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Relationships Between Dimensions of Disability Experienced by Adults Living with HIV: A Structural Equation Model Analysis

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Abstract

As individuals age with HIV it is increasingly important to consider the health-related consequences of HIV and multiple morbidities, known as disability. We assessed relationships between four dimensions of disability among adults living with HIV. We conducted a structural equation modeling analysis using data from 913 participants in the Ontario HIV Treatment Network Cohort Study to determine relationships between four latent variables of disability in the Episodic Disability Framework: physical symptoms and impairments, mental health symptoms and impairments, difficulties with day-to-day activities, and challenges to social inclusion. Results indicated that physical symptoms and impairments, mental health symptoms and impairments and difficulties with day-to-day activities directly or indirectly predicted challenges to social inclusion for adults living with HIV. Challenges to social inclusion were directly predicted by mental health symptoms and indirectly by physical health symptoms via (mediated by) having difficulties carrying out day-to-day activities and mental health symptoms and impairments. These findings provide a basis for conceptualizing disability experienced by people living with HIV.

Resumen

Cuando los individuos con VIH envejecen, se hace cada vez más importante considerar las consecuencias del VIH en la salud y sus múltiples comorbilidades, conocidas como discapacidad. Evaluamos las relaciones entre cuatro dimensiones de discapacidad entre adultos viviendo con VIH. Realizamos un análisis de ecuaciones estructurales usando los datos de 913 participantes en el Ontario HIV Treatment Network, para determinar las relaciones entre cuatro variables latentes de discapacidad en el Episodic Disability Framework: síntomas físicos y deficiencias, síntomas de salud mental y deficiencias, dificultades con actividades del día a día, y desafíos a la inclusión social de adultos viviendo con VIH. Los desafíos a la inclusión social fueron predichos directamente por síntomas de salud mental e indirectamente por síntomas de salud física vía (mediado por) tener dificultades llevando a cabo actividades del día a día y síntomas y deficiencias de salud mental. Estos hallazgos proveen una base para conceptualizar la discapacidad experimentada por las personas viviendo con VIH.

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Acknowledgments

This work was supported by the Canadian Institutes of Health Research (CIHR) and McMaster University DeGroote Postdoctoral Fellowship. Kelly O’Brien was supported by a Fellowship from the CIHR, HIV/AIDS Research Initiative. Trevor Hart is supported by an OHTN Career Scientist Award. We thank Carolina BarnettTapia for translating the abstract into Spanish. We gratefully acknowledge all of the people living with HIV who volunteered to participate in the OHTN Cohort Study and the work and support of the past and present members of the OCS Governance Committee: Dr. Evan Collins, Dr. Greg Robinson, Shari Margolese, Patrick Cupido, Tony Di Pede, Rick Kennedy, Michael J. Hamilton, Ken King, Brian Finch, Lori Stoltz, Dr. Ahmed Bayoumi, Dr. Clemon George, Dr. Curtis Cooper, Dr. Troy Grennan, Adrian Betts, Tracey Conway, and Colleen Price. We thank all the interviewers, data collectors, research associates and coordinators, nurses and physicians who provide support for data collection and extraction. The authors wish to thank the OHTN staff and their teams for data management and IT support (Mark Fisher, Director, IT), and OCS project coordination (Samantha Robinson, Project Coordinator). The OHTN Cohort Study is supported by the Ontario Ministry of Health and Long-Term Care. The opinions, results and conclusions are those of the authors and no endorsement by the Ontario HIV Treatment Network is intended or should be inferred.

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Authors and Affiliations

  1. Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, M5G 1V7, ON, Canada

    Kelly K. O’Brien

  2. School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada

    Kelly K. O’Brien & Patricia Solomon

  3. University Health Network, Toronto Western Research Institute, Toronto, ON, Canada

    Aileen M. Davis

  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Aileen M. Davis & Ahmed M. Bayoumi

  5. The Ontario HIV Treatment Network, Toronto, ON, Canada

    Sandra Gardner, Sergio Rueda & Sean B. Rourke

  6. Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Ahmed M. Bayoumi & Sean B. Rourke

  7. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Ahmed M. Bayoumi

  8. Department of Psychology, Ryerson University, Toronto, ON, Canada

    Trevor A. Hart

  9. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Sandra Gardner & Trevor A. Hart

  10. Division of Infectious Diseases, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada

    Curtis Cooper

  11. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Sergio Rueda & Sean B. Rourke

  12. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Steven Hanna

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  1. Kelly K. O’Brien
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OHTN Cohort Study Team

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Correspondence to Kelly K. O’Brien.

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The members of the OHTN cohort study team are listed in Appendix.

Appendix

Appendix

The OHTN Cohort Study Team consists of Dr. Sean B. Rourke (Principal Investigator, University of Toronto and OHTN), Dr. Ann Burchell (Co-Principal Investigator, OHTN), Dr. Sandra Gardner (OHTN), Dr. Sergio Rueda (OHTN), Dr. Ahmed Bayoumi, St. Michael’s Hospital; Dr. Jeffrey Cohen, Windsor Regional Hospital; Dr. Curtis Cooper, Ottawa General Hospital; Dr. Don Kilby, University of Ottawa Health Services; Dr. Mona Loutfy and Dr. Fred Crouzat, Maple Leaf Medical Clinic; Dr. Anita Rachlis and Dr. Nicole Mittmann, Sunnybrook Health Sciences Centre; Dr. Janet Raboud and Dr. Irving Salit, Toronto General Hospital; Dr. Edward Ralph, St. Joseph’s Health Care; Dr. Roger Sandre, Sudbury Regional Hospital; Dr. Marek Smieja, Hamilton Health Sciences, McMaster University Medical Centre; and Dr. Wendy Wobeser, Hotel Dieu Hospital.

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O’Brien, K.K., Davis, A.M., Gardner, S. et al. Relationships Between Dimensions of Disability Experienced by Adults Living with HIV: A Structural Equation Model Analysis. AIDS Behav 18, 357–367 (2014). https://doi.org/10.1007/s10461-012-0363-2

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