The Health Related Quality of Life of Hiv-aids Patients on Antiretroviral Therapy in Nairobi

Abstract

Background: It is estimated that less than 10% of PLWHA have access to anti -retroviral treatment in every region except the Americas. Until the year 2000, the cost of treatment was the single most significant factor influencing access. With the recent price reductions, wholesalers have reported a 30-50% increase in demand for these drugs. In just over one decade, anti-retroviral therapy has transformed the human immunodeficiency virus (HIV) infection from a fulminant and invariably fatal illness to a chronic albeit incurable disease. As in any other chronic illness, quality of life is emerging as a significant medical outcome and its enhancement is as important a treatment goal as viral suppression and immune reconstitution. Objective: To determine the health-related quality of life (HRQOL) status of HIV positive patients on anti-retroviral therapy in Nairobi (Kenya). Design: Cross-sectional survey to determine the HRQOL of HIV-infected individuals on anti -retroviral therapy. Setting and time frame: Four hospitals in Nairobi city between January and April 2003. Subjects: Non-pregnant HIV infected adults on Highly Active Anti-retroviral Therapy. Methods: Self-administered semi-structured questionnaires for patients who were physically able to fill the questionnaires. Those that were too weak to do so were assisted in filling the questionnaires. Results: Approximately 80% of all the respondents had above average HRQOL. Mental health was the most adversely affected domain of HRQOL. Female respondents scored better than their male counterparts (P<O.OOl). Those that were employed and working scored better than those that were unemployed or those that were employed but on sick leave (P<O.OOl). Respondents that were on protease inhibitor (PI) based regimens scored better than those that were on PI sparing regimens (P<O.OOl). Inpatients had worse scores than outpatients (P<O.OOl). Patients that were compliant to therapy had higher scores than those that reported non-compliance (P<O.OOl). Counseling did not have any impact on HRQOL as would have been expected (P=0.995). Patients that had disclosed their HIV status did not score differently from those that had not (P=O.203). Those that had CD4 counts of less than 200c/ml scored less than those that had CD4 counts of =>200c/ml (P<O.Ol). CD4 count was positively correlated to HRQOL and was found to predict 40% of the variance in HRQOL. Conclusion: Poor mental health is highly prevalent among HIV-patients on anti-retroviral agents. Counseling programs do not provide the required psychological support. CD4 counts can be used to predict overall HRQOL as well as the mental and physical health domains ofHRQOL. Recommendations: Palliative care for HIV infected individuals is an important component of HIV management. QOL assessment instruments can be used to monitor progress for patients on anti-retroviral therapy 'is well as to screen for underlying mental distress. Counseling programs need to be evaluated to establish if any deficiencies exist in content, type or staff qualification. HRQOL instruments need to be harmonized to enable meaningful comparison across various populations.