Health Adjusted Life Expectancy Among Adult Hiv/aids Patients in Kenya: a Comparative Study of Nyanza and Central Regions

Abstract

Introduction of advanced management and treatment of HIV/AIDS has seen life expectancy of people living with HIV/AIDS (PLWHA) increase over the years to almost the level of the general population. Little is however known what proportion of this life is spent in different health statuses as measured by health adjusted life expectancy (HALE) and if this measure differs across sub populations in Kenya. This longitudinal study set out to achieve five objectives namely: to assess health related quality of life (HRQOL) of adult HIV/AIDS patients newly started on HIV care and treatment in Nyanza and Central regions of Kenya; to compare transition probabilities from baseline health states to health states at one year follow-up for adult HIV/AIDS patients in Nyanza and Central regions of Kenya; to compare HALE among adult HIV patients in Nyanza and Central Kenya regions; to determine factors associated with HALE for adult HIV/AIDS patients in Nyanza and Central regions of Kenya; and to compare HALE results estimated using Sullivan and multistate life table (MSLT) approaches. Data were collected in two waves among adult HIV patients aged 15 years and above newly diagnosed with HIV in six public health facilities in Nyanza and Central regions of Kenya. Demographics, socio-economic, biomedical and self-reported health related quality of life (HRQOL) information. Two summary measures of health; physical health summary (PHS) measure and mental health summary (MHS) measure were obtained from HRQOL measures which were then categorized into different health thresholds and using both Sullivan and MSLT approaches, the number of years spent in each threshold (HALE) was obtained. The findings of the study showed that there were significant differences in health adjusted life expectancy between Nyanza and Central regions. Life expectancy adjusted for various MHS statuses was lower than that adjusted for various PHS statuses. The proportion of life spent in good health status was higher among male than female, was higher among those initially in good health statuses than those initially in poor health statuses and higher among those in Central than in Nyanza region. HALE estimates obtained using Sullivan method were higher for proportion of life spent in poor health statuses compared to estimates obtained using MSLT approach. The findings of the study clearly demonstrate PLWHA in Kenya spend substantial proportion of their lives in poor health states and regional differences persist. Different methodological approaches provide different estimates of health adjusted life expectancy. There is need for further studies to explain observed regional differences as well as further comparison of results obtained using the two approaches since Sullivan approach may have overestimated proportion of life spent in poor health status due to use of baseline HRQOL estimates.