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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 3  |  Page : 334-339

A cross-sectional study on predictors of quality of life of persons living with human immunodeficiency virus


Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India

Date of Submission22-Oct-2020
Date of Acceptance08-Apr-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Dr. Anuradha Gautam
Department of Community and Family Medicine, Medical College Building, AIIMS, Bhopal - 462 020, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_371_20

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  Abstract 

CONTEXT: Quality of life (QoL) in persons living with human immunodeficiency virus (HIV) (PLHIV)/acquired immune deficiency syndrome (AIDS) is a salient issue. The advent of highly active antiretroviral treatment has changed this deadly disease to a chronic manageable illness with focus shifting from fighting virus to ensuring a good QoL.
AIMS: The aim of the study was to assess the predictors of health-related QoL (HRQoL) of PLHIV.
SUBJECTS AND METHODS: A questionnaire-based cross-sectional study was conducted on 205 PLHIV at antiretroviral therapy (ART) plus center of a tertiary care hospital of Lucknow. Interview method was used to collect the data. The questionnaire contained the sociodemographic, clinical characteristics, and QoL, measured by the World Health Organization (WHO) QOL-HIV-BREF.
STATISTICAL ANALYSIS USED: The data were analyzed by using SPSS version 23.0. Bivariate associations were observed through Chi-square test and multivariate logistic regression analysis was performed to find the significant predictors of HRQoL.
RESULTS: The mean age of the study subjects was 39.42 years and 42.4% of the participants were females. Mean of HRQoL in the present study was 3.37 (standard deviations = 0.8) and 58.5% participants reported good HRQoL. Male gender, joint family, higher socioeconomic status, unreserved category, working functional status, and treatment other than ART were identified as independent predictors of good HRQoL.
CONCLUSIONS: Family and vocational counseling should be an essential component of the care of PLHIV to improve their HRQoL. It may create a better home environment.

Keywords: Human immunodeficiency virus/acquired immune deficiency syndrome, predictors of health-related quality of life, quality of life, World Health Organization quality of life-human immunodeficiency virus-BREF


How to cite this article:
Gautam A. A cross-sectional study on predictors of quality of life of persons living with human immunodeficiency virus. Indian J Health Sci Biomed Res 2021;14:334-9

How to cite this URL:
Gautam A. A cross-sectional study on predictors of quality of life of persons living with human immunodeficiency virus. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Dec 8];14:334-9. Available from: https://www.ijournalhs.org/text.asp?2021/14/3/334/327260


  Introduction Top


Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is a global public health challenge as it not only affects the physical health of persons living with HIV (PLHIV) but also affects the mental and social health of PLHIV due to social stigma and negative attitudes of community toward it.[1] With the advent of highly active antiretroviral therapy (HAART), life expectancy of PLHIV has increased; however, they might face some health-related issues such as side effects due to medication, psychological factors, social stigma, and supports.[2],[3]

Under these situations, quality of life (QoL) of these PLHIV needs to be well understood. QoL is a subjective multidimensional evaluation of one's functioning and well-being in day-to-day life.[4] It is a term that is popularly used to convey an overall sense of well-being and includes aspects such as happiness and satisfaction with life as a whole. The World Health Organization (WHO) has defined QoL as “individuals” perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, standards, expectations, and concerns.[5] However, health-related QoL (HRQoL) refers to aspects of QoL that are specifically related to physical and mental health of individuals. In the previous studies of PLHIV individuals, QoL of PLHIV was mostly poor so this study is conducted to identify factors that affect QoL.

Aims and objectives

The aim of the study was to assess the variables predicting HRQoL of PLHIV.


  Subjects and Methods Top


This study was a cross sectional study on PLHIV attending antiretroviral therapy (ART) plus center of the tertiary care hospital in Lucknow. This study was conducted from August 2017 to July 2018. The sample size was calculated by using the following formula n= [(Z (1−α/2)) 2 × p× (1 − p)]/d2. Taking value of Z statistic at a 5% level of significance as 1.96, the expected prevalence of poor QoL of PLHIV taken as 26.0%,[6] and assuming a 6% margin of error, the sample size was calculated to be 205.

Systematic random sampling was used to select cases of PLHIV. Approximately 100 patients came daily to the ART plus center. Every fifth patient registered at ART plus center was included in the study and if the selected patient did not fulfill the inclusion criteria then the next registered patient was included. PLHIV aged >18 years and who were on HAART for at least 6 months attending ART plus center were included in the present study, while those who were not able to give valid consent due to any psychiatric illnesses were excluded. Before the interview, the patients were explained about the purpose of the study and written informed consent was obtained from them.

Instruments

A predesigned and pretested semi-structured questionnaire was used for the collection of information regarding sociodemographic details, clinical characteristics, and QoL.

Quality of life

In this study, WHOQOL-HIV-BREF[7],[8] scale was used. It is a 31-item questionnaire that is grouped into six domains (physical, psychological, independence level, social relations, environment, and spirituality) and two general questions that examine self-perception of overall QoL and health.

HRQoL score is derived from the mean of question 1 (“How would you rate your quality of life?”) and question 2 (“How satisfied are you with your health?”). It ranges from 1 to 5, with 1 corresponding to very poor and 5 corresponding to very good QoL. Mean of HRQoL (3.37) in the present study was used as the cutoff point to define “Poor” (if ≤3.37 points) and “Good” (if the score is more than 3.37 points).

Sociodemographic and clinical characteristics

Sociodemographic and clinical variables included age, gender, religion, marital status, category, occupation, educational status, type of family, socioeconomic status, family history of HIV status, WHO clinical and functional status, duration of time on ART, opportunistic infections, motivation to take ART, and disclosure status.

Data collection procedures

The study participants were identified during the study period at ART center of tertiary care hospital, Lucknow. HIV-infected person who fulfilled the inclusion criteria was approached for data collection. Consent was obtained by the interviewers before participants underwent the structured interview which lasted for approximately 20–30 min. All the information collected was based on the patient's self-report, but the information related to clinical and functional staging, opportunistic infections, and whether the patient was on co-trimoxazole prophylactic treatment (CPT) or not was obtained from the medical records.

Statistical analysis

Descriptive statistics such as means and standard deviations (SD) for continuous variables and frequencies along with their percentages for categorical variables were determined. Association of sociodemographic and clinical variables with good and poor HRQoL was assessed by Chi-square test. Variables that were statistically significant with HRQoL at P < 0.05 in the analysis were subsequently entered into a multivariate logistic regression model to find the significant predictors of HRQoL. Statistical analysis was performed by using IBM SPSS Statistics Version 23 IBM Corp. @Copyright IBM Corporation and its licensors 1989,2015. Release 23.0.0.0 32-bit edition.

Ethical clearance

Ethical Clearance was obtained from Institutional Ethical Committee of KG's Medical University, UP, Lucknow with Ref no 88th ECM 11 B-Thesis/P-34 dated 06.04.2018.


  Results Top


[Table 1] shows that the mean score of HRQoL was 3.37 (SD = 0.8) with 58.5% PLHIV had good HRQoL. As shown by [Table 2], majority of PLHIV (88.3%) were in the age group of more than 25 years and the mean age of the study participants was 39.42 years. About 23 (63.4%) of PLHIV were married followed by 26.3% who were widowed/separated/divorced. Majority (82.4%) were Hindus and more than half (52.7%) belonged to the unreserved category. About 13 (31.2%) of PLHIV had education up to college or above followed by 28.3% who were illiterate. About three-fourth of female PLHIV were housewives and about 33.2% of the PLHIV belonged to higher socioeconomic class. The percentage of male was significantly higher in good HRQoL as compared to poor (P = 0.023). On average, participants with poor HRQoL were younger of SC/ST category (P = 0.016) and housewife by occupation (P = 0.006), and participants with good HRQoL were those who had higher level of education (P = 0.009), living with joint family (P = 0.014), and higher socioeconomic status (P < 0.001).
Table 1: Mean score of overall quality of life and general health of World Health Organization quality of life-human immunodeficiency virus-Bref

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Table 2: Sociodemographic characteristics of persons living with human immunodeficiency virus with good and poor health-related quality of life

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[Table 3] shows the personal characteristics of PLHIV which includes information of family history of HIV and disease history of PLHIV. Out of total PLHIV who were married/separated, nearly more than half (53.6%) of couples were those in which only one partner was HIV positive and about 46.4% of couples were those in which both the partners were positive for HIV infection. Among total widowed PLHIV, a maximum (90.9%) of PLHIV were those whose spouse died due to HIV/AIDS. Among total PLHIV who had children, about 8.9% PLHIV had at least one HIV positive child, about 12.2% participants had opportunistic infections, 13.2% participants were on treatment other than ART, and about one-third (28.3%) were on CPT. On average, participants with poor HRQoL were those whose spouse died due to HIV (P = 0.045), had less duration of taking ART (P = 0.001), on CPT (P = 0.012), had opportunistic infection (P = 0.045), and treatment other than ART (P = 0.004) and participants with good QoL were those who had clinical Stage I (P = 0.002) and had working functional status (P = 0.021).
Table 3: Distribution of persons living with human immunodeficiency virus based on their personal characteristics with good and poor health-related quality of life

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In the final multivariate logistic model, male gender, joint family status, unreserved category, higher socioeconomic status, working functional status, and treatment other than ART were significantly predicted good HRQoL [Table 4].
Table 4: Multivariate logistic regression model predicting good health-related quality of life in persons living with human immunodeficiency virus

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  Discussion Top


This cross-sectional study included a sample of 205 PLHIV attending ART center of tertiary care hospital, Lucknow, to assess their HRQoL and its predictors. Mean of HRQoL score in the present study was 3.37 (SD = 0.8), which is consistent with a study on PLHIV in Georgia by Karkashadze et al., which showed that the mean general QoL of PLHIV was 3.0 with SD 0.7.[9]

The mean age of the study subjects was 39.42 years and 25 (42.4%) participants were females, more than half PLHIV (63.4%) were married, about 13 (28.3%) were illiterate, majority (82.4%) were Hindus, about 50% belonged to unreserved category, 13 (31.2%) of PLHIV had education up to college or above, three-fourth of female PLHIV were housewives, and 14 (23.4%) belonged to lower-middle socioeconomic class. These findings are similar to a study done in Nepal by Giri et al., which showed that the mean age of the study population was 38.9 years and the male-to-female ratio was 1.9:1, about 77% were married and 37% were illiterate.[10] A study on Brazil population showed that about 63.8% belonged to >40 years of age, 51.8% were male, and most of them were categorized in higher socioeconomic status.[11] A study of Iran showed that the mean age of participants was 35.4 years, also a South Indian study showed that the mean age was 35.7 years, 60% of the respondents were married, 10% were single, 13.3% were widowed, 13.3% were separated, and 3.3% divorced.[12] An Indian study by Sarkar et al. showed that maximum (40.5%) participants belong to the age group of 31–40 years, about 80% of them were Hindu, 51.1% belong to unreserved category, majority (47.7%) were married, and 44.5% belong to the upper lower socialeconomic class.[13]

Most of the study participants were self-assessed their QoL as good (41.0%) and similarly, about 49.3% of study participants were satisfied with their health status. Similar findings are present in the study of Brazil which showed that 65% self-assessed their QoL as good and very good.[11] Contrary to this, Kumar A[6] et al. in their study showed that 22.0% of the participants rated their QoL as good and about 24.0% of the participants were satisfied with their health status. In addition, Sarkar[13] in their study showed that more than half (55.5%) participants rated their QoL as neither poor nor good and only 28.2% replied good. One-third (38.6%) were dissatisfied and 15 (19.1%) satisfied, while 41.4% mentioned that they were neither satisfied nor dissatisfied with their health.

Occupation, education, spouse died due to HIV, WHO clinical status, had opportunistic infections, on CPT, and duration of taking ART showed significant associations with HRQoL, but they did not predict HRQoL when entered into the multivariate logistic regression model. Similar observations were made in the study conducted among African-American men.[14]

This study identified variables predicting the HRQoL of PLHIV as male gender, joint family, higher socioeconomic status, unreserved category, working functional status, and treatment other than ART were predicting good HRQoL of PLHIV. A study of karnataka on people living with HIV/AIDS,[15] showed that male gender, being graduated were positive predictor of the QoL of PLHIV and having primary education, being in nuclear family, HIV-positive wife, HIV-positive children were negative predictor of the QoL of PLHIV. An Indian study by Basavaraj et al.[5] revealed that male gender, young age, higher socioeconomic status, and being employed were the positive predictors of the QoL.


  Conclusions Top


As HIV disease is among the most devastating of illnesses, having multiple and profound effects upon all aspec\ts of life, hence the evaluation of HRQoL is very important.

Recommendations

To create a better environment of PLHIV and improve their HRQoL, family and vocational counseling should be included in the care of PLHIV.

Acknowledgment

The authors are grateful to all the participants as well as all the staff of ART plus center for their support for the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest

 
  References Top

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Dejman M, Ardakani HM, Malekafzali B, Moradi G, Gouya MM, Shushtari ZJ, et al. Psychological, social, and familial problems of people living with HIV/AIDS in Iran: A qualitative study. Int J Prev Med 2015;6:126.  Back to cited text no. 1
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World Health Organization. WHOQOL-HIV Instrument User Manual. Substance; 2002. p. 1-13. Available from: https://www.who.int/mental_health/media/en/613.pdf. [Last accssed on 15.08.2021 ].  Back to cited text no. 7
    
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World Health Organization G. Whoqol-Hiv Bref Mental Health: Evidence and Research Department of Mental Health World Health Organization; 2012. p. 1-5. Available from: https://www.who.int/mental_health/media/en/613.pdf. [Last accssed on 15 Aug 2021].  Back to cited text no. 8
    
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Karkashadze E, Gates MA, Chkhartishvili N, DeHovitz J, Tsertsvadze T. Assessment of quality of life in people living with HIV in Georgia. Int J STD AIDS 2017;28:672-8.  Back to cited text no. 9
    
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Giri S, Neupane M, Pant S, Timalsina U, Koirala S, Timalsina S, et al. Quality of life among people living with acquired immune deficiency syndrome receiving anti-retroviral therapy: A study from Nepal. HIV AIDS (Auckl) 2013;5:277-82.  Back to cited text no. 10
    
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Ferreira AC, Teixeira AL, Silveira MF, Carneiro M. Quality of life predictors for people living with HIV/AIDS in an impoverished region of Brazil. Rev Soc Bras Med Trop 2018;51:743-51.  Back to cited text no. 11
    
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Nirmal B, Divya K R, Dorairaj V S, Venkateswaran K. Quality of life in HIV/AIDS patients: A cross-sectional study in south India. Indian J Sex Transm Dis 2008;29:15-7.  Back to cited text no. 12
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Sarkar T, Karmakar N, Dasgupta A, Saha B. Quality of life of people living with HIV/AIDS attending antiretroviral clinic in the center of excellence in HIV care in India. J Educ Health Promot 2019;8:226.  Back to cited text no. 13
    
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Shriharsha C, Rentala S. Quality of life among people living with HIV/AIDS and its predictors: A cross-sectional study at ART Center, Bagalkot, Karnataka. J Family Med Prim Care 2019;8:1011-6.  Back to cited text no. 15
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