A study to determine the quality of life of people living with HIV/AIDS before and during anti retroviral treatment

Abstract

The quality of life in People Living with HIV/AIDS (PLWHA) prior to Highly Active Antiretroviral Therapy (HAART) is said to be poor. However, Anti-retroviral Therapy (ART) has changed the natural history of HIV/AIDS from a disease characterized by the rapid and torturous downhill progression to a chronic illness. HIV/AIDS has substantially increased the demand for health services and negatively affected the quality of life (Gill et al 2002). The aim of the study was to determine quality of life for PLWHA after commencement of ART. The Null hypothesis of the study was that the PLWHA would have a better quality of life after commencement of HAART. The study focused on people living with HIV/AIDS in Livingstone particularly those that were obtaining medical services from Livingstone General Hospital. The study assessed the quality of life of PLWHA before and during ART. It also established intentions on how to improve the quality of life of PLWHA before and during ART. The domains assessed included. Disease, Treatment, Pain, Energy, Physical, function, sleep and mental health domains. The study design used was retrospective. Total samples of 210 files for PLWHA were randomly selected from the registry at Livingstone General Hospital by systematic random sampling. Data were collected by using a Medical Outcome Scale Human Immunodeficiency Syndrome (MOS-HIV) questionnaire. The questionnaire was used as a checklist to extract data from the medical record files. The results of the study showed that the majority of PLWHA before ART experienced poor quality of life. In the disease domain, it was observed that disease domain had 176 (84%) PLWHA who were ill looking before ART, only 132 (63%) were still ill looking after 12 months of ART (P<0.001. The number of PLWHA with Cd4 cell count less than 200 cells/mm3 before ART was 161(77 %>) and at 12 months ART, the number reduced to 83 (40%)). The Haemoglobin level assessment also followed the same trend of improvement, as the number of PLWHA with low haemoglobin reduced from 181 (86.1%) to 125 (60%). Health status domain was described by the Physicians as poor or better. 46 (22%)) were described as poor health status before ART and the number reduced to 15 (7%) after 12 months of ART. (p < 001) The treatment domain looked at the side effects experienced by PLWHA during ART. The majority of the PLWHA, 128 (61%) experienced side effects. The most common side effect was neuropathy 54 (26%). Therefore, side effects can cause considerable discomfort and non adherence to ART hence negatively affecting the quality of life. Pain domain showed that 147 (70%) of PLWHA complained of pain before ART only 63 (30%o) did not complain. During 12 months of ART, 114 (54%) had no pain and only 96 (46%) had pain (p< 0.001). The study showed that 99 (47.1%)) had sleep disturbances before ART. During ART only 18 (7%) had sleep disturbances, (p < 0.001).Physical and role function domains assessed the ability of PLWHA to walk with ease or difficulty. Before ART, 126 (66.7%) of PLWHA had walking problems and after 12 months ART The number reduced to 70 (33.3%o) and the number with no walking problems increased to 140 (P<0.001). Ability of PLWHA to go to work was also assessed. The study results showed that 45 (60%) were not able to go to work and only 30 (40%o) were able to go for work before ART. At 12 months of ART only 56% (42) PLWHA were not able to go for work. The number of PLWHA who were able to go for work increased slightly from 30 (40%)) to 33 (44 %) (p< 0.05). At 12 months only 102 (48%) complained of weakness. (p<0.001) Physical body function was assessed as normal but abnormal temperature was reported. Before ART the number of PLWHA with abnormal temperature was 47 (22%) and with normal was 163 (78%)). After 12 months on ART the number of PLWHA with abnormal temperature reduced to 19 (19%)) and normal improved greatly as it rose to 191 %) (91%) p<0.001. Mental appearance was assessed as normal and abnormal. The number of PLWHA described as abnormal was 195 (83%)) before ART. At 12 months of ART, the number dropped to 113 (54%)) (p< 0.0001). Orientation was assessed as either disoriented or oriented. The majority, 158 (73% ) were disoriented at commencement of ART (P>0.05) as compared to 52 ( 24.8%) after 12 months on ART.The study results show that HAART improved the quality of life for PLWHA in a poor setting in the city of Livingstone. Before commencement of ART, it was evident that quality of life was poor as shown by high rate of opportunistic infections, weakness and inability to walk. However, after commencement of ART, significant improvement in almost all the seven domains was recorded. The study results show that the quality of life of these people greatly improved hence the Null hypothesis was accepted.