|Year : 2021 | Volume
| Issue : 2 | Page : 78-83
Health-related quality of life of hiv infected persons on antiretroviral therapy in Jos, Plateau State Nigeria
Ibrahim Bakshak Kefas1, Esther A Envuladu2, Chungdung Miner2, Bupwatda W Pokop2, Jonathan C Daboer2, Moses P Chingle2, Mathilda E Banwat2, Ayuba Ibrahim Zoakah2
1 Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
2 Department of Community Medicine, Jos University Teaching Hospital; Department of Community Medicine, College of Medicine, University of Jos, Jos, Nigeria
|Date of Submission||13-Oct-2020|
|Date of Decision||07-May-2021|
|Date of Acceptance||07-May-2021|
|Date of Web Publication||10-Dec-2021|
Dr. Ibrahim Bakshak Kefas
Department of Community Medicine, Jos University Teaching Hospital, Jos
Source of Support: None, Conflict of Interest: None
Context: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains an important global health problem. People living with HIV (PLHIV) experienced physical, social and mental health challenges that can affect their quality of life (QOL). Aim: To determine the health-related quality of life (HRQOL) of HIV-infected adults. Settings and design: This was a cross-sectional study conducted in the APIN centre. One hundred and seventy-eight PLHIV were selected by a multistage sampling technique between 10 January 2018 and 31 March 2018. Materials and Methods: The world Health Organization QOL-HIV Bref Questionnaire was used to collect the information. Statistical analysis used: Data were analysed using SPSS version 23.0 statistical software We determined significant factors using Chi square and logistic regression at a 5% level of significance. Results: The physical domain has the lowest mean score of 13.25 ± 2.25, while the spiritual/religion/personal belief domain had the highest mean score of 14.955 ± 3.336. Clustered of differentiation 4 (CD4) count, adherence and currently ill status were significantly associated with QOL. The odds for good QOL were 13 times higher among those with CD4 count ≥500 cells/mm3 compared to those with CD4 count < 500 cells/mm3 (adjusted odds ratio [aOR]: 13.03; 95% confidence interval [CI]: 4.58-37.5). The odds for good HRQOL were six times higher among those with good adherence compared to those with poor adherence (aOR: 5.62;95%CI: 1.83-17.26). Conclusion: The study revealed that the spiritual/religion/personal belief domain has the highest QOL score, while the physical domain had the least score. Adherence, currently ill and CD4 count were predictors of good QOL.
Keywords: Health-related quality of life, people living with human immunodeficiency virus, plateau, World Health Organization human immunodeficiency virus-BREF
|How to cite this article:|
Kefas IB, Envuladu EA, Miner C, Pokop BW, Daboer JC, Chingle MP, Banwat ME, Zoakah AI. Health-related quality of life of hiv infected persons on antiretroviral therapy in Jos, Plateau State Nigeria. Niger J Basic Clin Sci 2021;18:78-83
|How to cite this URL:|
Kefas IB, Envuladu EA, Miner C, Pokop BW, Daboer JC, Chingle MP, Banwat ME, Zoakah AI. Health-related quality of life of hiv infected persons on antiretroviral therapy in Jos, Plateau State Nigeria. Niger J Basic Clin Sci [serial online] 2021 [cited 2022 Jan 20];18:78-83. Available from: https://www.njbcs.net/text.asp?2021/18/2/78/332189
| Introduction|| |
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a long-standing, debilitating and a disease that has much being stigmatised among the population in most of the world. It constitutes a significant threat to global public health, ensuring an increase in morbidity and mortality to millions of infected persons. Africa is the most affected part of the world with >27 million people living with the disease. Sub-Saharan Africa is the most affected region, with 25.8 million PLHIV in 2014. Despite the great attention and resources devoted to HIV prevention by the international community, the number of PLHIV has continued to increases, especially in developing countries.
The number of PLHIV in Nigeria was estimated at 1.9 million in 2018, with an estimated 130,000 new infections in the same year. This large number of new infections in the light of limited access to antiretroviral therapy (ART) is straining the already struggling health system reversing past achievements in maternal and child health.,, In Nigeria, 60% of the population relies on farming as their source of living. The disease may create and perpetuate the vicious cycle of poverty due to a reduction in the human capacity to produce. The magnitude of the HIV epidemic in Nigeria has caused attention to be focused on the provision of HIV information, ART, HIV testing and counselling, PMTCT, treatment of opportunistic infection, care and support., The quality of life (QOL) of PLHIV is relegated and at most underestimated.
QOL is a multidimensional concept that includes a person's physical health, psychological state, level of independence, environment, social relationships, spirituality, religion and personal beliefs.,, However, the World Health Organization (WHO) defines 'QOL as an individual's perception of their position in life in the context of their culture and value systems in which they live and to their goals, expectations, standards and concerns.',, QOL is a subjective health assessment index, and it is closely related to the specific individual's background of culture and social circumstance.,
PLHIV experienced challenges due to the virus, ART side effects, opportunistic infections and many social problems such as stigma, poverty and cultural beliefs which can affect their QOL. Clustered of differentiation 4 (CD4) count, viral load and retention in care are utilised proxy measures in monitoring disease progression and well-being of PLHIV. These measures were found to provide an insufficient picture of the disease's impact. However, health-related quality of life (HRQOL) evaluation has become an essential tool as a supportive indicator in monitoring the effects of disease and interventions on HIV-infected population. This study aims to determine the HRQOL of HIV-infected adults in the AIDS Prevention Initiative Nigeria (APIN) centre in Jos.
| Materials and Methods|| |
Study setting, design and sample size
A cross-sectional study was conducted in the APIN centre in Jos North Local Government Area (LGA), Plateau State, between 10 January 2018 and 31 March 2018. Jos North has a projected population of 588,413 in 2017. The APIN Centre is the primary centre providing HIV care and support services in the state. The centre has over twenty thousand clients on ART. The minimum sample size was 178, and the significant level placed at a 95% confidence interval (CI), power of 80%, and the mean, standard deviation score (66.8 ± 21.7) obtained from a previous study.
Study population and sampling technique
All consenting HIV-infected clients 18 years and above enrolled into care and are on HAART for at least 1 year, accessing treatment, care and support at APIN centre. Those who had co-morbid conditions of either tuberculosis, hypertension, diabetes, or cancers were excluded. The duration of a year was chosen to offers sufficient evidence that the participant had enough experience of ART to participate in the study.
A multistage sampling technique was used to select respondents. Jos North LGA was selected purposively out of the 17 LGAs for the study because it has the highest prevalence of HIV among the LGAs. Jos North had seven health facilities offering comprehensive HIV care and support services. They include APIN centre, Bingham University Teaching Hospital, Plateau Specialist Hospital, Our Lady of Apostle's Hospital, Faith Alive Hospital, Hwolshe Medical Centre and Solat Hospital. APIN was selected from the list of the health facilities via a simple random sampling technique using balloting. A list of 520 PLHIV out of 978 that met the inclusion criteria was drawn from the monthly clinic booking register of all the clients, assessing HIV/AIDS treatment, care and support of APIN centre, 317 females and 203 males. The list was stratified by sex into male and female. A simple random sampling technique using the computer-generated table of a random number of WINPEPI statistical software was used to obtain a sample size of 178, 89 males and 89 females. This was done by allocating numbers to all the eligible female and male participants from 1 to 317 and 1–203 following which a total of 520 eligible participants was imputed in the designated box on the computer's table of random number generation package. Number one was entered into the relevant box as the least number, then the total number of participants to be randomly selected was also entered as a command in the designated box, which was 89 each for males and females, and participants were selected.
Study instrument and data collection
A validated semi-structured interviewer-administered questionnaire adapted from the bref version of WHO's a disease-specific instrument (WHOQOL-HIV Bref) English version was used to obtain the information. Information on sociodemographic, clinical characteristics, behavioural characteristics and QOL was assessed. The calculated HRQOL domains mean scores were obtained from facets scores, items for each facet were measured on a five-point scale 1–5, where one is low QOL, and five is the highest QOL. Facets were scored through summative scaling. Each item contributed equally to the facet score, and each facet contributed equally to the domain score. The mean scores calculated were multiplied by four so that the domain scores range between 4 (lowest possible QOL) to 20 (highest possible QOL). The questionnaire was pretested among 10% of the total sample size in General Hospital Barikin Ladi LGA, a secondary health facility providing comprehensive HIV/AIDS care and support services.
Measurement of variables
The various domains and overall HRQOL were measured as dependent variables. Social demographic characteristics, clinical and immunological factors, psychological factors and behavioural factors were measured as independent variables. The overall QOL was scored from 1 to 5, scores of 1–3 and 4–5 were graded as poor and good overall QOL, respectively. The mean scores of the different domains are score between 4 and 20, the score of 4–12 was graded as poor QOL and the score of >12–20 was graded as good QOL.
Definition of terms
- Undetectable viral load = <50 copies of cell/mm3
- Detectable viral load = ≥50 copies of cell/mm3
- Good adherence = Missed only one dose of ART in a twice-daily regimen within the last 10 days (≥95%)
- Poor adherence = Missed two or more doses of ART in a twice-daily regimen within the last 10 days (<95%).
Data analysis was done using the IBM Statistical Product for the Service Solutions software IBM (SPSS), Chicago version 23.0. Basic descriptive statistics of the sociodemographic characteristic were presented in frequencies and percentages, and the quantitative variables were described with mean and standard deviation. The HRQOL domains were assessed using the WHOQOL-HIV instrument scoring system. Domain scores are scaled in a positive direction. Therefore, those scaled in the negative direction were recorded. Mean scores and standard deviations were used to summarize and to describe HRQOL. A Chi-square test was used to assess the association of clinical and social factors and the domains of HRQOL. The factors that were significant at bivariate analysis were modeled into multivariable logistic regression at a 5% level of significance.
The ethical approval for the study was obtained from the Jos University Teaching Hospital Health and Research Ethics Committee (JUTH/DCS/ADM147/XIX/6146), and permission was also obtained from APIN. Written informed consent was obtained from each study participant. Respondents were free to withdraw anytime during the study if they so desired. The confidentiality of information provided by the participants was maintained.
| Results|| |
The mean age of respondents was 38.37 ± 9.76 years. Age group 26–35 years had the highest frequencies of 62 (34.8%). Most of the respondents had tertiary education 70 (39.3%), and the majority were married 123 (69.1). More than half of the respondents were employed 109 (59.6%), and most earn less than the minimum wage of ₦18,000 [Table 1].
Most of the respondents had CD4 count 500 cell/mm3 and above 153 (86.0%). Over two-third had undetectable viral load 136 (76.4%). Slightly more than half of the respondents (90, 50.6%) were on ART for 2–10 years. Adherence was good among the majority of the respondents (156, 87.6%), and only 15 (8.4%) reported the presence of drugs side effects. The majority of the respondents (108, 80.7%) do not belong to HIV/AIDS support group [Table 2].
The physical domain has the lowest mean score of 13.25 ± 2.25, while the spiritual/religion/personal belief domain had the highest mean score of 14.96 ± 3.34 [Table 3].
Majority of the respondents with CD4 count ≥500 cells/mm3 (88.2%) had good QOL (P < 0.001). Similarly, good HRQOL was reported among most respondents with undetectable viral load (82.4%) compared with those having a detectable range of viral load, and this was not significant (P = 0.267). Duration on ART did not show a significant relationship with HRQOL (P = 0.420). Adherence shows a statistically significant association with overall QOL (P < 0.001). There was no significant association between ART side effects with QOL (P = 0.499). Furthermore, the current ill status of respondents was associated with overall QOL [Table 4].
|Table 4: Clinical factors associated with health-related quality of life of respondents|
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The odds for good QOL were 13 times higher among those with CD4 count ≥500 cells/mm3 compared to those with CD4 count <500 aOR: 13.03; 95% CI: 4.58–37.5). Those with good adherence had about six times the odds for good QOL compared to those with poor adherence (aOR: 5.62; 95% CI: 1.83–17.26) [Table 5].
|Table 5: Logistic regression showing clinical predictors of good health-related quality of life among respondents|
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| Discussion|| |
In this study, we found that physical and environmental domain has the lowest mean scores. Psychological, level of independence and the social relationship had similar mean scores, while the spiritual/religion domain had the highest mean score. A similar lower physical domain mean score was also reported in a study conducted in Ibadan. In contrast, other studies reported higher scores in the physical domain due to differences in the ART experience of patients and the effect of ART in reducing physical symptoms among infected individuals., The finding in this study may probably be because of the introduction of out-of-pocket payment for laboratory and other services. Poor government funding and limited international partners support, coupled with low health insurance coverage, may have affected access to care. This may remain so, if free care is withdrawn, bearing in mind twiddling donor funding. The government needs to take the initiative for building a sustainable capacity for free quality and affordable HIV/AIDS care at community levels in the light of twiddling donor support.
The spiritual/religion/personal beliefs had the highest domain mean score, indicating a better HRQOL. Similar findings were reported in Kogi, Ibadan and Brazil.,, An inverse picture was reported in India. Other studies had associated high spirituality with better QOL., The high score in this study may be due to the fact that people tend to associate their difficult health challenges to spiritual and religious factors, and this helps them build hope. Assessment of the spiritual domain will provide useful information about the patient perspective of life, death and health concern.
We found that those who had good adherence have better QOL compared to those with poor adherence. It was similar to findings obtained in other studies.,, This may be due to better virologic and immunological outcomes following good adherence to ART. A high level of literacy among respondents in this study may have contributed to this finding. Patients who are educated were more likely to understand instruction on treatment and side effects and to abide by it to avoid untoward outcomes of the disease and drug adverse effects. Family support and other support groups with healthcare workers repeated counselling might have also played a role in improving adherence. Good adherence is critical to achieving sustained virologic, immunologic and clinical outcomes. This is the key to reducing the risk of HIV transmission and preventing or delaying the development of drug resistance.
In this study, a CD4 count of ≥500 cells/mm3 was found to be significantly associated with good HRQOL. Other studies done in Nigeria, Uganda and India reported a similar finding.,,, This was consistent with the finding in a systematic review. This may be attributed to the impact of comprehensive and consistent counselling on patients' antiretroviral drugs and education on their disease state by health workers.
Our study used the robust WHOQOL HIV Bref Questionnaire in generating evidence. However, the exclusion of PLHIV with co-morbidity may be a limitation because this may not be absolute as they may have some occult malignancy that will affect their QOL. A population-based prospective cohort study among the infected population will be required to explore the predictors and their effect on HRQOL.
| Conclusions|| |
The study unveiled that the spiritual/religion/personal belief domain had the highest QOL mean score, while the physical domain had the least mean score. Good adherence, currently ill and a CD4 count of ≥500 cells/mm3 were found to be predictors of good QOL. Our findings were a call to action for national and international efforts to provide ART to the millions of people yet not on it and promote good adherence.
We are grateful to AIDS Prevention in Nigeria for permission to carry out this research and to the study participants for their contribution to this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]