Health-Related Quality of Life Among People Living with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy in Ethiopia: PROQOL-HIV Based Survey

Abstract

Background

As infection with the Human Immunodeficiency Virus (HIV) has evolved into a chronic disease, perceived health-related quality of life (HRQoL) is becoming a prominent and important patient-reported outcome measure in HIV care. This study aimed to assess HRQoL among people living with HIV on highly active antiretroviral therapy and factors associated with HRQoL in Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 160 HIV–infected patients who were initiated highly active antiretroviral therapy at Jimma University Medical Center in 2016. HRQoL was assessed using the patient-reported outcome quality of life-HIV (PROQOL-HIV) measuring scale. Linear regressions were used to identify factors associated with outcome. Statistical significance was considered at p-value <0.05.

Results

Out of a total of 160 participants, 63.13% were females. The mean (±SD) age of study participants was 41.47±9.45 years. The median baseline CD₄+ cell count was 182.00 cells/µL (IQR: 104.53–262.40 cells/µL). The mean (±SD) score of PROQOL-HIV scale domains was 77.58 ±15.11, 58.32 ±7.79, 61.75± 17.95, 85.07 ±15.67, 76.92 ± 20.52, 80.00 ±16.83, 74.37 ± 1.47, 81.45 ± 8.17 for physical health and symptoms, emotional distress, health concerns, body change, intimate relationships, social relationships, stigma, and treatment impact domains, respectively. Second line antiretroviral therapy showed a negative effect on the quality of life, especially on the treatment impact domain (β=−6.301). Cotrimoxazole preventive therapy had a significant positive effect on the physical health and symptoms of HIV patients (β= +8.381, p<0.05). Advanced disease (β=−2.709, p<0.05), and non-communicable disease comorbidity (β=−14.340, p<0.001) showed a significant negative effect on physical health and symptoms.

Conclusion

Several behavioral, clinical & immunological factors were negatively associated with health-related quality of life. The double burden of chronic non-communicable disease(s) and the impact of treatment were highly significant in all dimensions of HRQoL measures. Therefore, with HRQoL emerging as a key issue for HIV–infected patients, its routine assessment and appropriate interventions at each clinic visit would be very crucial.

Keywords:

• human immunodeficiency virus
• health-related quality of life
• patient-reported outcome

Abbreviations

HRQoL, Health-related quality of life; JUMC, Jimma University medical center; HIV, Human immune deficiency virus; PROQOL-HIV, Patient-reported quality of life-HIV; PLHIV, People living with human immune deficiency virus; NCD, Non-communicable disease; HAART, highly active antiretroviral therapy; CPT, Cotrimoxazole preventive therapy; IPT, Isoniazid preventive therapy; PHS, Physical health and symptoms; ED, emotional distress; HC, health concerns; BC, body change; IR, intimate relationships; SR, social relationships; ST, stigma; TI, treatment impact; MOS-HIV, Medical Outcomes Survey HIV Health Survey; FAHI, Functional Assessment of HIV Infection; HOPES, HIV Overview of Problems-Evaluation System; HAT-QOL, HIV/AIDS Targeted QOL; AIDS-HAQ, AIDS Health Assessment Questionnaire; MQoL-HIV, Multidimensional QOL Questionnaire for HIV/AIDS.

Ethics Approval and Consent to Participate

Ethical clearance and approval was obtained from the institutional review board (IRB) of Jimma University. Before the start of the survey, informed consent was requested and received from the patient. This study was conducted in accordance with the Declaration of Helsinki.

Data Sharing Statement

The data sets generated during and/or analyzed during the current study are available from the corresponding authors on reasonable request.

Acknowledgments

This research study is dedicated to our citizens lost their lives on Irreechaa festival, the Oromo’s thanksgiving holiday, on Sunday, 02-October-2016 G.C., at Hora Arsadi, Bishoftu, Oromia, Ethiopia. We would like to acknowledge study participants for their time and dedication to this study and the staff working at TB-HIV follow-up clinic in Jimma University medical center, Ethiopia, for their support during the study. Our deepest heartfelt gratitude also goes to Jimma University for providing grant funds for this research. We have also special thanks to Dr. Martin Duracinsky, for his collaboration in getting the health-related quality of life measuring scale questionnaire.

Author Contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Funding

This study was sponsored by Jimma University, Ethiopia.

Disclosure

The authors have no competing interests to declare. The funder had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript.