Impairments, activity limitations and participation restrictions: prevalence and associations among persons living with HIV/AIDS in British Columbia

Abstract

Background: To measure the prevalence of and associations among impairments, activity limitations and participation restrictions in persons living with HIV in British Columbia to inform support and care programs, policy and research.

Methods: A cross-sectional population-based sample of persons living with HIV in British Columbia was obtained through an anonymous survey sent to members of the British Columbia Persons With AIDS Society. The survey addressed the experience of physical and mental impairments, and the experience and level of activity limitations and participation restrictions. Associations were measured in three ways: 1) impact of types of impairment on social restriction; 2) impact of specific limitations on social restriction; and 3) independent association of overall impairments and limitations on restriction levels. Logistic regression was used to measure associations with social restriction, while ordinal logistic regression was used to measure associations with a three-category measure of restriction level.

Results: The survey was returned by 762 (50.5%) of the BCPWA participants. Over ninety percent of the population experienced one or more impairments, with one-third reporting over ten. Prevalence of activity limitations and participation restrictions was 80.4% and 93.2%, respectively. The presence of social restrictions was most closely associated with mental function impairments (OR: 7.0 for impairment vs. no impairment; 95% CI: 4.7 - 10.4). All limitations were associated with social restriction. Among those with <or= 200 CD4 cells/mm3, odds of being at a higher restriction level were lower among those on antiretrovirals (OR: 0.3 for antiretrovirals vs. no antiretrovirals; 95% CI: 0.1-0.9), while odds of higher restriction were increased with higher limitation (OR: 3.6 for limitation score of 1-5 vs. no limitation, 95%CI: 0.9-14.2; OR: 24.7 for limitation score > 5 vs. no limitation, 95%CI: 4.9-125.0). Among those with > 200 CD4 cells/mm3, the odds of higher restriction were increased with higher limitation (OR: 2.7 for limitation score of 1-5 vs. no limitation, 95%CI: 1.4-5.1; OR: 8.6 for limitation score > 5 vs. no limitation, 95%CI: 3.9-18.8), as well as by additional number of impairments (OR:1.2 for every additional impairment; 95% CI:1.1-1.3).

Conclusions: This population-based sample of people living with HIV has been experiencing extremely high rates of impairments, activity limitations and participation restrictions. Furthermore, the complex inter-relationships identified amongst the levels reveal lessons for programming, policy and research in terms of the factors that contribute most to a higher quality of life.

Figure 1

Prevalence of specific impairments for participants with CD4 counts ≤ 200 cells/mm3 (speckled bars), 201 to 500 cells/mm3 (downward diagonally-striped bars) and > 500 cells/mm3 (horizontally-striped bars). Significant p-value from chi-square test across CD4 categories.

Figure 2

Prevalence of specific activity limitations for participants with CD4 counts ≤ 200 cells/mm3 (speckled bars), 201 to 500 cells/mm3 (downward diagonally-striped bars) and > 500 cells/mm3 (horizontally-striped bars). Significant p-value from chi-square test across CD4 categories.

Figure 3

Prevalence of specific participation restrictions for participants with CD4 counts ≤ 200 cells/mm3 (speckled bars), 201 to 500 cells/mm3 (downward diagonally-striped bars) and > 500 cells/mm3 (horizontally-striped bars). Significant p-value from chi-square test across CD4 categories.