Introduction: Lifelong Anti-Retroviral Therapy (ART) promotes good quality of life and health among HIV-positive men and women. However, simplified newer and effective ART has not increased retention in care, or long-term ART adherence, especially among women. There are many factors that impede long-term adherence in women. This includes among other things female gender, depression, greater than once-daily dosing, longer time since HIV diagnosis, and patient beliefs. This study measures the quality of life in women whose ART durations range from one to fifteen years, using the standardized WHO Quality of Life questionnaire. Material and Methods: One hundred and fourteen women were divided into three groups based on ART duration. Group 1 had 37 women on ART for less than five years, Group 2 had 48 women on ART from 5 to 10 years and Group 3 had 29 women on ART for more than ten years. They were administered the WHO Quality of Life (QOL) questionnaire, which assesses QOL in six domains. QOL was considered poor in scores between 4 - 9.9, medium in scores of 10 - 14.9 and good in scores of 15 - 20. Results: Scores in all 3 groups were more than 85% in five domains and around 74.5% in the psychological domain. Domain mean scores were Physical 18 (CI 17.63 - 18.37), Psychological 14.9 (CI 14.55 - 15.25), Independence 18.6 (CI 18.33 - 18.87), Social relationships 17.5 (CI 17.07 - 17.93), Environmental 17.6 (CI 17.25 - 17.95), Spiritual, Religious, Personal beliefs, 17.4 (CI 16.93 - 17.87). Scores for women on long-term ART (Group 3) are not different from the other 2 groups and the p-values were not statistically significant. Conclusion: Women on long-term ART fare extremely well compared to other groups with more than 93% showing good QOL and none showing poor Quality of Health in spite of being on ART for a longer period of time than the other two groups. Despite a multitude of impeding factors, women who continue ART faithfully and consistently enjoy a good quality of health and life. Adequate preparation and a supportive health system are essential for ensuring long-term adherence, but the attitude and commitment of women are also critical.
KeywordsAntiretroviral Treatment-ARTQuality of Life-QOLWomen Living with HIV Quality of HealthLong-Term Adherence
Rai, S., Mahapatra, B., Sircar, S., Raj, P.Y., Venkatesh, S., et al. (2013) Adherence to Antiretroviral Therapy and Its Effect on Survival of HIV-Infected Individuals in Jharkhand, India. PLoS ONE, 8, Article ID: e66860. https://doi.org/10.1371/journal.pone.0066860
Becker N, Cordeiro LS, Poudel KC, Sibiya TE, Sayer AG, Sibeko LN (2020) Individual, Household, and Community Level Barriers to ART Adherence among Women in Rural Eswatini. PLoS ONE, 15, Article ID: e0231952. https://doi.org/10.1371/journal.pone.0231952
Colvin, C.J., Konopka, S., Chalker, J.C., Jonas, E., Albertini, J., et al. (2014) A Systematic Review of Health System Barriers and Enablers for Antiretroviral Therapy (ART) for HIV-Infected Pregnant and Postpartum Women. PLoS ONE, 9, Article ID: e108150. https://doi.org/10.1371/journal.pone.0108150
Mhaskar, R., Alandikar, V., Emmanuel, P., Djulbegovic, B., Patel, S., Patel, A., et al. (2013) Adherence to Antiretroviral Therapy in India: A Systematic Review and Meta-Analysis. Indian Journal of Community Medicine, 38, 74-82. https://doi.org/10.4103/0970-0218.112435
Fonsah, J.Y., Njamnshi, A.K., Kouanfack, C., Qiu, F., Njamnshi, D.M., Tagny, C.T., et al. (2017) Adherence to Antiretroviral Therapy (ART) in Yaounde′-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects. PLoS ONE, 12, Article ID: e0170893. https://doi.org/10.1371/journal.pone.0170893
Kumarasamy, N., Safren, S.A., Raminani, S.R., Pickard, R., James, R., Sri Krishnan, A.K., et al. (2005) Barriers and facilitators to Antiretroviral Medication Adherence among Patients with HIV in Chennai, India: A Qualitative Study. AIDS Patient Care STDS, 19, 526-537. https://doi.org/10.1089/apc.2005.19.526
Ramlagan, S., Rodriguez, V.J., Peltzer, K., Ruiter, R.A.C., Jones, D.L. and Sifunda, S. (2019) Self-Reported Long-Term Antiretroviral Adherence: A Longitudinal Study among HIV Infected Pregnant Women in Mpumalanga, South Africa. AIDS and Behavior, 23, 2576-2587. https://doi.org/10.1007/s10461-019-02563-z
Rather, Z.A., Chowta, M.N., Prakash Raju, G.J.K. and Mubeen, F. (2013) Evaluation of the Adverse Reactions of Antiretroviral Drug Regimens in a Tertiary Care Hospital. Indian Journal of Pharmacology, 45, 145-148. https://doi.org/10.4103/0253-7613.108294
Brown, T.T. and Qaqish, R.B. (2006) Antiretroviral Therapy and the Prevalence of Osteopenia and Osteoporosis: A Meta-Analytic Review. AIDS, 20, 2165-2174. https://doi.org/10.1097/QAD.0b013e32801022eb
Eileen, P. (2018) Scully-Sex Differences in HIV Infection. Current HIV/AIDS Reports, 15, 136-146. https://doi.org/10.1007/s11904-018-0383-2
Das, A., Detels, R., Afifi, A.A., Javanbakht, M., Sorvillo, F.J. and Panada, S (2017) Health-Related Quality of Life (HRQoL) and Its Correlates among Community-Recruited Children Living with HIV and Uninfected Children Born to HIV-Infected Parents in West Bengal, India. Quality of Life Research, 26, 2171-2180. https://doi.org/10.1007/s11136-017-1557-x
Ma, L., Xu, P., Lin, H., Ju, L. and Lyu, F. (2015) Quality of Life of People Living with HIV/AIDS: A Cross-Sectional Study in Zhejiang Province, China. PLOS ONE, 10, Article ID: e0135705. https://doi.org/10.1371/journal.pone.0135705
Wig, N., Lekshmi, R., Pal, H., Ahuja, V., Mittal, C.M. and Agarwal, S.K. (2006) The Impact of HIV/AIDS on the Quality of Life: A Cross Sectional Study in North India. Indian Journal of Medical Sciences, 60, 3-12.
Nyamathi, A., Ekstrand, M., Heylen, E., Ramakrishna, P., Yadav, K., Sinha, S., et al. (2018) Relationships among Adherence and Physical and Mental Health among Women Living with HIV in Rural India. AIDS and Behavior, 22, 867-876. https://doi.org/10.1007/s10461-016-1631-3
Gakhar, H., Kamali, A. and Holodniy, M. (2013) Health-Related Quality of Life Assessment after Antiretroviral Therapy: A Review of the Literature. Drugs, 73, 651-6728. https://doi.org/10.1007/s40265-013-0040-4
Buregyeya, E., Naigino, R., Mukose, A., Makumbi, F., Esiru, G., Arinaitwe, J., Musinguzi, J., Rhoda, K., Buregyeya, W., et al. (2017) Facilitators and Barriers to Uptake and Adherence to Lifelong Antiretroviral Therapy among HIV Infected Pregnant Women in Uganda: A Qualitative Study. BMC Pregnancy and Childbirth, 17, Article No. 94. https://doi.org/10.1186/s12884-017-1276-x
Martin, F., Russell, S. and Seeley, J. (2014) Higher Quality of Life and Lower Depression for People on ART in Uganda as Compared to a Community Control Group. PLoS ONE, 9, Article ID: e105154. https://doi.org/10.1371/journal.pone.0105154
Siefried, K.J., Mao, L., Kerr, S., Cysique, L.A., Gates, T.M., McAllister, J., et al. (2017) Socioeconomic Factors Explain Suboptimal Adherence to Antiretroviral Therapy among HIV Infected Australian Adults with Viral Suppression. PLoS ONE, 12, Article ID: e0174613. https://doi.org/10.1371/journal.pone.0174613
Patel, S.V., Patel, S.N., Baxi, R.K., Golin, C.E., Mehta, M., Shringarpure, K., et al. (2012) HIV Serostatus Disclosure: Experiences and Perceptions of People Living with HIV/AIDS and Their Service Providers in Gujarat, India. Industrial Psychiatry Journal, 21, 130-136. https://doi.org/10.4103/0972-6748.119615
Sarna, A., Sebastian, M., Bachani, D., Sogarwal, R. and Battala, M. (2014) Pretreatment Loss-to-Follow-up after HIV Diagnosis from 27 Counseling and Testing Centers across India: Findings from a Cohort Study. Journal of the International Association of Providers of AIDS Care, 13, 223-231. https://doi.org/10.1177/1545109712469686
Ekstrand, M.L., Ramakrishna, J., Bharat, S. and Heylen, E. (2013) Prevalence and Drivers of HIV Stigma among Health Providers in Urban India: Implications for Interventions. Journal of the International AIDS Society, 16, Article ID: 18717. https://doi.org/10.7448/IAS.16.3.18717
Venkatesh, K.K., Srikrishnan, A.K., Mayer, K.H., Kumarasamy, N., Raminani, S., Thamburaj, E., et al. (2010) Predictors of Nonadherence to Highly Active Antiretroviral Therapy among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings. AIDS Patient Care STDS, 24, 795-803. https://doi.org/10.1089/apc.2010.0153
Wasti, S.P., Simkhada, P., Randall, J., Freeman, J.V. and van Teijlingen, E. (2012) Barriers to and Facilitators of Antiretroviral Therapy Adherence in Nepal: A Qualitative Study. Journal of Health, Population and Nutrition, 30, 410-419. https://doi.org/10.3329/jhpn.v30i4.13294
Figuero, L.S.B., Luque, P.B., Martín, T.P., Sagrado, M.G. and Bouza, J.M.E. (2011) Assessment of Factors Influencing Health-Related Quality of Life in HIV-Infected Patients. HIV Medicine, 12, 22-30. https://doi.org/10.1111/j.1468-1293.2010.00844.x
Logie, C.H., Lacombe-Duncan, A., Wang, Y., Kaida, A., Conway, T., Webster, K., de Pokomandy, A. and Loutfy, M.R. (2018)Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada. Journal of Acquired Immune Deficiency Syndromes, 77, 144-153. https://doi.org/10.1097/QAI.0000000000001589
Katz, I.T., Annemarie, E., Ryu, A.E., Onuegbu, A.G., Psaros, C. and Weiser, S.D. (2013) Impact of HIV-Related Stigma on Treatment Adherence: Systematic Review and Meta-Synthesis. Journal of the International AIDS Society, 16, Article ID: 18640. https://doi.org/10.7448/IAS.16.3.18640
Moosa, A., Gengiah, T.N., Lewis, L., et al. (2019) Long-Term Adherence to Antiretroviral Therapy in a South African Adult Patient Cohort: A Retrospective Study. BMC Infectious Diseases, 19, Article No. 775. https://doi.org/10.1186/s12879-019-4410-8