Impact of HIV/AIDS on the Quality Of Life

A Cross Sectional Study among Patients Receiving Antiretroviral Therapy from a Peripheral STD Clinic in

Sri Lanka

P.H.M.P Bandara¹, A.A.I.N Jayasekara¹ S.N Jayasuriya², J. Ranatunga²

1. National STD/AIDS Control Programme, Sri Lanka. 2. STD Clinic, Teaching Hospital Colombo North, Sri Lanka

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Introduction

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Background of the study• With the miraculous effects of Anti Retroviral

Therapy, HIV has become just another chronic disease; having minimal impact on the life expectancy of an affected individual.

• On the other hand, increasingly health care planners are recognizing that measures of disease alone are insufficient determinants of health status.

• Therefore, Complementary Health Status Measures are required to determine HIV health status

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Complementary Health Status Measures

Health Status Measures

Functional HealthStatus

Health & Well being

Objective Subjective

These measures are multi-level & multi-dimensional

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Quality of Life(QOL) measure

Health Status Measures

Quality Of Life (QOL)

“An individual’s perception of their position in

life in the context of the cultural & value

systems in which they live and in relation to

their goals, expectations, standards &

concerns”

- World Health Organization

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Objectives

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Objectives

1. To assess the quality of life of HIV positive patients who are on ARV for more than six months under four main domains (Physical, Psychological, Social & Environmental)

2. To establish possible associations of each of the above domains with • Socio-demographic characteristics• Selected clinical parameters

• Based on literature review & conceptual framework

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Methodology

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Details of the study

Study designCross Sectional study

Study settingSTD Clinic, Ragama

• Total Number of adult HIV patients registered – 108• Number on ART – 59 / Number on ART for >6/12 – 47 • Total number of Children (<12 years)- 04

Study populationAll HIV positive adult outpatients who are on ART for more thansix months

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Inclusion & Exclusion criteria

• Inclusion Criteria• All HIV positive patients who are on ART for >6/12

• Exclusion Criteria• HIV positive patients who are still not started on ART• HIV positive patients who are on ART for <6/12• Children less than 12 years

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Study Methodology

• Study Instrument• Interviewer administered pre-tested questionnaire

• Sample Size: • Forty seven (47) patients

• Selection & training of the Interviewer• Interviewer – Trained nursing officer (Not involved in

HIV patient management)

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Study Methodology contd….

• Focus on validity of data• Training of the Interviewer• Random supervisions of the Interviewer

• Study Duration• Period of two months

• Data extraction• Clinical data extraction was done by the Investigators using the

clinic records

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Questionnaire• Questionnaire - WHOQOL-Bref (Sinhala) instrument • Process of Translation & modification• Pre testing of the questionnaire

• Training of the interviewer – by the Principal Investigator

• WHOQOL-BREF, an abbreviated version of the WHOQOL-100(WHOQOL-100 quality of life assessment was developed by the WHOQOL group with 15 international field centres, simultaneously, in an attempt to develop a quality of life assessment that would be applicable cross-culturally)

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Scoring system of the questions

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Summarizing into domains

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Process of calculating the transformed score from the raw score

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Transformedscore

= Actual raw domain score- lowest possible raw domain scorePossible raw domain score range x100

Analysis• Extraction using SPSS v20• One way Analysis of Variance (ANOVA)

• Significant difference between some selected clinical data & the socio-demographic variables on QOL domains

Results

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Characteristics of study sample

• The mean age of the study population was 44.23 years (range 27-68 years)(SD 10.4)

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Gender

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29.70%

70.20%

Distribution of study population by Gender

Female

Male

Marital Status

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21.20%

59.50%

0

4.30%8.50%6.30%

Distribution of the study population by the Marital Status

Single

Married

Livingto

Seperated

Divorced

Widowed

Highest level of Education

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2.10%

17.00%

57.5%

14.90%8.50%

0%

Distribution of study population by highest level of Education

1-5

6-10

GCEOL

GCEAL

DIPdeg

NoSchooling

Monthly Income

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12.80%12.80%

53.20%

21.20%

Distribution of study population by Monthly Income

Less than 10000

10000-20000

20000-50000

More than 50000

Current Occupation

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4.30%12.70%

0%

6.40%

29.80%

44.70%

2.10%

0%

Distribution of the study population by Current Occupation

Unemployed

Self

Student

Executive

MiddleLevelEmployed

Labourer

Retired

UnableToWork

Mode of transmission of HIV

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76.50%

23.50%

Distribution of the mode of Transmission of HIV infection of the study population

heterosexual

homosexual/bisexual

Stage at Diagnosis of infection

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46.80%

4.30%

27.70%

21.20%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

1

2

3

4

Percentage

WHO

clin

ical

stag

e

Distribution of Stage at Diagnosis of the Infection

Reported opportunistic infections

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50%

6%

7%

2%

13%

22%

0% 10% 20% 30% 40% 50% 60%

No OIs

Oesophagal candidiasia

Oral Candidiasis

Other OIs

PCP Pneumonia

TB

Percentage

Opp

orun

istic

Infe

cton

Distribution of reported Opportunistic Infections

Medical co-morbidities

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2.00%

2.00%

10.00%

2.00%

2.00%

76%

2.00%

4.00%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%

CKD

CLD

Diabetes

Hypertension

Hypercholoestreolaemia

None

Asthma

Other

Percentage

Med

ical

Co-

mor

bidi

ties

Distribution of Medical Co-morbidities

Results Contd……

• The overall QOL mean score on a scale of 0-100 was 74.38

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Comparison of Mean Scores

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86.8

74.17

57.13

79.41

0

10

20

30

40

50

60

70

80

90

100

Physical Psychological Social Environmental

Mea

n sc

ore

QOL domain

Mean Score four domains of QOL

Social domain observation

Three facets of social domain have been assessed

Observed:Low satisfaction related to sexual activity

Need further analysis

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Significance of physical health attributes

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0.922

0.851

0.829

0.735

0.67

0.548

0.512

0.508

0.431

0.318

0.079

0.026

0.004

0.001

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Age

Occupation

Gender

Medical Co-morbidities

CD4 at diagnosis

Marital Status

Income

Level of education

ARV Regimen

Side effects of ARV

Stage at diagnosis

Viral load

Adherence

CD4 at present

p-Value

Varia

ble

of in

tere

stDistribution of p-values for clinical & socio demographic parameters in the

Physical health domain

Significance of Psychological health attributes

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0.793

0.556

0.494

0.492

0.426

0.407

0.232

0.163

0.12

0.03

0.007

0.001

0.001

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

Gender

Alcohol

Recreational drug use

Mode of transmission

Marital Status

Medical Co-morbidities

Occupation

Age

Level of education

Stage at diagnosis

Side effects of ARV

Income

Adherence

p-Value

Varia

le o

f int

eres

t

Distribution of p-values for clinical & socio demographic parameters in the Psychology domain

Significance of Social Relationship domain parameters

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0.995

0.987

0.828

0.814

0.548

0.522

0.309

0.15

0.03

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 1.1

Gender

Recreational drug use

Income

Mode of transmission

Age

Alcohol

Occupation

Marital Status

Level of education

p-Value

Varia

ble

of in

tere

st

Distribution of p-values for clinical & socio demographic parameters in the Social Relationship domain

Significance of Environment domain parameters

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0.253

0.538

0.747

0.079

0.345

0.034

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

Age

Gender

Marital Status

Level of education

Occupation

Income

p-Value

Varia

ble

of in

tere

st

Distribution of p-values for clinical & socio demographic parameters in the Environment domain

Analysis & Results

• Significantly better QOL scores in the Physical Health domain (p=0.01) with respect to

• CD4 count• > 95% adherence

• Significantly better QOL scores in the Psychology domain (p=0.01) with respect to

• >95% adherence• Income• ARV

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Results Cont.No associations were observed with;• Socio demographic parameters

• Age• Gender• Marital status• Occupation

• Clinical parameters• Duration of ARV medications• Current ARV regimen• Alcohol and recreational drugs

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Inter-domain correlationDomain Parameter Physical health Psychology Social Environmental

Physical health domain Transformed score

Pearson Correlation .567** .178 .713**

p-value (2-tailed) .000 .231 .000N 47 47 47

Psychological domain Transformed score

Pearson Correlation .567** .158 .671**

p-value (2-tailed) .000 .290 .000N 47 47 47

Social domain Transformed score

Pearson Correlation .178 .158 .297*

p-value (2-tailed) .231 .290 .042N 47 47 47

Environment Domain Transformed score

Pearson Correlation .713** .671** .297*

p-value (2-tailed) .000 .000 .042N 47 47 47

Inter Domain Correlation

• Environmental domain attributes are positively correlated with Physical and Psychological domainattributes at 1% significance

• Psychological domain attributes are positively correlated with Physical domain attributes at 1% significance

Detailed study on Inter-attribute correlation across the above domain pairs will provide specific clues in

improving QOL10/27/2014 40

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ConclusionTesting at 1% Significance level,

QOL of HIV patients is associated with;• Income • Current CD4 count• Drug adherence• Side effects of ARV

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Recommendations

1. National cohort analysis of patients on ART should be done annually to assess the ART outcome

2. QOL assessment should be integrated into the HIV management protocols

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Future Scope

• Detailed analysis of each domain• To find relative contribution of each component• To address the facets with low contribution

• Comparison of QOL of different cohorts in different ART centers in Sri Lanka

• To assess the significance in order to take necessary actions to improve QOL

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Limitations

• Small sample size

• Relatively low sample size of females ( 70% vs 30%)

• Quality of life of children could not be assessed

• Need a separate tool for that

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Acknowledgement

• Staff at the STD Clinic Ragama

• Co-researchers• Dr Jayadarie Ranatunga• Dr Niroshan Jayasekara• Dr Subashini Jayasuriya

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Thank You

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