Health-related quality of life in HIV/AIDS patients on antiretroviral therapy at a tertiary care facility in Zimbabwe

ABSTRACT

Health-related quality of life (HRQoL) is a broad concept reflecting a patient’s general subjective perception of the effect of an illness or intervention on physical, psychological and social aspects of their daily life. HRQoL among patients infected with HIV has become an important indicator of impact of disease and treatment outcomes. A cross-sectional survey was carried out at Chitungwiza Central Hospital, Zimbabwe, to assess HRQoL in patients with HIV/AIDS receiving antiretroviral therapy (ART), using two validated instruments. The HIV/AIDS-targeted quality of life (HAT-QoL) and EuroQoL Five-dimensions-Three-level (EQ-5D-3L) instruments were used to assess HRQoL. Internal consistency reliability and convergent validity of the two instruments were also evaluated. For construct validity, the relationships between HRQoL scores and socio-economic and HIV/AIDS-related characteristics were explored. The median scores for the HAT-QoL dimensions ranged from 33.3 (financial worries) to 100 (HIV mastery). A considerably low HAT-QoL dimension score of 50.0 was observed for sexual function. There were ceiling effects for all HAT-QoL dimension scores except for financial worries and disclosure worries. Floor effects were observed for financial worries and sexual function. The median of the EQ-5D-3L index and visual analogue scale (VAS) was 0.81 and 79.0, respectively. There were no floor or ceiling effects for both the EQ-5D-3L index and VAS. The overall scale Cronbach’s alpha was 0.83 for HAT-Qol and 0.67 for EQ-5D-3L. HAT-QoL demonstrated good convergent validity with EQ-5D index (0.58) and VAS (0.40). A higher level of HRQoL was positively and significantly related to income, education and employment. The patients’ self-reported HRQoL was generally satisfactory in all the HAT-QoL dimensions as well as the two components on the EQ-5D-3L instrument. The two instruments demonstrated good measurement properties in HIV/AIDS patients receiving ART and have potential for use, alongside biomarkers, in monitoring outcomes of interventions.

KEYWORDS:

• Health-related quality of life
• HIV/AIDS
• HAT-QoL
• EQ-5d
• Zimbabwe
• antiretroviral therapy

Acknowledgements

The views expressed in the manuscript do not reflect the views nor do they imply endorsement of the suggestion by the funders. NM and BD contributed to conception and design of the study, collected the data, drafted the manuscript and participated in analysis and interpretation. SK and MvH contributed to the conception and design of the study, participated in the review process of the manuscript for intellectual content and contributed to the analysis and interpretation. MJP participated in the review of the manuscript for intellectual content and contributed to analysis and interpretation.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

N. Mafirakureva http://orcid.org/0000-0001-9775-6581

Additional information

Funding

This work was supported by the European Union Seventh Framework Programme (FP7/2007–2013) [grant agreement no. 266194]; Office of Global AIDS Coordinator and the US Department of Health and Human Services (National Institutes of Health (Fogarty International Centre) [grant number TW008881].