Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe

Abstract

Little is known about the psychosocial impact of antiretroviral therapy (ART) among women in sub-Saharan Africa. Therefore, we conducted a cross-sectional study in Zimbabwe to assess the impact of ART on HIV-positive women's health-related quality of life, using the Medical Outcomes Study-HIV Quality of Life (QOL) questionnaire. Additionally, we assessed socio-demographics, reproductive and sexual health, HIV-related history, disclosure, social stigma, self-esteem, and depression. Structured interviews were conducted with 200 HIV-positive women and categorized into three groups by treatment: (1) Group 1 (n=31) did not meet clinical or laboratory criteria to begin treatment; (2) Group 2 (n=73) was eligible to begin treatment but awaiting initiation of treatment; and (3) Group 3 (n=96) was on ART for a median of 13 months. The women had similar socio-demographic characteristics but varied significantly in clinical characteristics. Women on ART reported fewer AIDS-related symptoms in the last week and year and had higher current and lower baseline CD4 counts compared to women not on ART. On most QOL domains women on ART reported higher mean scores as compared to women not on ART (p<0.01). Additionally, women on ART reported less depression compared to women not on ART (p<0.001). Between the two groups of women not on ART, unexpectedly, there were no significant differences in their scores for QOL or depression. Thus, Zimbabwean women living with HIV experience better overall QOL and lower depression on ART. Altogether, our findings suggest that ART delivery in resource-poor communities can enhance overall QOL as well as psychosocial functioning, which has wide-ranging public health implications.

Keywords:

• quality of life
• depression
• HIV treatment
• sub-Saharan Africa
• Zimbabwe

Acknowledgements

We acknowledge foremost the Zimbabwean women's participation in this project. Thank you to the staff at Zimbabwean AIDS Prevention Project (ZAPP) and Tessa Andermann for providing support during study implementation. Thank you to Dr. Mark Vosvick for providing guidance on the psychosocial measures and Dr. Albert Wu on analyzing the quality of life questionnaire.

The study was supported by the Medical Scholars Fellowship at Stanford University School of Medicine, National Institutes of Health (NIAID R01 AI060399), and the Fogarty International Center (ICOHRTA U2R TW006878).