File
Kietrys D.1, Myezwa H.2, Parrott J.S.1, Davis T.1, O'Brien K.3, Levin T.4, Mezaros M.1, Galantino M.L.5,6,7
1Rutgers, The State University of New Jersey, Newark, United States, 2University of the Witwatersrand, Johannesburg, South Africa, 3University of Toronto, Toronto, Canada, 4Rowan University - School of Osteopathic Medicine, Stratford, United States, 5Stockton University, Galloway, United States, 6University of the Witwatersrand, Johanessburg, South Africa, 7University of Pennsylvania, Philadelphia, United States
Background: Antiretroviral therapy (ART) has increased the longevity of people living with HIV (PLWH), but chronic impairments, co-morbidities and disability may develop over time. Functional limitations, health symptoms, and age were associated with depressive symptoms in a South African cohort of PLWH. Understanding the relationship between depression and HIV-related disability and will inform the development of strategies to improve health and quality of life.
Purpose: To compare self-reported disability and depression between PLWH in the United States (US) and South Africa (SA), and to investigate if depression and other health or demographic covariates are associated with disability.
Methods: Demographic, health characteristics, and disability were compared using bivariate statistics. Between country differences in presence of disability were assessed using logistic regression. Degree of disability was assessed using multiple regression. Predictors were identified based on theoretical considerations. We also included variables that differed significantly between countries. A priori alpha was set at p 0.05.
Results: We included 1143 cases (n=127 from US; n=1016 from SA) in the analysis. US and SA samples differed significantly across all variables with the exception of muscle pain and depression. US participants were 6.15 times more likely to report disability than SA participants (odds ratio (OR) 95% CI:3.64-10.40, p0.001) in the unadjusted analysis. After adjusting for demographic and clinical characteristics, US participants were 9.64 times more likely to report disability (OR 95% CI:4.85-19.18). Sex (females 61% were more likely to report disability, p=0.002), years with HIV (3.5% increase in odds of reporting disability with each additional year living with HIV, p=.015), muscle pain (82% more likely to report disability if experiencing muscle pain, p0.001), and depression (67% more likely to report disability if depressed, p0.001) all significantly contributed to the model. The model predicting degree of disability was significant (p0.001), explaining 18.0% of the variance. In the US, degree of disability was 4.12 points higher than in SA (p.001). Sex (females 1.56 points higher, p=0.010), adherence status (ART adherent participants 2.04 points lower than non-adherent participants, p=.004), depression (depressed participants 4.30 points higher, p.001), and work status (individuals with jobs 1.72 points lower than individuals without, p=.024) were also significantly associated with degree of disability.
Conclusion(s): There were differences between cohorts for all characteristics except for muscle pain and depression. The reason for the disparity in prevalence of disability (87% in US; 51% in SA) is not explained by our data, but may be related to differences in recruitment settings, differences in health care/disability policies and cultural differences in perception of health and illness. In both countries, there was a high (>45%) prevalence of depression and muscle pain. While country had the strongest effect on whether the participants reported any disability, presence of depression was the strongest predictor of the degree of disability, explaining 9% of the variance in the combined sample.
Implications: Depression and muscle pain appear to be key predictors of disability for PLWH in US and SA; thus, treatment strategies should include assessment and treatment of these impairments.
Funding acknowledgements: This project was partially funded by the Dean's Office, School of Health Professions at Rutgers (USA).
Topic: Oncology, HIV & palliative care
Ethics approval: This study was approved by the Rutgers Institutional Review Board (Newark, NJ, USA)
All authors, affiliations and abstracts have been published as submitted.
