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Measuring quality of life in rural Uganda: reliability and validity of summary scores from the Medical Outcomes Study HIV Health Survey (MOS-HIV)

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Abstract

Purpose

Summary scores derived from the Medical Outcomes Study HIV Health Survey (MOS-HIV) are used to assess treatment impacts among HIV-infected patients in Western settings, but have yet to be validated in rural, African settings. We examined the reliability, validity and responsiveness of scores among a prospective cohort of 947 HIV-1-infected adults initiating antiretroviral therapy between May 2003 and May 2004 in rural Uganda.

Methods

Physical (PHS) and mental health (MHS) summary scores were developed from baseline MOS-HIV sub-domains using exploratory factor analysis. Construct and discriminant validity were established by comparing mean summary scores across known groups of sociodemographic, clinical and health status characteristics. Effect sizes were calculated to assess responsiveness to therapy.

Results

Reliability of the PHS and MHS scores was 0.79 and 0.85, respectively. Mean baseline PHS and MHS scores varied significantly by CD4 cell count, HIV viral load, WHO stage of disease and Karnofsky performance status scores. By 12 months on antiretroviral therapy, PHS and MHS scores improved by 14.6 points (P < 0.001) and 13.9 points (P < 0.001), respectively.

Conclusions

PHS and MHS scores can be derived from the MOS-HIV and used to assess health status among cohorts of patients taking antiretroviral therapy in rural Uganda.

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Abbreviations

ANOVA:

Analysis of variance

ART:

Antiretroviral therapy

CD4:

Cluster of differentiation 4

CDC:

US centers for disease control and prevention

HIV:

Human immunodeficiency virus

KPS:

Karnofsky performance status

MHS:

Mental health summary score

MOS-HIV:

Medical outcomes study HIV health survey

PHS:

Physical health summary score

PLHA:

People living with HIV and AIDS

QOL:

Quality of life

WHO:

World health organization

References

  1. UNAIDS, World Health Organization. (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5”. In Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS) (pp. 1–55). World Health Organization (WHO).

  2. Wu, A. W. (2000). Quality of life assessment comes of age in the era of highly active antiretroviral therapy. AIDS, 14(10), 1449–1451.

    Article  PubMed  CAS  Google Scholar 

  3. Wu, A. W., Revicki, D. A., Jacobson, D., & Malitz, F. E. (1997). Evidence for reliability, validity and usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Quality of Life Research, 6(6), 481–493.

    Article  PubMed  CAS  Google Scholar 

  4. Revicki, D. A., Sorensen, S., & Wu, A. W. (1998). Reliability and validity of physical and mental health summary scores from the Medical Outcomes Study HIV Health Survey. Medical Care, 36(2), 126–137.

    Article  PubMed  CAS  Google Scholar 

  5. Holmes, W., Bix, B., & Shea, J. (1996). SF-20 score and item distributions in a human immunodeficiency virus-seropositive sample. Medical Care, 34(6), 562–569.

    Article  PubMed  CAS  Google Scholar 

  6. World Health Organization. (2002). Scaling up antiretroviral therapy in resource limited settings: Guidelines for a Public Health Approach. Geneva: World Health Organization.

  7. Bunnell, R., Ekwaru, J. P., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W., et al. (2006). Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS, 20(1), 85.

    Article  PubMed  Google Scholar 

  8. Stangl, A. L., Wamai, N., Mermin, J., Awor, A. C., & Bunnell, R. (2007). Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda. AIDS Care, 19(5), 626–636.

    Article  PubMed  CAS  Google Scholar 

  9. Mermin, J., Were, W., Ekwaru, J. P., Moore, D., Downing, R., Behumbiize, P., et al. (2008). Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: A prospective cohort study. The Lancet, 371(9614), 752–759.

    Article  CAS  Google Scholar 

  10. Mast, T. C., Kigozi, G., Wabwire-Mangen, F., Black, R., Sewankambo, N., Serwadda, D., et al. (2004). Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care, 16(1), 81–94.

    Article  PubMed  CAS  Google Scholar 

  11. WHO, & The WHO International Collaborating Group for the study of the WHO staging system. (1993). Proposed ‘World Health Organization staging system for HIV infection and disease’: preliminary testing by an international collaborative cross-sectional study. The WHO International Collaborating Group for the Study of the WHO Staging System. AIDS, 7(5), 711–718.

    Google Scholar 

  12. Mor, V., Laliberte, L., Morris, J. N., & Wiemann, M. (1984). The Karnofsky performance status scale: An examination of its reliability and validity in a research setting. Cancer, 53(9), 2002–2007.

    Article  PubMed  CAS  Google Scholar 

  13. Kazis, L. E., Anderson, J. J., & Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27(3), S178.

    Article  PubMed  CAS  Google Scholar 

  14. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York: Academic Press.

    Google Scholar 

  15. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates.

    Google Scholar 

  16. Katz, J. N., Larson, M. G., Phillips, C. B., Fossel, A. H., & Liang, M. H. (1992). Comparative measurement sensitivity of short and longer health status instruments. Medical Care, 30(10), 917–925.

    Article  PubMed  CAS  Google Scholar 

  17. Bolton, P., & Tang, A. M. (2002). An alternative approach to cross-cultural function assessment. Social Psychiatry and Psychiatric Epidemiology, 37(11), 537–543.

    Article  PubMed  Google Scholar 

  18. Murri, R., Fantoni, M., Del Borgo, C., Visona, R., Barracco, A., Zambelli, A., et al. (2003). Determinants of health-related quality of life in HIV-infected patients. AIDS Care, 15(4), 581–590.

    Article  PubMed  CAS  Google Scholar 

  19. Liu, C., Johnson, L., Ostrow, D., Silvestre, A., Visscher, B., & Jacobson, L. P. (2006). Predictors for lower quality of life in the HAART era among HIV-infected men. Journal of Acquired Immune Deficiency Syndromes, 42(4), 470.

    Article  PubMed  Google Scholar 

  20. Mannheimer, S. B., Matts, J., Telzak, E., Chesney, M., Child, C., Wu, A. W., et al. (2005). Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care, 17(1), 10–22.

    Article  PubMed  CAS  Google Scholar 

  21. Cederfjall, C., Langius-Eklof, A., Lidman, K., & Wredling, R. (2001). Gender differences in perceived health-related quality of life among patients with HIV infection. AIDS Patient Care STDs, 15(1), 31–39.

    Article  PubMed  CAS  Google Scholar 

  22. Babikako, H. M., Neuhauser, D., Katamba, A., & Mupere, E. (2010). Feasibility, reliability and validity of health-related quality of life questionnaire among adult pulmonary tuberculosis patients in urban Uganda: Cross-sectional study. Health and Quality of Life Outcomes, 8, 93.

    Article  PubMed  Google Scholar 

  23. Bajunirwe, F., Tisch, D. J., King, C. H., Arts, E. J., Debanne, S. M., & Sethi, A. K. (2009). Quality of life and social support among patients receiving antiretroviral therapy in Western Uganda. AIDS Care, 21(3), 271–279.

    Article  PubMed  Google Scholar 

  24. Sowell, R. L., Seals, B. F., Moneyham, L., Demi, A., Cohen, L., & Brake, S. (1997). Quality of life in HIV-infected women in the south-eastern United States. AIDS Care, 9(5), 501–512.

    Article  PubMed  CAS  Google Scholar 

  25. Cohen, C., Revicki, D. A., Nabulsi, A., Sarocco, P. W., & Jiang, P. (1998). A randomized trial of the effect of ritonavir in maintaining quality of life in advanced HIV disease. AIDS, 12(12), 1495.

    Article  PubMed  CAS  Google Scholar 

  26. Tarwater, P. M., Gallant, J. E., Mellors, J. W., Gore, M. E., Phair, J. P., Detels, R., et al. (2004). Prognostic value of plasma HIV RNA among highly active antiretroviral therapy users. AIDS, 18(18), 2419.

    PubMed  Google Scholar 

  27. Wu, A. W., Rubin, H. R., Mathews, W. C., Ware, J. E., Jr, Brysk, L. T., Hardy, W. D., et al. (1991). A health status questionnaire using 30 items from the Medical Outcomes Study: Preliminary validation in persons with early HIV infection. Medical Care, 29(8), 786.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was funded by the Centers for Disease Control and Prevention through the President’s Emergency Plan for AIDS Relief and the US Department of Health and Human Services. The authors wish to thank the participants and study team in Tororo, especially Kenneth Khana. We also wish to thank Stevens Bechange for data management and Drs. Dominique Meekers, Paul Hutchinson and Lisanne Brown for providing comments on earlier versions of this manuscript.

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Authors and Affiliations

  1. The Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Anne L. Stangl

  2. CDC-Uganda, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Mailstop D-21, 1600 Clifton Rd, Atlanta, GA, 30333, USA

    Rebecca Bunnell & Jonathan Mermin

  3. International Center for Research on Women, 1120 20th St. NW Suite 500 N, Washington, DC, WA, 20036, USA

    Anne L. Stangl

  4. CDC-Uganda, C/o Uganda Virus Research Institute, Plot 51 to 59 Nakiwogo Road Entebbe, P.O. Box 49, Entebbe, Uganda

    Anne L. Stangl, Nafuna Wamai & Humphrey Masaba

Authors
  1. Anne L. Stangl
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  2. Rebecca Bunnell
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  3. Nafuna Wamai
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  4. Humphrey Masaba
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  5. Jonathan Mermin
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Corresponding author

Correspondence to Anne L. Stangl.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Stangl, A.L., Bunnell, R., Wamai, N. et al. Measuring quality of life in rural Uganda: reliability and validity of summary scores from the Medical Outcomes Study HIV Health Survey (MOS-HIV). Qual Life Res 21, 1655–1663 (2012). https://doi.org/10.1007/s11136-011-0075-5

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