Healthcare infrastructure and emotional support are predictors of CD4 cell counts and quality of life indices of patients on antiretroviral treatment in Free State Province, South Africa

Abstract

While many AIDS patients in sub-Saharan Africa are receiving antiretroviral treatment (ART) via public clinics, improvements in health status also depend on socioeconomic and psychological factors and quality of healthcare services. Inter-dependence between patients’ clinical markers and quality of life indicators should be analyzed using comprehensive models. This longitudinal study compiled socioeconomic and clinical variables at six monthly intervals on patients receiving ART in South Africa; patients’ ratings of quality of services and staff in “Assessment” and “Treatment” sites were assessed. Dynamic random effects models were estimated by maximum likelihood for CD4 cell counts and for quality of life indices (EQ-5D and Visual Analogue Scale), incorporating the inter-dependence between plasma HIV RNA levels and CD4 cell counts. The results showed that emotional support received by patients was a significant predictor (P<0.05) of CD4 cell counts and quality of life indices. Ratings of services and staff in Assessment and Treatment sites were significantly associated with CD4 cell counts and quality of life indices; CD4 cell count was a significant predictor of quality of life indices. The results indicated that it is important to compile socioeconomic and psychological variables for AIDS patients and monitor healthcare services for improving their health status and quality of life.

Keywords:

• antiretroviral treatment
• healthcare infrastructure
• socioeconomic and psychological factors
• random effects models
• maximum likelihood estimation

Acknowledgements

We thank the study participants and the field staff for their generous help, and the three referees for helpful comments. The study was supported by International Development Research Center Canada, Research Committee of the World Bank, and Bank Netherlands Program Partnership. The findings, interpretations and conclusions in the article are those of the authors and do not reflect the views of supporting agencies.