Determinants of health related quality of life (HRQoL) of adults in a public sector HAARTprogram in Botswana
Date
2009-01-29T07:50:11Z
Authors
Buliva, Evans Muhavani
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Abstract
ABSTRACT
Introduction
The advent of potent anti-retroviral agents for HIV treatment has resulted in
marked decrease in deaths. Health workers now have to ensure that their
patient’s physical, social, and psychological well-being is optimized. This study
used a validated tool to measure Health Related Quality of Life concepts
amongst HIV patients in a public treatment program. The main objective of this
research was to establish factors that are associated with poor quality of life of
these patients with the purpose of using this information as a basis for
determining who would require individualized medical care and attention.
Materials and methods
The study is set at Bontleng Clinic in Gaborone, Botswana. The study
questionnaire consisted of two parts: part one for collecting data on sociodemographic,
illness and treatment related factors, and part two was the Medical
Outcomes Study – Short Form tool used to obtain data on quality of life concepts.
Two groups of participants were interviewed: ART-Naïve (n=90) and ARTExperienced
(n=110). The study protocol had ethical approval from both the
University of the Witwatersrand, Johannesburg and the Ministry of Health in
Botswana.
iv
Results
A smaller proportion of ART-experienced participants reported various disease
symptoms as compared to those participants who were ART-naïve. Statistically
significant differences were noted for: weight loss (25% vs 77%), diarrhoea (3%
vs 11%), cough (19% vs 39%), and night sweats (24% vs 43%) for ART
experienced and ART Naïve patients respectively. CD4 counts and HB levels
were also significantly higher in patients on HAART. The overall QoL summary
score was significantly higher (better) in the ART-experienced (mean score 53
out of 100) compared to the ART-naïve group (mean score 47 out of 100).
Therefore being on ART favoured a higher QoL score. However, changes in the
three laboratory indices of CD4 count, Hb level, and viral load had no statistical
significant association with HRQoL scores. Multiple regression identified only five
factors as being associated with better QoL scores. These factors were to do with
the absence of the following disease symptoms: weight loss, diarrhoea, night
sweats, and feet pains; as well as absence of recent hospitalisation.
Discussion
The study patients do respond well to HAART with significant improvements in all
dimensions of QoL. This is in keeping with findings from other populations. In
assessing these patients at the initiation of HAART, and at subsequent visits, one
must take into account any history of recent hospital admission, history of weight
loss, and most importantly presence/absence of various disease symptoms. Conclusions and recommendations
Symptoms, regardless of the underlying cause: be it due to HIV disease itself or
drug side effects; greatly impact patients’ quality of life. Efforts should be made to
include the assessment of symptoms in the continuum of care of HIV patients.
The introduction of newer potent anti-retroviral agents with fewer side effects
should also favour the beneficial impact of HAART.
Description
Keywords
HIV, Health Related Quality of Life, Botswana