+ Lymphocytes: <200 (reference), 200‐499, >500
  16. 16. LIMITATIONS• Small sample size.• Not representative to all HIV infected population in Tijuana, B.C. Mexico. – High socioeconomics status.• Social desirability bias.• Cross sectional. – Temporal association cannot be ascertained.
  17. 17. CONCLUSIONS• Our study shows that the summary scores were higher than those reported from other countries (Briongos et al, 2011. Perez et al, 2005. Miners, et al, 2004).• Sexual orientation, still affecting HRQoL, may be related with stigma.• Years since diagnosis, increases HRQoL, probably because late start ART.• ART regimen affects HRQoL, related with newest ART.• Positive relation between TCD4+ and HRQoL.• Negative tendency between viral load and HRQoL.
  18. 18. IMPLICATIONS• HRQoL must be considered multidimensional, to modify and improve health in these patients.• HRQoL monitoring should be incorporated in standard HIV care in Mexico.• Prospective studies are needed to better understand factors related to HRQoL.
  19. 19. ACKNOWLEDGEMENT• Dr. Goodman, Dr. Burgos, Dr. Muñoz, Dr.  Ibarra, Dr. Zuñiga, Dr. Strathdee.• AIDS International Training and Research  Program (AITRP).• Hospital ISSSTECALI, Tijuana.• Center for AIDS Research (CFAR).

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