Factors That Affect Quality of Life among People Living with HIV Attending an Urban Clinic in Uganda: A Cohort Study

RESEARCH ARTICLE Factors That Affect Quality of Life among People Living with HIV Attending an Urban Clinic in Uganda: A Cohort Study Doris Mutabazi-Mwesigire1¤*, Achilles Katamba1☯¤, Faith Martin2☯, Janet Seeley3☯, Albert W. Wu4☯ 1 Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, 2 Department of Psychology, University of Bath, Bath, United Kingdom, 3 Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda, 4 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America ☯ These authors contributed equally to this work. ¤ Current Address: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda * OPEN ACCESS Citation: Mutabazi-Mwesigire D, Katamba A, Martin F, Seeley J, Wu AW (2015) Factors That Affect Quality of Life among People Living with HIV Attending an Urban Clinic in Uganda: A Cohort Study. PLoS ONE 10(6): e0126810. doi:10.1371/journal. pone.0126810 Academic Editor: Stefano Federici, University of Perugia, ITALY Received: August 6, 2014 Accepted: April 8, 2015 Published: June 3, 2015 Copyright: © 2015 Mutabazi-Mwesigire et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The work was supported by Training Health Researchers into Vocational Excellence (THRiVE) in East Africa, grant number 087540, funded by Wellcome Trust. This work was made possible by Medical Education for Equitable Services to All Ugandans, a Medical Education Partnership Initiative, grant number 5R24TW008886, from the Office of Global AIDS Coordinator and the U. S. Department of Health and Human Services, Health Resources and Services Administration, and National Abstract Introduction With the availability of antiretroviral therapy (ART) and primary general care for people living with HIV (PLHIV) in resource limited settings, PLHIV are living longer, and HIV has been transformed into a chronic illness. People are diagnosed and started on treatment when they are relatively well. Although ART results in clinical improvement, the ultimate goal of treatment is full physical functioning and general well-being, with a focus on quality of life rather than clinical outcomes. However, there has been little research on the relationship of specific factors to quality of life in PLHIV. The objective of this study was to investigate factors associated with quality of life among PLHIV in Uganda receiving basic care and those on ART. Methods We enrolled 1274 patients attending an HIV outpatient clinic into a prospective cohort study. Of these, 640 received ART. All were followed up at 3 and 6 months. Health related quality of life was assessed with the MOS-HIV Health Survey and the Global Person Generated Index (GPGI). Multivariate linear regression and logistic regression with generalized estimating equations were used to examine the relationship of social behavioral and disease factors with Physical Health Summary (PHS) score, Mental Health Summary (MHS) score, and GPGI. Results Among PLHIV receiving basic care, PHS was associated with: sex (p=0.045) - females had lower PHS; age in years at enrollment (p=0.0001) - older patients had lower PHS; and PLOS ONE | DOI:10.1371/journal.pone.0126810 June 3, 2015 1 / 21 Factors That Affect Quality of Life among People Living with HIV Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the government. Competing Interests: The authors have declared that no competing interests exist. depression (p<0.001) - depressed patients had lower PHS. MHS was only associated with opportunistic infection (p=0.01) - presence of an opportunistic infection was associated with lower MHS. For the GPG the associated variables were age (p=0.03) - older patients had lower GPGI; education (p=0.01) – higher education associated with higher GPGI; and depression - patients with depression had a lower GPGI (p<0.001). Among patients on ART, PHS was associated with: study visit (p=0.01), with increase in time there was better PHS, and this also improved with increase in education level (p=0.002). Patients with WHO disease stage 3&4 had a lower PHS compared to patients at stage 1&2 (p=0.006), and depressed patients had lower PHS (p<0.001). MHS improved from baseline to six month study visit (p<0.001), and females had lower MHS compared to males (p=0.01). GPGI was associated with higher income (p=0.04), alcohol use was associated with lower GPGI (p=0.004), and depressed patients had a lower GPGI (p<0.001). Conclusion Quality of life improved over time for PLHIV on ART. Regardless of treatment status, PLHIV with depression or low education level and female gender were at risk of having a poor quality of life. Clinicians and policy makers should be aware of these findings, and address them to improve quality of life for PLHIV. Introduction According to Joint United Nations Program on HIV/AIDS, there were 21 million people living with HIV in sub-Saharan Africa in 2012, of whom 32% received antiretroviral therapy (ART) [1]. In the same year, it was reported that Uganda had 1.4 million (1.2–1.6 million) adults living with HIV [2]. By June 2013, 524,603 (37%) adults were on ART [3]. Uganda has had a generalized HIV epidemic for the last 30 years. The HIV prevalence is estimated to be 7.3% [4]. This represents an increase from 6.4% from the 2005 sero-survey [5], which may reflect earlier diagnosis and increased life expectancy of people living with HIV (PLHIV) to a rate similar to the general population [6]. HIV/AIDS has been transformed into a chronic condition, albeit one with no cure, making it important to assess determinants of quality of life (QoL) and, if required, improve the QoL of PLHIV. Assessment of determinants of QoL is vital to understanding the impact of both HIV and ART on people’s lives [6]. Progress has been made in assessing QoL among PLHIV in developed countries and QoL outcomes have been used in decision making about ARV regimens [7,8,9,10,11]. A recent literature review of determinants of QoL among PLHIV in developed countries reported the following factors to be associated with QoL: gender, age, family situation, education, employment, income, virological and immunological status, staging and time since diagnosis, ART, presence of symptoms, co morbidity, depression and anxiety, social support, neuro psychological status, health care, disclosure, stigma, smoking, alcohol use, drug use, adherence and life style and sexual risk behavior [12]. There is limited evidence of determinants of QoL among HIV/AID (...truncated)