Quality of life in HIV/AIDS patients: A cross-sectional study in south India

B Nirmal; KR Divya; VS Dorairaj; K Venkateswaran

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ORIGINAL ARTICLE

Year : 2008 \| Volume : 29 \| Issue : 1 \| Page : 15-17

Quality of life in HIV/AIDS patients: A cross-sectional study in south India

B Nirmal, KR Divya, VS Dorairaj, K Venkateswaran
Institute of Venereology, Madras Medical College, Chennai, India

Correspondence Address:
B Nirmal
Institute of Venereology, Madras Medical College, Chennai
India

Source of Support: None, Conflict of Interest: None

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Abstract

With developing countries on the wave of a HIV epidemic, issues like quality of life (QOL) have come to fore. We aimed to assess the quality of life in human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients at antiretroviral therapy (ART) clinic in a tertiary healthcare centre in South India. The study was conducted on 60 HIV/AIDS patients attending ART clinic at a tertiary health hospital, Chennai, South India. QOL was evaluated using the WHO QOL-BREF (Field trial version) instrument using 26 items grouped under 4 domains, namely physical health, psychological well-being, social relationships, and environment on 60 HIV/AIDS patients. Standard error of the difference between means was employed to find out significant difference between domain scores and clinical categories. QOL scores were highest for environmental domain which is 46.19 (0-100 scale). QOL scores were significantly lower among persons with lower CD4 counts ( P < 0.001). Women had lower QOL scores than men despite having less advanced disease. Patients with better educational background had significantly higher psychological domain scores. Also, a supportive family kept environmental domain scores better ( P < 0.001). A need for good healthcare support system was perceived. Better education helps the patient to cope with the disease well. Family support is essential for healthier environment.

Keywords: HIV, AIDS, quality of life

How to cite this article:
Nirmal B, Divya K R, Dorairaj V S, Venkateswaran K. Quality of life in HIV/AIDS patients: A cross-sectional study in south India. Indian J Sex Transm Dis 2008;29:15-7

How to cite this URL:
Nirmal B, Divya K R, Dorairaj V S, Venkateswaran K. Quality of life in HIV/AIDS patients: A cross-sectional study in south India. Indian J Sex Transm Dis [serial online] 2008 [cited 2023 Jun 6];29:15-7. Available from: https://ijstd.org/text.asp?2008/29/1/15/42708

Introduction

Dr. Peter Piot, Executive Director, UNAIDS, struck an alarm by stating that the situation the world now faces in China, India, Russia, and its surrounding countries bears alarming similarities to the situation faced 20 years ago in Africa, with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) rate coming perilously close to a tipping point.^[1] Vital issues like QOL have come to limelight with a booming increase in HIV/AIDS cases in these countries. We aimed to find association between CD4 count and QOL also the difference it had between the sexes. We also wanted to ascertain the role of education on psychological domain and family support on environmental domain. WHO has defined QOL as "Individual´s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns."

Materials and Methods

Participants

This study was done from july to september,2007 in the outpatient department of the ART clinic at a tertiary care hospital, Chennai, South India. The design is a cross-sectional study with one time assessment of QOL. 60 HIV positive patients were interviewed with a structured questionnaire.Informed written consent of all the respondents enrolled in the study was duly taken. Only patients on regular ART were taken for consideration. Terminally ill and newly diagnosed patients were excluded from the study.

Procedure

QOL was evaluated using WHO QOL-BREF instrument^[2] ideally suited for busy clinics. WHO QOL-BREF has 26 items grouped under four domains. The items under the domains are:

Physical health - dependence of treatment, energy and fatigue, mobility, presence of pain and discomfort, sleep and rest, activities of daily living, and perceived working capacity.

Psychological well-being - affect, positive self-concept, negative feelings, higher cognitive functions, body image, and spirituality.

Social relations - social contacts, family support, sexual activity.

Environment - freedom, quality of home environment, physical safety and security, involvement in recreational activity, quality of health and social care, and accessibility to services.

There are also two items examined separately. One about the individual´s overall perception of QOL; and the other about the individual´s overall perception of his or her health. Each item uses a five-point Likert-type scale.

All 26 items were checked and scores ranging from 1-5 were assigned. Scores of three negatively phrased items were reversed. Scores were transformed to 0-100 scale using of WHO QOL-BREF instrument. Cases with greater than 20% of missing data were deleted and the data set was saved.

Statistical analysis

Standard error of the difference between means^[3] was employed to find out significant difference between domain scores and clinical categories. The difference between the two sample means is considered significant if the P -value calculated from the reference table is less than 0.05.

Results

Of the patients included in the study, there were equal number of men and women. Their mean income was less than 5000 rupees per month and mean age was 35.7 years (Range, 26-60 years). Sixty percent of the respondents were married, 10% were single, 13.33% were widowed, 13.33% were separated, and 3.33% divorced. Majority of the patients (50%) were in the clinical category B (CD4 200-500/mm³ ). Only 10 of the 60 patients had tertiary education, whereas most patients had primary education only [Table 1].

The mean score (0-100) of domains was highest for the environmental domain (47.63), followed closely by psychological domain (47.4), then physical (46.37), and lowest for social (43.37).

Patients with higher CD4 counts had higher overall QOL scores as indicated by a statistically significant P-value of less than 0.001. In the male population, most of them were under clinical category A whereas the female population included in the study were mostly in categories B&C [Table 2].

Women had statistically significant lower QOL scores compared to men in first two clinical categories [Table 3].

Significant difference in psychological domain scores were found between patients who have had no education and secondary school education ( P < 0.001); no education and tertiary education ( P < 0.01); and those with primary school education and tertiary education ( P < 0.001) [Table 4].

There was also statistically significant difference in the environmental domain scores between patients who have family support - married or single and those without support - separated, widowed, or divorced ( P < 0.001) [Table 5].

Discussion

In our study, the environmental domain had the maximum QOL score of the four QOL domains. This suggests that the patients had relatively better quality of health services and good accessibility to them, whereas the domain hardly hit was the social domain with scores way behind the other three domains indicating that the patients' social contacts and sexual activity were affected markedly to a great extent.

The QOL scores had linear relationship with the CD4 counts. When the study population was divided into men and women and their CD4 counts were compared, women in the study had better CD4 counts compared to their male counterparts. But they had lower QOL scores as opposed to men despite having less advanced disease. This was probably because women in this part of the country are more likely to sacrifice their own health for the welfare of their family and postpone treatment or because they have low income or perhaps they drop out of schools early.^[4]

As the education of the patients increased, they had better psychological domain scores. It reflects that education enhances problem-solving and active decision-making making the patient to cope with the dreaded disease better, both emotionally and problem focused.^[5]

Family support significantly influenced the scores of environmental domain, which implies that a good supportive family helps to keep the patient's environment healthier.^[6]

Thus, the ultimate goal for treatment is not only to promote longevity but also to enhance the QOL. Strategies developed to foster communication with a good healthcare support system, especially for women, may result in potentially higher QOL outcomes. Facilitating access to care including mental health for all HIV/AIDS patients should be made a priority.

Limitations of the Study

The number of patients included in the study was only 60.Future studies in this topic can be directed to compare other variables with the domains.

Comparisons with other similar studies

The impact of HIV/AIDS on the quality of life: a cross sectional study in north India

Wig N, Lekshmi R, Pal H, Ahuja V, Mittal CM, Agarwal SK

The pitfalls of the study like having very few female patients were rectified in our study and we even compared CD4 counts and QOL separately in males and females.

Quality of life in HIV subtype C infection among asymptomatic subjects and its association with CD4 counts and viral loads--a study from South India.

Chandra PS, Gandhi C, Satishchandra P, Kamat A, Desai A, Ravi V, Ownby RL, Subbakrishna DK, Kumar M.

Unlike the results of this study, the CD4 counts varied linearly with domain scores.

References

1.	Peter Piot at the Woodrow Wilson Center for International Scholars on the eve of World AIDS Day, November 30,2004
2.	Saxena S, Carlson D, Billington R; WHOQOL Group. World Health Organisation Quality Of Life. The WHO quality of life assessment instrument (WHOQOL-Bref): The importance of its items for cross-cultural research. Qual Life Res 2001;10:711-21.
3.	Gupta MC, Mahajan BK. Textbook of preventive and social medicine. 3^rd ed. p. 380-6.
4.	Joshi PL, Holmes KK. Global and National overview of HIV/AIDS epidemic. Sexually Transmitted Diseases & AIDS. Ch3. 2003. p. 59-76.
5.	Chesney MA, Folkman S. Sexually transmitted diseases. 3rd ed, Ch72. 1999. p. 987-92.
6.	Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS 2006;20:1571-82.