Determinants of health related quality of life (HRQoL) of adults in a public sector HAARTprogram in Botswana

[摘要] ABSTRACTIntroductionThe advent of potent anti-retroviral agents for HIV treatment has resulted inmarked decrease in deaths. Health workers now have to ensure that theirpatient’s physical, social, and psychological well-being is optimized. This studyused a validated tool to measure Health Related Quality of Life conceptsamongst HIV patients in a public treatment program. The main objective of thisresearch was to establish factors that are associated with poor quality of life ofthese patients with the purpose of using this information as a basis fordetermining who would require individualized medical care and attention.Materials and methodsThe study is set at Bontleng Clinic in Gaborone, Botswana. The studyquestionnaire consisted of two parts: part one for collecting data on sociodemographic,illness and treatment related factors, and part two was the MedicalOutcomes 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 theUniversity of the Witwatersrand, Johannesburg and the Ministry of Health inBotswana.ivResultsA smaller proportion of ART-experienced participants reported various diseasesymptoms as compared to those participants who were ART-naïve. Statisticallysignificant differences were noted for: weight loss (25% vs 77%), diarrhoea (3%vs 11%), cough (19% vs 39%), and night sweats (24% vs 43%) for ARTexperienced and ART Naïve patients respectively. CD4 counts and HB levelswere also significantly higher in patients on HAART. The overall QoL summaryscore was significantly higher (better) in the ART-experienced (mean score 53out 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 thethree laboratory indices of CD4 count, Hb level, and viral load had no statisticalsignificant association with HRQoL scores. Multiple regression identified only fivefactors as being associated with better QoL scores. These factors were to do withthe absence of the following disease symptoms: weight loss, diarrhoea, nightsweats, and feet pains; as well as absence of recent hospitalisation.DiscussionThe study patients do respond well to HAART with significant improvements in alldimensions of QoL. This is in keeping with findings from other populations. Inassessing these patients at the initiation of HAART, and at subsequent visits, onemust take into account any history of recent hospital admission, history of weightloss, and most importantly presence/absence of various disease symptoms. Conclusions and recommendationsSymptoms, regardless of the underlying cause: be it due to HIV disease itself ordrug side effects; greatly impact patients’ quality of life. Efforts should be made toinclude the assessment of symptoms in the continuum of care of HIV patients.The introduction of newer potent anti-retroviral agents with fewer side effectsshould also favour the beneficial impact of HAART.

[发布机构] University of the Witwatersrand