Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2020

01-12-2020 | Opportunistic Infection | Research

Correlates of health-related quality of life among adults receiving combination antiretroviral therapy in coastal Kenya

Authors: Moses K. Nyongesa, Paul Mwangi, Stanley W. Wanjala, Agnes M. Mutua, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Published in: Health and Quality of Life Outcomes | Issue 1/2020

Login to get access

Abstract

Background

Health-related quality of life (HRQoL) is an important metric of perceived wellbeing in people living with HIV/AIDS (PLWHA). However, research on HRQoL among PLWHA in sub-Saharan Africa is limited. This study investigates factors associated with HRQoL among PLWHA in Kilifi, coast of Kenya.

Methods

Between February and April 2018, 450 adults living with HIV and on combined antiretroviral therapy (cART) between 18 to 60 years were sequentially recruited from an HIV-specialized clinic. The Functional Assessment of HIV Infection (FAHI) questionnaire, previously adapted for assessing HRQoL in this setting, was slightly modified and administered to participants alongside other measures of sociodemographic, health and treatment characteristics in a face-to-face interview.

Results

Linear regression analyses indicated that depressive symptoms, HIV-related stigma, non-disclosure of HIV status, living alone, clinic inaccessibility, and presence of any current opportunistic infection were significantly associated with lower HRQoL scores at both the FAHI overall and sub-scale level. Higher physician empathy, male sex, and higher body mass index were significantly associated with better HRQoL scores at both FAHI overall and sub-scale level. Age and longer duration on cART were significantly associated with better HRQoL only at the sub-scale level.

Conclusions

Interventions aimed at reducing depressive symptoms and HIV stigma, making HIV-related services more accessible, addressing opportunistic infections, strengthening social support systems, serostatus disclosure and put in place caring, respectful, and compassionate model of care are necessary to improve the HRQoL of PLWHA.
Appendix
Available only for authorised users
Literature
3.
go back to reference Bhaskaran K, et al. Changes in the risk of death after HIV seroconversion compared with mortality in the general population. JAMA. 2008;300(1):51–9.PubMedCrossRef Bhaskaran K, et al. Changes in the risk of death after HIV seroconversion compared with mortality in the general population. JAMA. 2008;300(1):51–9.PubMedCrossRef
4.
go back to reference Panos G, et al. Mortality and morbidity of HIV infected patients receiving HAART: a cohort study. Curr HIV Res. 2008;6(3):257–60.PubMedCrossRef Panos G, et al. Mortality and morbidity of HIV infected patients receiving HAART: a cohort study. Curr HIV Res. 2008;6(3):257–60.PubMedCrossRef
5.
go back to reference Johnson LF, et al. Life expectancies of south African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418.PubMedPubMedCentralCrossRef Johnson LF, et al. Life expectancies of south African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418.PubMedPubMedCentralCrossRef
6.
go back to reference Nsanzimana S, et al. Life expectancy among HIV-positive patients in Rwanda: a retrospective observational cohort study. Lancet Glob Health. 2015;3(3):e169–77.PubMedCrossRef Nsanzimana S, et al. Life expectancy among HIV-positive patients in Rwanda: a retrospective observational cohort study. Lancet Glob Health. 2015;3(3):e169–77.PubMedCrossRef
8.
go back to reference Degroote S, Vogelaers D, Vandijck DM. What determines health-related quality of life among people living with HIV: an updated review of the literature. Arch Public Health. 2014;72(1):40.PubMedPubMedCentralCrossRef Degroote S, Vogelaers D, Vandijck DM. What determines health-related quality of life among people living with HIV: an updated review of the literature. Arch Public Health. 2014;72(1):40.PubMedPubMedCentralCrossRef
9.
go back to reference Cleary PD, et al. Health-related quality of life in persons with acquired immune deficiency syndrome. Med Care. 1993;31(7):569–80.PubMedCrossRef Cleary PD, et al. Health-related quality of life in persons with acquired immune deficiency syndrome. Med Care. 1993;31(7):569–80.PubMedCrossRef
10.
go back to reference Swindells S, et al. Quality of life in patients with human immunodeficiency virus infection: impact of social support, coping style and hopelessness. Int J STD AIDS. 1999;10(6):383–91.PubMedCrossRef Swindells S, et al. Quality of life in patients with human immunodeficiency virus infection: impact of social support, coping style and hopelessness. Int J STD AIDS. 1999;10(6):383–91.PubMedCrossRef
11.
go back to reference Mitchell MM, et al. Psychosocial and service use correlates of health-related quality of life among a vulnerable population living with HIV/AIDS. AIDS Behav. 2017;21(6):1580–7.PubMedPubMedCentralCrossRef Mitchell MM, et al. Psychosocial and service use correlates of health-related quality of life among a vulnerable population living with HIV/AIDS. AIDS Behav. 2017;21(6):1580–7.PubMedPubMedCentralCrossRef
12.
go back to reference Viala-Danten M, et al. Psychometric evaluation of the functional assessment of HIV infection (FAHI) questionnaire and its usefulness in clinical trials. Qual Life Res. 2010;19(8):1215–27.PubMedCrossRef Viala-Danten M, et al. Psychometric evaluation of the functional assessment of HIV infection (FAHI) questionnaire and its usefulness in clinical trials. Qual Life Res. 2010;19(8):1215–27.PubMedCrossRef
13.
go back to reference Abrams DI, Steinhart C, Frascino R. Epoetin alfa therapy for anaemia in HIV-infected patients: impact on quality of life. Int J STD AIDS. 2000;11(10):659–65.PubMedCrossRef Abrams DI, Steinhart C, Frascino R. Epoetin alfa therapy for anaemia in HIV-infected patients: impact on quality of life. Int J STD AIDS. 2000;11(10):659–65.PubMedCrossRef
14.
go back to reference Smith M, et al. Health-related quality of life of HIV-infected women: evidence for the reliability, validity and responsiveness of the medical outcomes study short-form 20. Qual Life Res. 1996;5(1):47–55.PubMedCrossRef Smith M, et al. Health-related quality of life of HIV-infected women: evidence for the reliability, validity and responsiveness of the medical outcomes study short-form 20. Qual Life Res. 1996;5(1):47–55.PubMedCrossRef
15.
go back to reference O'leary JF, et al. Toward a better understanding of health-related quality of life: a comparison of the medical outcomes study HIV health survey (MOS-HIV) and the HIV overview of problems-evaluation system (HOPES). J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17(5):433–41.PubMedCrossRef O'leary JF, et al. Toward a better understanding of health-related quality of life: a comparison of the medical outcomes study HIV health survey (MOS-HIV) and the HIV overview of problems-evaluation system (HOPES). J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17(5):433–41.PubMedCrossRef
16.
go back to reference WHOQOL HIV Group. Initial steps to developing the World Health Organization's Quality of Life Instrument (WHOQOL) module for international assessment in HIV/AIDS. AIDS Care. 2003;15(3):347.CrossRef WHOQOL HIV Group. Initial steps to developing the World Health Organization's Quality of Life Instrument (WHOQOL) module for international assessment in HIV/AIDS. AIDS Care. 2003;15(3):347.CrossRef
17.
go back to reference Peterman AH, et al. Psychometric validation of the revised functional assessment of human immunodeficiency virus infection (FAHI) quality of life instrument. Qual Life Res. 1997;6(6):572–84.PubMedCrossRef Peterman AH, et al. Psychometric validation of the revised functional assessment of human immunodeficiency virus infection (FAHI) quality of life instrument. Qual Life Res. 1997;6(6):572–84.PubMedCrossRef
18.
go back to reference Nyongesa MK, et al. A mixed methods approach to adapting and evaluating the functional assessment of HIV infection (FAHI), Swahili version, for use with low literacy populations. PLoS One. 2017;12(4):e0175021.PubMedPubMedCentralCrossRef Nyongesa MK, et al. A mixed methods approach to adapting and evaluating the functional assessment of HIV infection (FAHI), Swahili version, for use with low literacy populations. PLoS One. 2017;12(4):e0175021.PubMedPubMedCentralCrossRef
19.
go back to reference Mekuria LA, et al. Health-related quality of life of HIV-infected adults receiving combination antiretroviral therapy in Addis Ababa. AIDS Care. 2015;27(8):934–45.PubMedCrossRef Mekuria LA, et al. Health-related quality of life of HIV-infected adults receiving combination antiretroviral therapy in Addis Ababa. AIDS Care. 2015;27(8):934–45.PubMedCrossRef
20.
go back to reference Mofolorunsho KC, Nwankwo EO, Babatunde T. Socio-economic factors influencing the quality of life of people living with HIV/AIDS in Kogi, Nigeria. Nat Sci. 2013;11(8):33–9. Mofolorunsho KC, Nwankwo EO, Babatunde T. Socio-economic factors influencing the quality of life of people living with HIV/AIDS in Kogi, Nigeria. Nat Sci. 2013;11(8):33–9.
21.
go back to reference Surur AS, et al. Health related quality of life of HIV/AIDS patients on highly active anti-retroviral therapy at a university referral hospital in Ethiopia. BMC Health Serv Res. 2017;17(1):737.PubMedPubMedCentralCrossRef Surur AS, et al. Health related quality of life of HIV/AIDS patients on highly active anti-retroviral therapy at a university referral hospital in Ethiopia. BMC Health Serv Res. 2017;17(1):737.PubMedPubMedCentralCrossRef
22.
go back to reference Mutabazi-Mwesigire D, et al. Factors that affect quality of life among people living with HIV attending an urban clinic in Uganda: a cohort study. PLoS One. 2015;10(6):e0126810.PubMedPubMedCentralCrossRef Mutabazi-Mwesigire D, et al. Factors that affect quality of life among people living with HIV attending an urban clinic in Uganda: a cohort study. PLoS One. 2015;10(6):e0126810.PubMedPubMedCentralCrossRef
25.
go back to reference Hunger M, et al. Multimorbidity and health-related quality of life in the older population: results from the German KORA-age study. Health Qual Life Outcomes. 2011;9(1):53.PubMedPubMedCentralCrossRef Hunger M, et al. Multimorbidity and health-related quality of life in the older population: results from the German KORA-age study. Health Qual Life Outcomes. 2011;9(1):53.PubMedPubMedCentralCrossRef
26.
go back to reference Nyongesa MK, et al. Neurocognitive and mental health outcomes and association with quality of life among adults living with HIV: a cross-sectional focus on a low-literacy population from coastal Kenya. BMJ Open. 2018;0:e023914.CrossRef Nyongesa MK, et al. Neurocognitive and mental health outcomes and association with quality of life among adults living with HIV: a cross-sectional focus on a low-literacy population from coastal Kenya. BMJ Open. 2018;0:e023914.CrossRef
28.
go back to reference Akena D, et al. Sensitivity and specificity of clinician administered screening instruments in detecting depression among HIV-positive individuals in Uganda. AIDS Care. 2013;25(10):1245–52.PubMedCrossRef Akena D, et al. Sensitivity and specificity of clinician administered screening instruments in detecting depression among HIV-positive individuals in Uganda. AIDS Care. 2013;25(10):1245–52.PubMedCrossRef
29.
go back to reference Cholera R, et al. Validity of the patient health questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014;167:160–6.PubMedPubMedCentralCrossRef Cholera R, et al. Validity of the patient health questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014;167:160–6.PubMedPubMedCentralCrossRef
30.
go back to reference Gelaye B, et al. Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210(2):653–61.PubMedCrossRef Gelaye B, et al. Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210(2):653–61.PubMedCrossRef
31.
go back to reference Monahan PO, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24(2):189.PubMedCrossRef Monahan PO, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24(2):189.PubMedCrossRef
33.
go back to reference Hojat M, et al. The Jefferson scale of physician empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61(2):349–65.CrossRef Hojat M, et al. The Jefferson scale of physician empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61(2):349–65.CrossRef
34.
go back to reference Borracci RA, et al. Patients’ perceptions of argentine physicians’ empathy based on the Jefferson scale of patient's perceptions of physician empathy: psychometric data and demographic differences. Educ Health. 2017;30(1):19.CrossRef Borracci RA, et al. Patients’ perceptions of argentine physicians’ empathy based on the Jefferson scale of patient's perceptions of physician empathy: psychometric data and demographic differences. Educ Health. 2017;30(1):19.CrossRef
35.
go back to reference Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.PubMedCrossRef Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.PubMedCrossRef
36.
go back to reference Flaherty JA, et al. Developing instruments for cross-cultural psychiatric research. J Nerv Ment Dis. 1988;176(5):257–63. Flaherty JA, et al. Developing instruments for cross-cultural psychiatric research. J Nerv Ment Dis. 1988;176(5):257–63.
37.
go back to reference Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417–32.PubMedCrossRef Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417–32.PubMedCrossRef
38.
go back to reference Nyongesa MK, et al. Prevalence and correlates of depressive symptoms among adults living with HIV in rural Kilifi, Kenya. BMC Psychiatry. 2019;19(1):333.PubMedPubMedCentralCrossRef Nyongesa MK, et al. Prevalence and correlates of depressive symptoms among adults living with HIV in rural Kilifi, Kenya. BMC Psychiatry. 2019;19(1):333.PubMedPubMedCentralCrossRef
39.
go back to reference Hasanah C, Zaliha A, Mahiran M. Factors influencing the quality of life in patients with HIV in Malaysia. Qual Life Res. 2011;20(1):91–100.PubMedCrossRef Hasanah C, Zaliha A, Mahiran M. Factors influencing the quality of life in patients with HIV in Malaysia. Qual Life Res. 2011;20(1):91–100.PubMedCrossRef
40.
41.
go back to reference Royston P, et al. Prognosis and prognostic research: developing a prognostic model. BMJ. 2009;338:b604.PubMedCrossRef Royston P, et al. Prognosis and prognostic research: developing a prognostic model. BMJ. 2009;338:b604.PubMedCrossRef
42.
go back to reference Canovas L, et al. Impact of empathy in the patient-doctor relationship on chronic pain relief and quality of life: a prospective study in Spanish pain clinics. Pain Med. 2018;19(7):1304–14.PubMedCrossRef Canovas L, et al. Impact of empathy in the patient-doctor relationship on chronic pain relief and quality of life: a prospective study in Spanish pain clinics. Pain Med. 2018;19(7):1304–14.PubMedCrossRef
43.
go back to reference Berhe H, et al. Status of caring, respectful and compassionate health care practice in Tigrai regional state: patients’ perspective. Int J Caring Sci. 2017;10(3):1119. Berhe H, et al. Status of caring, respectful and compassionate health care practice in Tigrai regional state: patients’ perspective. Int J Caring Sci. 2017;10(3):1119.
44.
go back to reference Sinclair S, et al. Compassion in health care: an empirical model. J Pain Symptom Manag. 2016;51(2):193–203.CrossRef Sinclair S, et al. Compassion in health care: an empirical model. J Pain Symptom Manag. 2016;51(2):193–203.CrossRef
45.
go back to reference Anand D, Puri S, Mathew M. Assessment of quality of life of HIV-positive people receiving ART: an Indian perspective. Indian J Commun Med. 2012;37(3):165–9.CrossRef Anand D, Puri S, Mathew M. Assessment of quality of life of HIV-positive people receiving ART: an Indian perspective. Indian J Commun Med. 2012;37(3):165–9.CrossRef
46.
go back to reference George S, et al. Health-related quality of life and associated factors in people with HIV: an Irish cohort study. Health Qual Life Outcomes. 2016;14(1):115.PubMedPubMedCentralCrossRef George S, et al. Health-related quality of life and associated factors in people with HIV: an Irish cohort study. Health Qual Life Outcomes. 2016;14(1):115.PubMedPubMedCentralCrossRef
47.
go back to reference Luppino FS, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9.PubMedCrossRef Luppino FS, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9.PubMedCrossRef
48.
go back to reference Arjun BY, et al. Factors influencing quality of life among people living with HIV in coastal South India. J Int Assoc Providers AIDS Care (JIAPAC). 2017;16(3):247–53.CrossRef Arjun BY, et al. Factors influencing quality of life among people living with HIV in coastal South India. J Int Assoc Providers AIDS Care (JIAPAC). 2017;16(3):247–53.CrossRef
49.
go back to reference Protopopescu C, et al. Health-related quality of life in HIV-1-infected patients on HAART: a five-years longitudinal analysis accounting for dropout in the APROCO-COPILOTE cohort (ANRS CO-8). Qual Life Res. 2007;16(4):577.PubMedCrossRef Protopopescu C, et al. Health-related quality of life in HIV-1-infected patients on HAART: a five-years longitudinal analysis accounting for dropout in the APROCO-COPILOTE cohort (ANRS CO-8). Qual Life Res. 2007;16(4):577.PubMedCrossRef
50.
go back to reference Perez IR, et al. Health-related quality of life of patients with HIV: impact of sociodemographic, clinical and psychosocial factors. Qual Life Res. 2005;14(5):1301–10.CrossRef Perez IR, et al. Health-related quality of life of patients with HIV: impact of sociodemographic, clinical and psychosocial factors. Qual Life Res. 2005;14(5):1301–10.CrossRef
51.
go back to reference Oliveira FBM, et al. Quality of life and associated factors in people living with HIV/AIDS. Acta Paulista de Enfermagem. 2015;28(6):510–6.CrossRef Oliveira FBM, et al. Quality of life and associated factors in people living with HIV/AIDS. Acta Paulista de Enfermagem. 2015;28(6):510–6.CrossRef
54.
go back to reference Hong DTM, et al. Quality of life and related factors among people living with HIV in Quang Tri province, Vietnam in 2016. Vietnam J Prev Med. 2017;27(12):97–105. Hong DTM, et al. Quality of life and related factors among people living with HIV in Quang Tri province, Vietnam in 2016. Vietnam J Prev Med. 2017;27(12):97–105.
55.
go back to reference Monteiro F, Canavarro MC, Pereira M. Factors associated with quality of life in middle-aged and older patients living with HIV. AIDS Care. 2016;28(sup1):92–8.PubMedPubMedCentralCrossRef Monteiro F, Canavarro MC, Pereira M. Factors associated with quality of life in middle-aged and older patients living with HIV. AIDS Care. 2016;28(sup1):92–8.PubMedPubMedCentralCrossRef
57.
58.
go back to reference Mutabazi-Mwesigire D, et al. Perceptions of quality of life among Ugandan patients living with HIV: a qualitative study. BMC Public Health. 2014;14(1):343.PubMedPubMedCentralCrossRef Mutabazi-Mwesigire D, et al. Perceptions of quality of life among Ugandan patients living with HIV: a qualitative study. BMC Public Health. 2014;14(1):343.PubMedPubMedCentralCrossRef
Metadata
Title
Correlates of health-related quality of life among adults receiving combination antiretroviral therapy in coastal Kenya
Authors
Moses K. Nyongesa
Paul Mwangi
Stanley W. Wanjala
Agnes M. Mutua
Hans M. Koot
Pim Cuijpers
Charles R. J. C. Newton
Amina Abubakar
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2020
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-020-01421-0

Other articles of this Issue 1/2020

Health and Quality of Life Outcomes 1/2020 Go to the issue