|Year : 2021 | Volume
| Issue : 1 | Page : 68-75
Overall health-related quality of life of HIV infected and non-infected adults in Jos North Local Government Area, Plateau State
IB Kefas1, EA Envuladu2, C Miner2, BW Pokop1, JC Daboer2, MP Chingle2, ME Banwat2, AI Zoakah2
1 Department of Community Medicine, Jos University Teaching Hospital, Nigeria
2 Department of Community Medicine, Jos University Teaching Hospital; College of Medicine, University of Jos, Jos, Nigeria
|Date of Submission||07-May-2020|
|Date of Decision||29-Jun-2020|
|Date of Acceptance||09-Jul-2020|
|Date of Web Publication||28-Apr-2021|
Dr. I B Kefas
Department of Community Medicine, Jos University Teaching Hospital
Source of Support: None, Conflict of Interest: None
Background: The burden of HIV has effects on Health-related quality of life (HRQOL). HRQOL assessment is an essential tool in understanding the patient perspective of their quality of life. This study aimed to determine and compare the HRQOL of HIV infected and non-infected adults in Jos North, Plateau State. Method: This was a comparative cross-sectional study conducted in Jos North LGA between January-March 2018. One hundred and seventy-eight of HIV infected and non-infected adults who met the inclusion criteria were selected using a multistage sampling technique. We used a WHOQOL-HIV Bref questionnaire to collect information. We calculated the difference in domain mean score using student t-test and determine factors associated with HRQOL using Chi-square test and logistic regressions at the 5 % level of significance. Statistical analysis was carried out using SPSS version 23.0. Results: The mean ages of HIV infected and non-infected respondents were 38 ± 9 and 35 ± 10 years, respectively. The overall HRQOL mean score for HIV infected was 3.98 ± 0.70 and 4.06 ± 0.60 for non- infected adults, and this was comparative (P = 0.223). In all the domains, the HRQOL mean scores were significantly different between the HIV infected and non-infected except physical domain (P = 0.962). The odds of good HRQOL was higher among those with tertiary education [aOR:8.33; 95%CI: 2.4–29.3] and those employed [aOR:2.34; 95%CI: 1.1–5.2] among HIV infected respondents. Conclusions: This study showed that the overall HRQOL of HIV infected and non-infected adults were similar in Jos North LGA. However, there was a significant difference in all the domains except for physical domain.
Keywords: HIV infected, HIV non-infected, HRQOL, Plateau
|How to cite this article:|
Kefas I B, Envuladu E A, Miner C, Pokop B W, Daboer J C, Chingle M P, Banwat M E, Zoakah A I. Overall health-related quality of life of HIV infected and non-infected adults in Jos North Local Government Area, Plateau State. J Med Trop 2021;23:68-75
|How to cite this URL:|
Kefas I B, Envuladu E A, Miner C, Pokop B W, Daboer J C, Chingle M P, Banwat M E, Zoakah A I. Overall health-related quality of life of HIV infected and non-infected adults in Jos North Local Government Area, Plateau State. J Med Trop [serial online] 2021 [cited 2021 Sep 19];23:68-75. Available from: https://www.jmedtropics.org/text.asp?2021/23/1/68/314847
| Introduction|| |
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has caused a severe threat to global public health., HIV has affected negatively the QOL of people infected with the diseases due to increasing prevalence of TB, opportunistic infections and cancers. It has also affected the socioeconomic and demographic profile of many communities and countries., It was estimated that 37.9 million people worldwide are living with HIV at the end of 2018. In Africa, 25.7 million people lived with HIV in 2018. This is more worrisome in a region with an already high burden of infectious disease, increasing burden of non-communicable diseases and a weakened health system. This implies an adverse effect on the HRQOL of the people in the region.
In Nigeria, an estimated 1.9 million people were living with HIV in 2018. Access to antiretrovirals is limited, and the number in need of ART is increasing. The QOL among infected person in Nigeria was found to be low,,,, and was adjudged to be better among the HIV non-infected persons.,, In the light of Test and Treat policy of the World Health Organization (WHO) Nigeria need to do more to achieving the 2015 UNAIDS fast-track targets.,,
HRQOL is a multidimensional construct defined in terms of an individual’s subjective experience and a construct that cannot be generalized across cultures., WHO defines QOL as an individual’s perception of their position in life in the context of culture and value systems in which they live and about their goals, expectations, standards, and concerns.
ARVs are assumed to improve QOL of PLHIV but do not address the challenges of the social environment of the infected persons, and their QOL may still be compromised. Little evidence exists about the HRQOL of HIV-positive people compared with the attainable HRQOL of the HIV negative population. This study aims to determine and compare the health-related quality of life of HIV-infected and non-infected adults in Jos North LGA, Plateau State.
| Materials and methods|| |
Study setting, design and sample size
This was a comparative cross-sectional study carried out in January-March 2018, in AIDS Prevention in Nigeria (APIN) treatment centre. APIN is among the seven health facilities providing comprehensive HIV treatment, care and support services in Jos North. These facilities include: (APIN)-Jos University Teaching Hospital (JUTH), Bingham University Teaching Hospital (BUTH), Plateau Specialist Hospital, Our Lady of Apostle Hospital, Faith Alive Foundation, Hwolshe Medical Centre and Solat Hospital., APIN has over twenty thousand clients on ART in care.
The minimum sample size was 159 for each group was calculated using the formula for two independent samples for a quantitative study. The significant level was placed at a 95% confidence interval, power of 80% and the mean, standard deviation score for HIV infected 59.8 ± 21.7 and for non-infected 66.8 ± 22.8 respondents was obtained from a previous study.
Study population and sampling technique
The study population consisted of all consenting HIV-infected clients 18 years and above, enrolled into care and have been on HAART for at least one year, accessing treatment, care and support at APIN centre, JUTH in Jos North LGA, Plateau State were recruited into the study. Duration on HAART for a year is used as one of the criteria because; this period offers sufficient evidence that the participant had enough experience on ART to participate in the study. In the comparison group, all consenting HIV non-infected clients 18 years and above, who were attending (clients who had attended the OPD clinic at least four times) OPD for medical care for at least one year, in Jos University Teaching Hospital in Jos North LGA, Plateau State were also recruited. The OPD clinic attendance of at least four times and duration of one year was used to allow enough time for patients to have been screened for co-morbid conditions of Tuberculosis, Hypertension, Diabetes or Cancers. Those with co-morbid conditions of either tuberculosis, hypertension, diabetes or cancers were excluded for both groups from patient’s hospital record.
A two-stage sampling technique was used to select the study population. Jos North was selected out of the 17 LGAs Plateau State purposively because it is the LGA with the highest prevalence of HIV/AIDS in the State. The LGA has seven health facilities providing comprehensive HIV/AIDS care and support services (APIN-JUTH, BUTH, Plateau Specialist Hospital, Our Lady of Apostle’s Hospital, Faith Alive Hospital, Hwolshe Medical Centre and Solat Hospital). APIN-JUTH was purposively selected as the major Health Facility providing HIV treatment, care and support services in the State.
Four resident doctors from the department of community medicine and four ART nurses from APIN had 3 hours daily training sessions for two days as research assistants on the study protocol and questionnaire conducted by the principal researcher. Written informed consent was sought and obtained from each eligible participant, and a semi-structured interviewer-administered questionnaire was used to collect information from all participants that fulfilled the inclusion criteria and gave consent. All the HIV non-infected participants for the study had counselling and testing in groups by the HIV/AIDS counselling and testing unit in the hospital
A list of PLHIV that met the inclusion criteria was drawn from the monthly clinic booking register of all the clients, assessing HIV/AIDS treatment, care and support of APIN centre, categorized into females and males were sample on their clinic days. A simple random sampling technique using the computer-generated table of a random number of WINPEPI statistical software was used to obtain a sample size of 178 (89 males and 89 females). Similarly, using the same technique, the non-infected respondents were selected from a list of those who have met the inclusion criteria from the weekly booking register of those attending OPD in JUTH.
Study instrument and data collection
A semi-structured interviewer-administered questionnaire adapted from the WHO disease-specific instrument (WHOQOL-HIV) bref version was used., The questionnaire was pretested among 10% of the total sample size in General Hospital Barkin Ladi LGA, a secondary health facility providing comprehensive HIV/AIDS care and support services. Information was collected on sociodemographic, clinical characteristics, behavioural characteristics and quality of life. Counselling and testing using Determine (Rapid Diagnostic Test kit) were done following the national guideline for all the HIV non-infected to ascertain their status.
The quality of life was assessed using questions distributed into six domains of the WHOQOL HIV bref questionnaire, namely, physical, psychological, level of independence, social relationship, environment and spirituality, overall HRQOL and general health. A 5-point Likert scale was used to rate the individual questions in each of the domains. The rating was done based on the WHO guidelines; the facet and domain mean scores were also obtained.
Measurement of variables
The dependent variables were the various domains and overall HRQOL, while social, demographic characteristics were independent.
QOL score was graded from 1–5, 1–3 graded as poor and 4–5 graded good QOL. The domains are scored between 4 and 20, the score of 4–12 and >12–20 was graded poor and good QOL respectively.
All the data generated was entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS) version 23. A P < 0.05 was considered statistically significant for all statistical tests. Mean scores and standard deviations were used to summarise the HRQOL of the domains and the overall HRQOL. Chi-square was done to describe associations between sociodemographic features stratified by HIV status. The difference in mean score HRQOL among the infected and non-infected was determined for domains and the overall using student independent t-test. The variables that were significant at bivariate analysis were modelled in multiple logistic regression at the 5 % level of significance.
Ethical approval for the study was obtained from the JUTH Health and Research Ethics Committee. The principal investigator of APIN gave permission. Written informed consent was obtained from each study participant. Respondents were free to withdraw anytime during the study if they so desired. The participants were assured of the confidentiality of their information.
| Results|| |
The mean age of respondents in the HIV infected respondents was 38 ± 9 years, and in the HIV non-infected was 35 ± 10 years. This was comparable (X2 = 4.358; df =░ P = 0.227). Tertiary level of education was significantly lower in HIV infected 70(39.3%) compared with non-infected (P = 0.006). The majority of the respondents were ever married in both the infected 144 (80.9) and non-infected 135(75.8%, P = 0.303). The employment status for both HIV infected 106(59.6%) and non-infected 92(51.7%) were also comparable (P = 0.741) [Table 1].
|Table 1: Sociodemographic characteristics of HIV infected and non-infected respondents|
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The overall mean score of HRQOL of HIV infected and non-infected respondent were comparable (HIV infected 15.91 ± 2.79 and HIV non-infected 16.25 ± 2.4, P-value > 0.05). The HRQOL mean scores of the were significantly different between the HIV infected and non-infected in all the domains; psychological (P = 0.020), social relationship (P < 0.001), level of independence (P < 0.001), environmental (P = 0.008) and spiritual/religion (P = 0.019), except physical domain (P = 0.962) [Table 2].
|Table 2: Comparison of HRQOL domains mean scores of HIV-infected and non-infected respondents|
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Age was not associated with overall HRQOL among HIV positive respondents (P = 0.295), while the association was statistically significant among the HIV negative respondents (P = 0.014). Among the HIV infected respondents, gender was not associated with overall HRQOL (P = 0,451, but the association was statistically significant among the non-infected respondents (P = 0.006). Level of education was significantly associated with overall HRQOL among HIV infected (P < 0.001) while this was not statistically significant among the non-infected respondents (P = 0.143). Most HIV infected 113(78.5%) and non-infected 93(93.0%) respondents were ever married. Marital status was not associated with overall HRQOL among HIV infected (P = 0.587), and the association was significant among the non-infected respondents (P = 0.012). Employment status was significantly associated with overall QOL among HIV positive, compared with those that are unemployed (P = 0.012), while, among the non-infected respondent’s employment status was not statistically significantly associated with HRQOL (P = 0.824) [Table 3].
|Table 3: Comparison of sociodemographic factors with overall HRQOL among HIV positive and HIV negative respondents|
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Among the HIV infected respondents, the odds of good HRQOL was eight times for those with tertiary education compared to those with no formal education (OR: 8.33; 95%CI: 2.4–29.3). Those who are employed had 2.3 times the odds of good HRQOL compared with those who are unemployed (OR: 2.34; 95%CI: 1.1–5.2) [Table 4].
|Table 4: Logistic regression showing predictors of overall HRQOL among HIV positive|
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In the non-infected group, females had 3.6 times higher odds of having a good HRQOL compared to male (aOR:3.60;95%CI:1.2–10.1) [Table 5].
|Table 5: Logistic regression showing predictors of overall HRQOL among non-HIV positive|
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| Discussion|| |
This study found no difference in overall HRQOL of HIV infected and non-infected respondents. In studies conducted in South Africa, Zambia and the United Kingdom, similar findings were reported., A study carried out in Uganda reported differences in HRQOL domains. The finding in this study may be due to the effect of ART in improving immune competence and reducing physical symptoms among infected individuals., This may also be since those on ART may have developed the ability to overcome stigma and discrimination over time.
However, HRQOL was different in all domains between HIV infected and non-infected adults except in the physical domain. The physical domain has the lowest score in both the HIV infected and non-infected group. A similar finding was reported in a study done in Ibadan. However, studies done in Kogi and Cross River among PLHIV found a higher score in the physical domain., The finding in this study may probably be because, those on ART and have achieved viral suppression, experience fewer symptoms not more than the non-infected individuals. Also, the introduction of payment for laboratory services and some other service charge due to limited funding and lack of health insurance scheme may have affected access to care.
The psychological domain assesses the individual’s thought about body image and appearance, negative or positive feelings and self-esteem worsened with advanced disease. In this study, the psychological domain means the score is significantly lower among HIV infected than the non-infected respondents. The score among HIV infected respondents was higher than that obtained in studies done in Nigeria and Swaziland.,, The finding was also consistent with a study done in Benin, where participants with HIV symptoms had a lower psychological domain mean score than participants that reported no symptoms. The therapeutic success of antiretroviral has not been able to remove the stigma and discrimination associated with the disease, and this may have accounted for the lower score. The persistence of stigma and discrimination may be associated with cultural and religious taboos concerning sex and drug use, and their links to a viral transmission. 
The social relationships domain mean score was lower among HIV infected compared with non-infected respondents. The domain assesses an individual’s perception of personal relationships, social support, social inclusion. Studies were done in Nigeria, and Brazil reported a lower mean score in the social relationship domain of PLHIV compared with our finding., This may be due to the effect of HIV on an individual’s perception of personal relationships, social support, social inclusion and sexual activity resulting from stigma and discrimination and challenges of coping with the long-term treatment. HIV infected persons may lose their job due to disease progression, which in turn will affect their financial resources.
The environmental domain means the score was low among both groups, though higher among non-infected than the HIV infected respondents. Similar findings were reported in studies conducted in Nigeria.,, Studies done among PLHIV in Nigeria and Brazil reported a lower score in the environmental domain compared to other domains., Poor environmental and social factors fuel the spread of HIV infection and affect the quality of life of people. The low environmental score in this study may be due to lack of money, and poor condition of living in the face of repeated crisis displacing people from their homes.The HRQOL mean score was highest for the spiritual/religion/personal beliefs domain in both groups, indicating a better HRQOL in this domain than the other domains. This was corroborated in studies done in, Kogi, Ibadan and Brazil.,, However, the lower score was reported in more than half of respondents in a study done in Bangladesh. In most African culture, most people attribute spirituality and religiosity to difficult circumstances that are beyond them seeking to find meaning and purpose of life. A greater level of spirituality was found to be associated with good health outcomes such as less mental health challenges and better overall HRQOL in PLHIV., This domain assessment, therefore, can provide critical information about patients view of life, death and health concerns.
Our study utilized comparative design with the non-infected as a benchmark for comparison; most prior studies in Nigeria were a cross-sectional survey among HIV infected adults. We also used the robust WHO HIV QOL-bref questionnaire in generating evidence. The study unveiled the differences in the HRQOL domains of HIV infected and non-infected adults and the influence of sociodemographic factors on QOL. The low score in the physical domain may remain so if free care is withdrawn, bearing in mind twiddling donor funding. Nigeria needs to build local capacity for long-time sustainability of free HIV/AIDS care at community levels. More, need to be done beyond the provision of ART in terms of policies and program for non-pharmacologic interventions like counselling, care and support, and improve socioeconomic to enhance the QOL of HIV infected adults.
However, this was a comparative cross-sectional study carried out in a facility. A more robust community-based survey to explore HIV infected, those on therapy, those not on therapy and undiagnosed is needed to understand their QOL to inform care and support. QOL should be routinely introduced for clinical assessment of HIV infected and non-infected persons to improve clinical outcomes at all levels of health care.
| Conclusion|| |
We found no difference in the overall HRQOL mean score of HIV-infected and non-infected adults in Jos North LGA, Plateau State. However, there was a difference in all the domains mean score (psychological, social relationship, level of independence, environmental and spiritual/religion) except for physical domain. Tertiary level of education and being employed were predictors of good QOL among HIV infected. Interventions to create employment and social net programs to empower PLHIV as this can improve their QOL.
We are grateful to Aids Prevention in Nigeria for permission to carried out this research and to the study participants for their contribution to this research.
KIB and ZAI contributed to the conception and design. KIB acquired article for review, abstracted findings to tables, contributed to analysis and interpretation. All the authors participated in the review and critique process and revised it critically for intellectual content. All the authors read and approved the final manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]