STUDENT RESEARCH PROJECT Faculty of Medical Sciences The University of the West Indies St. Augustine Assessing Quality of Life (QOL) among People Living with HIV/AIDS (PLWHA) Receiving Highly Active Antiretroviral Therapy (HAART) in Two Caribbean Countries (2006)

Incidence of HIV/AIDS Approx. 30,000 PLWHA in Trinidad Approx. 30,000 PLWHA in Trinidad Approx. 3,000 PLWHA in Barbados Approx. 3,000 PLWHA in Barbados (CAREC 2005)

Why study the QOL of HIV patients on HAART? HIV/AIDS is a terminal illness but patients are living longer due to HAART HIV/AIDS is a terminal illness but patients are living longer due to HAART Biochemical tests measure health of these patients quantitatively Biochemical tests measure health of these patients quantitatively However, assessing QOL of these patients determines whether this increased lifespan is meaningful and productive However, assessing QOL of these patients determines whether this increased lifespan is meaningful and productive

What is Quality of Life (QOL)? QOL measures an individual’s perception of their overall well being QOL measures an individual’s perception of their overall well being QOL serves as a means of assessing the effectiveness of treatment of a chronic, lifelong or terminal disease on an individualized basis QOL serves as a means of assessing the effectiveness of treatment of a chronic, lifelong or terminal disease on an individualized basis

This Study Aims to: Describe and compare the QOL of PLWHA on HAART in Barbados and Trinidad Describe and compare the QOL of PLWHA on HAART in Barbados and Trinidad Determine the predictors of the QOL of PLWHA on HAART in Barbados and Trinidad Determine the predictors of the QOL of PLWHA on HAART in Barbados and Trinidad

Methodology Study Design: Study Design: –Descriptive cross-sectional study with an analytical component Setting: Setting: –San Fernando General Hospital (SFGH) Trinidad and Ladymeade Reference Unit (LRU) Barbados

Methodology (Cont’d) Sample size: Sample size: –100 adult outpatients on HAART from SFGH and 112 from LRU –Cluster sampling was performed for the duration of one month in each clinic

Methodology (Cont’d) Interventions: –A piloted WHOQOL-HIV BREF Questionnaire  Adjustments were made to the language of the scale to account for cultural idiosyncrasies  This is a standardized test consisting of 31 questions that explore 6 domains

Methodology (Cont’d) DOMAINS SAMPLE QUESTION Physical Do you have enough energy for everyday life? Psychological How often do you have negative feelings such as hopelessness, despair, anxiety and depression? Level of Independence How satisfied are you with your ability to perform your daily activities? Social Relationship How satisfied are you with your sex life? Environment How satisfied are you with the conditions of your living place? Spiritual How much do you worry about death?

Methodology (Cont’d) All questions were graded on a 1 to 5 Likert scale All questions were graded on a 1 to 5 Likert scale Scores for each domain were calculated and mean domain scores were determined Scores for each domain were calculated and mean domain scores were determined Calculated QOL was determined by finding the mean of all 6 domains (Q 3-31) Calculated QOL was determined by finding the mean of all 6 domains (Q 3-31) ‘Self-reported’ QOL was determined from Q1 of the questionnaire ‘Self-reported’ QOL was determined from Q1 of the questionnaire “ How would you rate your quality of life?”

Methodology (Cont’d) Assessment of Data Assessment of Data –Descriptive Component –Analytical Component (SPSS)  Multiple linear regression  Univariate Analysis of Variance  Paired sample T-test

Results Response Rate Response Rate –Trinidad 92.0% –Barbados 95.5%

Results: Description of Population A ge Distribution

Male to Female Ratio In Trinidad and Barbados

Ethnic Distribution of Participants in Barbados

Ethnic Distribution of Participants in Trinidad

Distribution of Participants Within Each Income (TTD) Category In Trinidad and Barbados

Results Trinidad –Highest score in spiritual domain  70.0% of participants were not worried about dying –Lowest score in level of independence  36% participants unemployed  79% were incompletely satisfied with their ability to work

Results Barbados –Highest score in Physical domain  75% of participants at least “satisfied” with health  64.3% of participants said physical pain did not prevent daily activity –Lowest score in Social Relationships domain  73.2% single, separated, divorced or widowed  76.8% were not completely satisfied with their sex life

Description of QOL Paired T-test Trinidad Trinidad –Mean calculated = 3.79 / 5.00 –Mean self reported = 3.63 / 5.00 –No significant difference (P = 0.131) Barbados Barbados –Mean calculated = 4.27 / 5.00 –Mean self reported = 3.96 / 5.00 –Significantly different (P = 0.000)

Diagram showing QOL values for Barbados and Trinidad

Bar Chart Comparing Mean Domain Scores For HIV Population In Trinidad and Barbados

Univariate Analysis of Variance QOL QOL –Not associated with sex (P = 0.352) –Associated with country (P = 0.048) –Associated with age (P = 0.048)

QOL Predictors Multivariate Analysis Trinidad Trinidad –None (P>0.05) Barbados Barbados –Psychological (P=0.003) –Environment (P=0.010)

Discussion Synopsis Our findings suggest: Mean QOL of B’dos was higher than that of T’dad Mean QOL of B’dos was higher than that of T’dad No significant difference in QOL b/w males & females in both countries No significant difference in QOL b/w males & females in both countries Average QOL of a person is related to their age and country Average QOL of a person is related to their age and country

Discussion (Cont’d) Comparison of calculated and self-reported QOL scores showed that in Trinidad: Trinidad: –Trinidadian PLWHA had more accurate sense of their QOL –Self-reported QOL reflected the mean calculated QOL Barbados: Barbados: –Barbadian PLWHA may expect more out of life

Discussion (Cont’d) Predictors of QOL No predictors of QOL were found for PLWHA in Trinidad among domains or demographic factors explored No predictors of QOL were found for PLWHA in Trinidad among domains or demographic factors explored 2 domains were useful predictors in B’dos 2 domains were useful predictors in B’dos –psychological & environmental domains are sufficient to accurately assess QOL –Both domains relate to standard of living, which may have had particular bearing on how the participants viewed their QOL

Discussion Patients’ Perspectives –HAART affected QOL  May relate to success in drug therapy in alleviating physical problems  All of participants on daily medical treatment –Appreciation of life  Some expressed heightened devotion after learning of infection  Many accepted that “Death is a part of life” –No guilt about HIV infection  Many reported preference for few friends  Isolated cases of discrimination, in public or within families –Willing participation

Strengths of Study Comparative study between two Caribbean countries Comparative study between two Caribbean countries Novel Research Novel Research Develops a baseline QOL Develops a baseline QOL Investigates the patients’ perspectives and views Investigates the patients’ perspectives and views WHOQOL- HIV BREF was used WHOQOL- HIV BREF was used Study had a high response rate Study had a high response rate

Limitations In Trinidad In Trinidad –Decreased sample size –Location bias Financial and time constraints Financial and time constraints Could not determine the effect of the HAART; QOL of PLWHA not receiving HAART was not studied Could not determine the effect of the HAART; QOL of PLWHA not receiving HAART was not studied Duration of therapy was not taken into account Duration of therapy was not taken into account

Conclusion Overall QOL of PLWHA on HAART was better than anticipated in both T’dad and B’dos Overall QOL of PLWHA on HAART was better than anticipated in both T’dad and B’dos The QOL score established for PLWHA in Trinidad is 3.79 and in Barbados is 4.26, each of a maximum score of 5.00 The QOL score established for PLWHA in Trinidad is 3.79 and in Barbados is 4.26, each of a maximum score of 5.00 QOL score in each domain higher for PLWHA in Barbados than in Trinidad QOL score in each domain higher for PLWHA in Barbados than in Trinidad No predictors of QOL found in Trinidad but Psychological and Environment domains found to be predictors of QOL in Barbados No predictors of QOL found in Trinidad but Psychological and Environment domains found to be predictors of QOL in Barbados

Recommendations Education Education Reintegration of PLWHA into workforce Reintegration of PLWHA into workforce Emphasis on treatment Emphasis on treatment Future studies could: Future studies could: –Compare before and after treatment –Compare the QOL of PLWHA on HAART to those not receiving treatment –Include PLWHA receiving private treatment –Compare findings to other populations

Acknowledgements Staff of LRU, especially Dr. Timothy Roach Staff of LRU, especially Dr. Timothy Roach Our supervisor, Dr. Rohan Maharaj Our supervisor, Dr. Rohan Maharaj Dr. Paula Nunes Dr. Paula Nunes Prof. Henry Fraser Prof. Henry Fraser Staff of SFGH, especially Dr. Ricardo Mohammed, Dr. Seetharam, Dr. Sandy, Dr. Prithi Staff of SFGH, especially Dr. Ricardo Mohammed, Dr. Seetharam, Dr. Sandy, Dr. Prithi Dr. George Legall and Mr. Rudy Singh Dr. George Legall and Mr. Rudy Singh Staff of the Medical Sciences Library Staff of the Medical Sciences Library All of patients who participated in this study All of patients who participated in this study

THANK YOU!