Correlates of health-related quality of life in primary caregivers of perinatally HIV infected and HIV exposed uninfected adolescents at the Kenyan Coast

Abstract

Background Mothers and other primary caregivers play a crucial role in looking after perinatally HIV infected, and HIV exposed uninfected adolescents in sub-Saharan Africa. Day- to-day caregiving in the context of limited instrumental support and added biomedical risk (HIV seropositivity) may expose these caregivers to adverse states of health. Unfortunately, very few studies have examined their health-related quality of life (HRQoL). Our study documents the HRQoL profile, and associated factors in primary caregivers of perinatally HIV infected, perinatally HIV exposed but uninfected and HIV unexposed/uninfected adolescents aged 12–17 years at the Kenyan Coast. Methods This was a cross-sectional analysis of 485 primary caregivers: 195 of perinatally HIV infected adolescents, 128 of perinatally HIV exposed but uninfected adolescents and 162 of HIV unexposed/uninfected adolescents. All caregivers completed a self-report measure of HRQoL (having 8 subscales), depressive symptoms, and parenting stress. They also provided their sociodemographic information and that of the care recipients. We used one-way analysis of variance to assess statistical differences among the groups. Linear regression analyses were used to identify correlates of HRQoL. Results Overall, caregivers of HIV unexposed/uninfected adolescents reported significantly higher mean HRQoL scores than the other caregivers in the overall HRQoL domain and majority of the subscales. There were no statistical differences in the overall HRQoL scores and most subscales between caregivers of HIV exposed adolescents. Linear regression analyses across the sample indicated that depressive symptoms, increasing age of caregiver, and caring for an adolescent perinatally exposed to HIV were significantly associated with reduced HRQoL at both the overall and sub-scale level. Having a professional job relative to subsistence farming was the only factor associated with improved overall HRQoL. At subscale level, higher socioeconomic status correlated positively with HRQoL while being a grandparent, level of education, parenting stress were negatively associated with HRQoL. Conclusions Caregivers in this sample, especially those who are ageing, at risk of mental ill-health, and taking care of adolescents perinatally exposed to HIV, appear to be vulnerable to poor quality of life. Inclusive and multi-component interventions tailored to the caregivers' psychosocial and mental needs will potentially enhance their quality of life.

Exploring Factors Associated with Quality of Life in Caregivers of Children and Adolescents with Sickle Cell Disease and HIV: A Comparative Analysis

“…No HIV caregiver had depression, and only 1.05% had anxiety. This finding was contrary to the median PHQ-9 at 6.0 (denoting mild depression) obtained by Mwangala et al in Kenya [ 49 ]. The poor reliability of the PHQ-9 questionnaire in HIV caregivers in our study (Cronbach alpha coefficient at 0.58) may explain why these values differ.…”

“…In our study, depression score, anxiety score, spending more than 75,000 FCFA on medications monthly, and being a SCDc had a negative impact on the quality of life of caregivers. Depression is a recognized factor influencing QoL [ 9 , 49 ]. Untreated anxiety and depression could result in impaired economic productivity, reduced ability to perform work and social roles, loss of relationships, physical decline, and problem-solving deficits for the caregivers, hence negatively impacting their QoL [ 49 ].…”

“…Depression is a recognized factor influencing QoL [ 9 , 49 ]. Untreated anxiety and depression could result in impaired economic productivity, reduced ability to perform work and social roles, loss of relationships, physical decline, and problem-solving deficits for the caregivers, hence negatively impacting their QoL [ 49 ]. Mwangala et al [ 49 ] also reported that caregiver's age and secondary level of education negatively influence the QoL of caregivers, while Van den tweel [ 9 ] additionally reported that limitation in daily activities and vitality negatively influenced QoL.…”

“…Untreated anxiety and depression could result in impaired economic productivity, reduced ability to perform work and social roles, loss of relationships, physical decline, and problem-solving deficits for the caregivers, hence negatively impacting their QoL [ 49 ]. Mwangala et al [ 49 ] also reported that caregiver's age and secondary level of education negatively influence the QoL of caregivers, while Van den tweel [ 9 ] additionally reported that limitation in daily activities and vitality negatively influenced QoL. SCD is a chronic disease, which may lead to debilitating complications like stroke [ 3 , 51 , 52 ] and femoral osteonecrosis [ 53 , 54 ] which could significantly impair patient's mobility and autonomy making them fully dependent on caregivers.…”

Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast

“…This may be related to the high caregiving burden often experienced by OALWH caring for HIV‐positive children. This observation concurs with previous findings in the study setting [ 53 ].…”