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Brown D1, Nelson M2, Boffito M2, Sedgwick P3, Harding R4, Lewko A5
1Chelsea and Westminster Hospital NHS Foundation Trust, Therapies Department, London, United Kingdom, 2Chelsea and Westminster Hospital NHS Foundation Trust, HIV Medicine, London, United Kingdom, 3St George's University of London, Institute of Medical and Biomedical Education, London, United Kingdom, 4King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom, 5Kingston University and St Georges University of London, Faculty of Health, Social Care and Education, London, United Kingdom
Background: HIV is now considered a chronic and episodic health condition. As people live longer with chronic HIV, they may face new or worsening experiences of disability. High prevalence of functional disability has been reported by PLHIV, however there is no functional disability prevalence data among PLHIV in the UK.
Purpose: Measure prevalence of functional disability among PLHIV attending routine outpatient HIV care; report types of disability experienced; evaluate associations between age and disability.
Methods: This is a quantitative, cross-sectional study. Inclusion criteria: diagnosis of HIV, stable on HIV treatments for ≥6 months, aged ≥18 months. Exclusion criteria: unable to consent, experiencing acute disease/illness.
Primary outcome: disability prevalence, measured as recommended using two methods; classification of disabled people within UK Equality Act 2010; operationalised criteria to determine presence of activity limitations/disability on WHODAS 12-item.
Secondary outcomes:
(a) report disability experienced by PLHIV with WHODAS 12-item and HIV Disability Questionnaire (HDQ);
(b) evaluate associations between categorised age ( 50 and ≥50 years) and disability measured with WHODAS and HDQ, with Mann-Whitney U, and Chi-Squared tests. Bonferroni adjusted critical level of significance, 0.02% (0.002).
Results: Total 201 participants recruited. Sample characteristics: male (87.6%), gay/bisexual (78.6%), white ethnicity (72.2%), mean age 47years, 96.5% virally suppressed, median 2 comorbidities.
Prevalence of disability: UK Equality Act 2010 classification, 39.5%, CI [0.33,0.46]; WHODAS presence of activity limitations/disability, 70.5%, CI [0.64,0.77].
WHODAS sum scores; “simple” (mean 9.4, SD 11.3); “complex” (mean 19.6, SD 23.7). Reported WHODAS disability mostly in domains participation (52%) and life activities (41.5%), with 20.5% not scoring on any, and 50.5% scoring ≥4 activity limitations. HDQ total scores; presence (36/100), severity (13/100) and episodic (17/100). Most present dimensions; uncertainty and mental health. Most severe dimensions; uncertainty and social/community life. Most episodic dimensions; physical and mental health.
No significant associations were found between age and WHODAS sum scores, or presence of activity limitations/disability. PLHIV ≥50 years report significantly greater presence (p 0.001) and severity (p 0.001) of physical impairments, and presence (p 0.001) and severity (p 0.001) of difficulties with day-to-day activities. Close to significant associations; ≥50 years might report greater WHODAS "simple" (p=0.011) and "complex" (p-0.011) sum scores, severity of cognitive impairments (p=0.015); 50 years might report greater episodic mental health (p=0.003), and episodic uncertainty (p=0.011).
Conclusion(s): High disability prevalence is reported by PLHIV during routine outpatient HIV care in London, UK. Disability might be experienced by PLHIV at different levels to general population and other HIV populations. Initial reports of functional disability are provided. Disability might also be experienced across the life-course, however different levels/types of disability are reported between PLHIV 50 and ≥50 years. Older PLHIV report significantly greater physical impairments and challenges with day-to-day activities. Trends towards significance may provide important initial findings.
Implications: This data represents important initial UK findings of; proportions of PLHIV reporting functional disability; descriptions of functional disability; associations with age. These findings identify extent of functional disability among PLHIV, enabling requisite sample size calculations, and can support future HIV services adopt approaches for chronic HIV care.
Keywords: HIV, Disability, Ageing
Funding acknowledgements: This research was funded by a National Institute of Health Research (NIHR) award to study a Masters of Clinical Research
Purpose: Measure prevalence of functional disability among PLHIV attending routine outpatient HIV care; report types of disability experienced; evaluate associations between age and disability.
Methods: This is a quantitative, cross-sectional study. Inclusion criteria: diagnosis of HIV, stable on HIV treatments for ≥6 months, aged ≥18 months. Exclusion criteria: unable to consent, experiencing acute disease/illness.
Primary outcome: disability prevalence, measured as recommended using two methods; classification of disabled people within UK Equality Act 2010; operationalised criteria to determine presence of activity limitations/disability on WHODAS 12-item.
Secondary outcomes:
(a) report disability experienced by PLHIV with WHODAS 12-item and HIV Disability Questionnaire (HDQ);
(b) evaluate associations between categorised age ( 50 and ≥50 years) and disability measured with WHODAS and HDQ, with Mann-Whitney U, and Chi-Squared tests. Bonferroni adjusted critical level of significance, 0.02% (0.002).
Results: Total 201 participants recruited. Sample characteristics: male (87.6%), gay/bisexual (78.6%), white ethnicity (72.2%), mean age 47years, 96.5% virally suppressed, median 2 comorbidities.
Prevalence of disability: UK Equality Act 2010 classification, 39.5%, CI [0.33,0.46]; WHODAS presence of activity limitations/disability, 70.5%, CI [0.64,0.77].
WHODAS sum scores; “simple” (mean 9.4, SD 11.3); “complex” (mean 19.6, SD 23.7). Reported WHODAS disability mostly in domains participation (52%) and life activities (41.5%), with 20.5% not scoring on any, and 50.5% scoring ≥4 activity limitations. HDQ total scores; presence (36/100), severity (13/100) and episodic (17/100). Most present dimensions; uncertainty and mental health. Most severe dimensions; uncertainty and social/community life. Most episodic dimensions; physical and mental health.
No significant associations were found between age and WHODAS sum scores, or presence of activity limitations/disability. PLHIV ≥50 years report significantly greater presence (p 0.001) and severity (p 0.001) of physical impairments, and presence (p 0.001) and severity (p 0.001) of difficulties with day-to-day activities. Close to significant associations; ≥50 years might report greater WHODAS "simple" (p=0.011) and "complex" (p-0.011) sum scores, severity of cognitive impairments (p=0.015); 50 years might report greater episodic mental health (p=0.003), and episodic uncertainty (p=0.011).
Conclusion(s): High disability prevalence is reported by PLHIV during routine outpatient HIV care in London, UK. Disability might be experienced by PLHIV at different levels to general population and other HIV populations. Initial reports of functional disability are provided. Disability might also be experienced across the life-course, however different levels/types of disability are reported between PLHIV 50 and ≥50 years. Older PLHIV report significantly greater physical impairments and challenges with day-to-day activities. Trends towards significance may provide important initial findings.
Implications: This data represents important initial UK findings of; proportions of PLHIV reporting functional disability; descriptions of functional disability; associations with age. These findings identify extent of functional disability among PLHIV, enabling requisite sample size calculations, and can support future HIV services adopt approaches for chronic HIV care.
Keywords: HIV, Disability, Ageing
Funding acknowledgements: This research was funded by a National Institute of Health Research (NIHR) award to study a Masters of Clinical Research
Topic: Oncology, HIV & palliative care; Disability & rehabilitation; Older people
Ethics approval required: Yes
Institution: St George's University of London
Ethics committee: NHS Research Ethics Committee - London Queen Square
Ethics number: IRAS: 236835
All authors, affiliations and abstracts have been published as submitted.
