Quality of Life of HIV Patients in a Rural Area of Western Uganda: Impact of a Community-Based Antiretroviral Treatment Program

Arif      Alibhai; Leah      J. Martin; Walter      Kipp; Joseph      Konde-Lule; L.      Duncan Saunders; Tom      Rubaale; Stan      Houston; Joa      Okech-Ojony

Abstract

Objective: Community-based antiretroviral treatment (CBART) programs should aim to achieve positive quality of life outcomes. The purpose of this study was to investigate changes in the health related quality of life (HRQOL) outcomes of patients in a CBART program supported by community volunteers in one sub-county in western Uganda located 50 km from the nearest urban centre. Methods: We administered a translated version of the MOS-HIV survey and collected clinical data at baseline and after one year from 130 patients. Inclusion criteria included residency in the sub-county, eighteen years of age or, treatmentnaive, eligible for ART based on CD4 cell count < 200 cells/mm3 or WHO clinical stage 3 or 4, and willing to accept daily treatment support by family/friends and to be visited by a community volunteer weekly. We assessed changes in physical health (PHS) and mental health (MHS) summary scores and examined associations between patient characteristics and changes in HRQOL. Results: After one year, we observed significant increases in mean PHS (42.7 to 50.1; p < 0.01) and MHS (43.5 to 49.5; p < 0.01) scores. Lower age (p < 0.01) and lower baseline PHS scores (p < 0.01) were associated with increases in PHS scores and lower age (p=0.03) and lower baseline MHS scores (p < 0.01) were associated with increases in MHS scores. Fifteen patients (12%) had reductions in their HRQOL after one year which were not associated with patient or clinical characteristics, including virological suppression. Conclusions: The observed improvements in HRQOL demonstrate that positive treatment outcomes can be achieved in CBART programs in rural Uganda. However, some patients appear to experience declines in their overall well-being, despite achieving virological suppression. HRQOL surveys can be useful in identifying these patients, who may require additional attention and support to achieve the full benefits of ART.

Keywords: Antiretroviral therapy, HIV/AIDS, quality of Life, Uganda, rural health services, community based treatment

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