Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda

Abstract

We examined trends and predictors of quality of life (QOL) over 12 months among a prospective cohort of 947 HIV-1-infected adults initiating highly active antiretroviral therapy (HAART) between May 2003 and May 2004 in rural Uganda. Participants provided clinical, demographic and psychosocial data at baseline and every three months thereafter. Outcome measures included physical and mental health summary scores based on the Medical Outcomes Study-HIV Health Survey (MOS-HIV). Generalised estimating equations were used to assess magnitude of change in summary scores and factors associated with QOL. Of 710 women and 237 men enroled, the mean age was 38.7 years and mean baseline CD4 cell count was 124.1 cells/µL. At enrolment, physical and mental health summary scores were 39.2 and 40, respectively. By 12 months of HAART, scores increased by 11.2 points (p <0.001) and 7.4 points (p <0.001), respectively. For both scores, most gains were achieved by the third month of therapy. While several clinical, psychosocial and sociodemographic factors predicted QOL at HAART initiation, financial dependence on others was the only remaining predictor after controlling for time on HAART. Interventions to enhance the economic and employment opportunities of patients taking HAART in rural Africa may help maximise gains in QOL.

Acknowledgements

This study was funded by the Centers for Disease Control and Prevention through the President's Emergency Plan for AIDS Relief and the US Department of Health and Human Services. The authors wish to thank the participants and study team in Tororo, especially Kenneth Khana and Humphrey Masaaba. We also wish to thank Stevens Bechange for data management, Dr David Glidden for statistical assistance, Drs George Rutherford and Dominique Meekers for providing comments on earlier versions of this manuscript and Theopista Wamala for assistance with citations.

Author Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.