Health-Related Quality of Life Dynamics of HIV-positive South African Women up to ART Initiation: Evidence from the CAPRISA 002 Acute Infection Cohort Study

Abstract

Few studies have investigated the long-term dynamics in health-related quality of life (HRQoL) among HIV-positive persons from acute infection. From 2004, 160 women were enrolled into the CAPRISA 002 Acute Infection study at two sites in the province of KwaZulu-Natal and underwent 3–6 monthly HRQoL assessments using the functional assessment of HIV infection (FAHI) instrument. Overall and 5 sub-scale FAHI scores [physical well-being (PWB), emotional well-being (EWB), functional and global well-being (FGWB), social well-being (SWB) and cognitive functioning (CF)] were calculated up to antiretroviral therapy (ART) initiation and scores at enrollment were compared to the acute, early and established infection phases. Mixed-effects regression models adjusting for behavioral and clinical factors were applied to assess HRQoL trends and the proportion of women meeting minimally important differences was calculated. Our analyses revealed that overall/sub-scale scores improved over time, except from PWB and CF. A higher educational status, contraceptive use and a higher BMI were the strongest predictors of higher overall/sub-scale FAHI scores. CD4 count and HIV viral load were strongly associated with PWB and CF, but not overall FAHI and other sub-scales. Women newly diagnosed with acute HIV infection face profound HRQoL challenges. While early ART delivery may be important for PWB and CF, factors such as education, contraception provision and good nutritional status should be promoted to maximize HRQoL in HIV positive individuals.

Gender Differences and Psychosocial Factors Associated with Quality of Life Among ART Initiators in Oromia, Ethiopia

“…Although the cause of psychological distress is beyond the scope of this study, the availability of ongoing counseling services to PLWHA has been shown to help mitigate the trauma or other psychological effects that may result from receiving an HIV diagnosis, navigating complex drug regimens, or isolation caused by stigma [40, 41]. Our findings that persons who initiated treatment late (CD4+ count <150 cells/µL or WHO stage 4) had lower HAT-QoL scores than those with less advanced disease were also consistent with studies performed in other resource-limited settings that showed a strong correlation between clinical indicators and HRQoL [2, 12]. Both unemployed men and women reported lower overall function scores but the effect of unemployment on HAT-QoL scores was larger in men.…”

Impact of Antiretroviral Therapy on Health-Related Quality of Life among South African Women in the CAPRISA 002 Acute Infection Study

“…Cognitive decline is known to accompany HIV progression, a finding detected in our previous investigation of the natural history of HIV 1 subtype C infection in ART-naïve women with extensive follow-up after acute infection [16]. In our current study, however, CF exhibited a non-monotonic shape, indicating initial stabilization and later rebounding, a finding consistent with a systematic review suggesting only partial improvement in neurocognitive function due to ART [44].…”

“…Few longitudinal studies, and even less recruiting at acute HIV infection, have been conducted in sub-Saharan Africa. In our previously published report in this journal [16], we used data from the CAPRISA 002 Acute Infection Study, a cohort study with extensive follow-up to assess HRQoL of HIV-positive South African women from acute infection up to ART initiation. Building on these investigations, here, we report on the long-term impact of ART on HRQoL among HIV-infected women from the CAPRISA 002 study.…”

Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics

“…6,7 At an individual and population level, suboptimal access and retention in care and poor HIV clinical outcomes (e.g., unsuppressed viral load) may impact women’s morbidity, mortality and overall quality of life, including emotional and psychological health, sexual and reproductive health and economic productivity. 8 …”