Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

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dc.contributor.authorO’Brien, Kelly K
dc.contributor.authorHanna, Steven
dc.contributor.authorSolomon, Patricia
dc.contributor.authorWorthington, Catherine
dc.contributor.authorIbáñez-Carrasco, Francisco
dc.contributor.authorCarusone, Soo Chan
dc.contributor.authorNixon, Stephanie
dc.contributor.authorMerritt, Brenda
dc.contributor.authorGahagan, Jacqueline
dc.contributor.authorBaxter, Larry
dc.contributor.authorGayle, Patriic
dc.contributor.authorRobinson, Greg
dc.contributor.authorTurje, Rosalind Baltzer
dc.contributor.authorTattle, Stephen
dc.contributor.authorYates, Tammy
dc.date.accessioned2020-10-30T23:39:25Z
dc.date.available2020-10-30T23:39:25Z
dc.date.copyright2019en_US
dc.date.issued2019
dc.description.abstractBackground People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as ‘disability’. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV. Methods We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2–0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis. Results Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001). Conclusions Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions.en_US
dc.description.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.description.sponsorshipWe acknowledge contributions of the Knowledge Users, Collaborator Organizations and Recruitment Network Organizations. We thank the HIV Health and Rehabilitation Survey (HHRS) study participants. We thank the following members of the HHRS team who were integrally involved in refining the survey instrument, recruiting participants, interpreting findings, and knowledge translation efforts including: Murray Jose-Boerbridge (Toronto People With AIDS (PWA) Foundation, Toronto, Ontario, Canada), Patrick McDougall (Dr. Peter AIDS Foundation, Vancouver, British Columbia, Canada), Tammy Reimer (Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada), Wayne Campbell (Positive Living Society of British Columbia, Vancouver, British Columbia, Canada), Liz Harrop- Archibald (AIDS Coalition of Nova Scotia (ACNS), Halifax, Nova Scotia, Canada), and William Chegwidden (National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom). We thank the following community organizations for their collaboration and support of the HHRS Study: Realize, formerly the Canadian Working Group on HIV and Rehabilitation (CWGHR), Casey House (Toronto), Toronto People With AIDS Foundation (Toronto PWA), AIDS Committee of Durham Region, AIDS Niagara, HIV Care Program Windsor Regional Hospital, AIDS Committee of Toronto (ACT), Prisoners with HIV/AIDS Support Action Network (PASAN), Dr. Kovacs’ Office-Maple Leaf Medical Centre (Toronto), The AIDS Network (Hamilton), AIDS Committee of Ottawa (Ottawa), Teresa Group (Toronto), HIV/AIDS Regional Services (Kingston), AIDS Committee of Windsor, Dr. Peter AIDS Foundation (Vancouver), Positive Living Society of British Columbia, HIV Edmonton, Positive Women’s Network (Vancouver), Pacific AIDS Network (Vancouver), Alberta Community Council on HIV (Edmonton), Nine Circles Community Health Centre (Winnipeg), AIDS Community Care Montreal (ACCM), Northern AIDS Connection Society, AIDS Committee of Newfoundland and Labrador, AIDS Saint John, and AIDS New Brunswick (Fredericton). We thank Ayesha Nayar and Nkem Iku (Research Coordinators, University of Toronto) for their contributions to the study. The HIV Health and Rehabilitation Survey (HHRS) Team includes a group of researchers, knowledge users, and collaborators in Canada and the United Kingdom. HHRS Team Researchers: Kelly K. O’Brien (University of Toronto), Patty Solomon (McMaster University), Francisco Ibáñez-Carrasco (Ontario HIV Treatment Network / St. Michael’s Hospital), Catherine Worthington (University of Victoria), Jacqueline Gahagan (Dalhousie University), Stephanie Nixon (University of Toronto), Steven Hanna (McMaster University), Brenda Merritt (Dalhousie University). HHRS Team Knowledge Users: Tammy Yates, Stephen Tattle, Elisse Zack (Realize, formerly known as the Canadian Working Group on HIV and Rehabilitation (CWGHR)), Will Chegwidden (National Hospital for Neurology and Neurosurgery, University College Hospitals), Patriic Gayle (Gay Men's Health Collective, Three Flying Piglets), Larry Baxter (Community Member), Greg Robinson (Community Member), Tara Carnochan, Dawn James, and Tammy Reimer (Nine Circles Community Health Centre), Rosalind Baltzer Turje and Patrick McDougall (Dr. Peter AIDS Foundation). HHRS Team Collaborators: Toronto PWA Foundation (Murray Jose- Boerbridge), Casey House (Soo Chan Carusone), Positive Living Society of British Columbia (Wayne Campbell and Adam Reibin), AIDS Coalition of Nova Scotia (Liz Harrop-Archibald and Laura Toole)en_US
dc.identifier.citationO’Brien, K. K., Hanna, S., Solomon, P., Worthington, C., Ibáñez-Carrasco, F., Carusone, S. C., …Yates, T. (2019) Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey. BMC Infectious Diseases, 19. https://doi.org/10.1186/s12879-019-4203-0en_US
dc.identifier.urihttps://doi.org/10.1186/s12879-019-4203-0
dc.identifier.urihttp://hdl.handle.net/1828/12286
dc.language.isoenen_US
dc.publisherBMC Infectious Diseasesen_US
dc.subjectHIV/AIDS
dc.subjectDisability
dc.subjectStructural equation modeling
dc.subjectAging
dc.subjectRehabilitation
dc.subjectUncertainty
dc.subject.departmentSchool of Public Health and Social Policy
dc.titleCharacterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation surveyen_US
dc.typeArticleen_US

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