Key stakeholder prioritization of comorbidities to monitor for good quality of life for people living with HIV in Spain
1. Abstracts based on Formal Research WorkMaría José Fuster-RuizdeApodaca2, 3, Carlos Prats-Silvestre2, Jeffrey V. Lazarus1, 4
1 Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
2 Spanish Interdisciplinary AIDS Society (SEISIDA), Madrid, Spain
3 National University of Distance Education (UNED), Madrid, Spain
4 Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, USA
Abstract
Introduction
Although many people living with HIV (PLHIV) with more comorbidities than HIV-negative peers report experiencing a lower quality of life, national health systems are not always equipped to address their long-term health needs in ways that consider their health-related quality of life (HRQoL). Long-term health needs beyond viral suppression that can affect HRQoL include psychosocial impacts of neurocognitive and mental health comorbidities, polypharmacy and burdensome symptoms. This study aimed to identify comorbidities important for measuring the Fourth 90 in Spain, or a measurement for the goal that all PLHIV have a good HRQoL. The study focused on seven autonomous communities, the level to which health governance is devolved in Spain, with high rates of HIV prevalence and incidence.
Methods
This qualitative analysis of expert focus groups consisted of seven online meetings, of 1.5 hours in each of 7 autonomous communities (Andalusia, Aragon, the Basque country, Catalonia, Galicia, Madrid, and Valencia) from 17 May to 9 November 2021 for the purpose of obtaining the perspectives of PLHIV and other key informants (e.g., healthcare providers, HIV researchers, and community representatives) regarding comorbidities negatively impacting the HRQoL of PLHIV. To facilitate each meeting in Spanish, two researchers used an interview guide and a closed-ended question that asked participants to prioritize three of ten comorbidities for monitoring. Two other researchers observed and recorded the discussions for subsequent narrative analysis. Descriptive statistics are presented for each autonomous community as well as pooled averages across communities and adjusted for focus group size.
Results
Mental health problems were the most commonly selected comorbidity, selected by 94% of respondents (n=118), followed by cardiovascular diseases (55%), neurologic and neurodegenerative diseases (43%), substance use problems (35%) and neoplasms/cancers (35%) (Table 1). In the prioritization process, four comorbidities (bone, kidney, lung and liver disease as well as diabetes) were selected by fewer than 10% of participants.
Discussion/Conclusion
This study highlights the importance of monitoring common comorbidities among PLHIV. Health systems in Spain and elsewhere should consider including mental health comorbidities, cardiovascular diseases, neurologic and neurodegenerative diseases, substance use problems and neoplasms/cancers in their monitoring of HIV care, while also considering the feasibility to collect, integrate, interpret and operationalize this data. By monitoring these comorbidities, health systems may be better able to address the long-term health needs of PLHIV and improve their HRQoL.
