Health-Related Quality of Life and Antiretroviral Therapy in Kwazulu-Natal, South Africa

Abstract

In studies conducted with African and Asian cohorts researchers have shown the clinical efficacy of antiretroviral therapy (ART) in resource-limited settings. However, studies on the longer term changes in health-related quality of life (HRQoL) with patients receiving ART in these settings are still scarce. The aim in this study was to assess HIV patients' HRQoL, clinical, psychosocial, and sociodemographic factors at 3 public hospitals in KwaZulu-Natal, South Africa over 20 months. Patients (N = 735) who attended 3 HIV clinics completed interview assessments prior to initiation of antiretroviral therapy; 519 after 6 months, 557 after 12, and 499 after 20 months on ART. Results indicate that total HRQoL increased, as did general quality of life, general health, independence, social relationships, and environment. HIV symptoms, depression symptom ratings, and internalized stigma reduced over time, whereas CD4 cell counts (number of helper T cells per cubic milliliter of blood), adherence to ART, and social support increased. Total HRQoL, the physical and psychological HRQoL domains, and internalized stigma improved at first and then deteriorated almost to baseline levels. Significant independent predictors of good HRQoL were low internalized stigma, being employed, earning wages, higher CD4 cell counts, and fewer and less severe HIV and depressive symptoms. In order to maximize gains in HRQoL for patients on ART, interventions are needed that address and reduce stigmatization and enhance the economic and employment opportunities.Keywords: health-related quality of life, antiretroviral therapy, HIV patients.Health-related quality of life (HRQoL) is a multidimensional concept that refers to how a person feels about their life and how well they function in their daily activities (Lorenz, Shapiro, Asch, Bozette, & Hays, 2001) and includes global SOCIAL

Predictors of internalised HIV-related stigma: a systematic review of studies in sub-Saharan Africa

“…Time on ART produced inconsistent effects on internalised stigma. Longer time on ART resulted in an increase in internalised stigma in one study (Pearson et al, 2009), a U trend in another study (Peltzer, 2012) and an overall decline in a third study (Tsai, Bangsberg, Bwana, et al, 2013). …”

“…Six articles reported on prospective cohort data (Cuca et al, 2012;Makoae et al, 2009;Peltzer, 2012;Tsai, Bangsberg, Bwana, et al, 2013;Wagner, Ghosh-Dastidar, Garnett, Kityo, & Mugyenyi, 2013) and one reported on both prospective cohort data and cross-sectional data (Pearson et al, 2009). …”

“…The most common measurement used in seven included articles was the Internalized AIDSrelated Stigma Scale (IA-RSS), developed by Kalichman and colleagues (2009) (Cloete et al, 2008;Kalichman et al, 2009;Peltzer, 2012;Simbayi et al, 2007b;Takada et al, 2014;Tsai et al, 2012;Tsai, Bangsberg, Bwana, et al, 2013). Five articles (Cuca et al, 2012;Holzemer et al, 2007;Makoae et al, 2009;Nattabi et al, 2011;Sorsdahl et al, 2011) reported use of the negative self-perception subscale of the HIV/AIDS Stigma Instrument-PLWA (HASI-P).…”

“…Three studies (Cuca et al, 2012;Makoae et al, 2009;Peltzer, 2012) reported response or retention rates below 70%.…”

“…Another article conducted within-group change in internalised stigma over time while adequately controlling for confounders (Wagner et al, 2013). One article explored within group changes in internalised stigma over time without taking confounders into consideration (Peltzer, 2012).…”