(P15) Comparing The Euroqol 5 Dimension And Patient Generated Index In Assessing Health Related Quality Of Life Among Pregnant Women Living With HIV In Kenya.
Jonathan Mwangi, Laura Ternent, Patricia Opondo Awiti Ujiji1], Edwin Were, Anna Mia Ekström
Karolinska Institutet, Dept of Public Health (Global Health/IHCAR) Stockholm, Sweden  Newcastle University, United Kingdom  Moi University, Eldoret, Kenya 
Health Related Quality of Life (HRQoL) is mainly assessed using generic or disease specific standardized tools. These tools focus on selected physical, emotional and social functioning and have often been designed and validated for use in high income countries. This approach may miss out on the heterogeneity of HRQoL among sub-populations. The patient generated index (PGI ) is a tool used to measure HRQoL based on patients’ own expectations, beyond the generic metrics used by existing standard tools. Among patients living with HIV, HRQoL is an indicator of growing importance as the world moves beyond the 90-90-90 targets of UNAIDS towards the so called fourth 90 aiming for good HRQoL among patients who have reached viral suppression but remain on lifelong treatment. We used a PGI to identify areas of importance to pregnant women living with HIV in Kenya and correlated these findings to outcomes of the Euroqol 5 Dimension 3-level (EQ-5D-3L™), a commonly used generic tool to assess HRQoL
The study was conducted in western Kenya in four public health facilities. A convenience sample of 100 pregnant women living with HIV, mean age 29.4(SD 5.364,)who provided consent, were interviewed using the PGI and EQ-5D-3L
For the PGI, participants were interviewed by a trained interviewer and asked to state areas of importance to their lives affected by their HIV status. They were then asked to rate the severity of impact on these areas on a scale of 0-10 and thereafter, allocate points to each area in order of priority picking from a total of 10 points. A PGI score for each participant was generated by multiplying the ratings the woman assigned for each area of importance and the proportion of the 10 points allocated for identified areas. Summary scores from the PGI were then correlated to the EQ-5D-3L and EQ5D-VAS score.
Using the PGI a total of 64% of the women reported two to three main priority areas of their lives to be affected by their HIV status. These areas centered on themes of economic wellbeing (84% of the women), physical health (58%), psychological/emotional health (49%) and relationships (28%). The mean PGI score was 2.00 (SD 1.120) on a scale of 0-10, with 0 indicating no impact on their health with no deviation of HRQoL between reality and patient’s expectations, and 10 indicating the worst possible state.
The majority of the women reported to have no problems in any of the 5 dimensions captured in the EQ-5D-3L, resulting in a mean EQ-5D 3L score of 0.94 (SD 0.04 ) and a median of 1.00,with 1 indicating perfect health and 0 death. Eight percent (8%) reported to have some problems with mobility, 5%, had problems with self-care, 10% reported some problems performing some activities, 19% reported some pain or discomfort, while 17% reported to be moderately anxious or depressed on the EQ5D. On the EQ-VAS scale, the mean score was 74.62.
Both the VAS and the PGI thus showed less than perfect HRQoL, the PGI more so than the VAS, while the EQ5D score indicated close to perfect health. There was a positive correlation between the PGI and the EQ 5D score, however this correlation was not statistically significant .
The PGI captures aspects of contextual social and emotional life for Kenya women living with HIV that may not be identified by standard tools and could complement these by highlighting areas of importance to patients’ HRQoL and the so called fourth 90. It may also facilitate the design of more patient-centered care in accordance to patient needs.