Multidimensional Patient-Reported Problems within Two Weeks of HIV Diagnosis in East Africa: A Multicentre Observational Study

Victoria Simms* (Corresponding Author), Nancy Gikaara, Grace Munene, Mackuline Atieno, Jeniffer Kataike, Clare Nsubuga, Geoffrey Banga, Eve Namisango, Suzanne Penfold, Peter Fayers, Richard A. Powell, Irene J. Higginson, Richard Harding

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Objectives: We 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. 

Methods: Recently 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. 

Results: There 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. 

Conclusions: Patients 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.

Original languageEnglish
Article numbere57203
Number of pages5
JournalPloS ONE
Issue number2
Publication statusPublished - 19 Feb 2013

Bibliographical note

Keira Lowther read and commented on the manuscript. The authors are grateful for the guidance provided by the United States Government (USG) Palliative Care Technical Working Group and to the Kenyan and Ugandan USG Country Teams. Finally we are grateful to the staff and patients at the participating facilities.
Author Contributions
Conceived and designed the experiments: VS IJH RH. Performed the experiments: NG GM MA JK CN GB EN RAP. Analyzed the data: VS PF SP. Wrote the paper: VS.

Funding: The project was funded by USAID ( through Cooperative Agreement GPO-A-00-03-00003-00, under the authority provided to the University of North Carolina. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


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