Health-related quality of life of antiretroviral treatment defaulters in Botswana

Abstract

BackgroundAntiretroviral therapy (ART) improves patients’ health-related quality of life (HRQoL). Defaulting from ART has detrimental consequences, including the development of viral resistance, treatment failure and increased risks of disease progression. Little is known about the quality of life of ART defaulters and reasons for discontinuing their ART.ObjectivesThis study sought to measure the HRQoL of ART patients in Botswana who were on ART for up to 5 years but had discontinued treatment for at least 3 months, and to identify factors associated with ART defaulting.MethodWe conducted a cross-sectional study with 104 eligible respondents in four ART clinics in south eastern Botswana. We assessed respondents’ HRQoL using the World Health Organization Quality of Life Questionnaire for HIV short form. Clinical information was obtained from respondents’ medical records. Data were analysed using SAS version 9.2.ResultsReasons for discontinuing ART were inaccessible clinics (22.4%), feeling better (21.4%), running out of pills (11.2%), depression (8.2%), lack of care and/or support (8.2%), failure to understand instructions (7.7%), medications’ side effects (6.1%) and alcohol abuse (3.1%). In multivariate analyses, respondents aged 36–45 years had a 0.03 lower independence HRQoL score compared to those aged 35 and younger (β = -0.03; 95% confidence interval: -1.72, -1.66). Despite defaulting from their ART, respondents’ calculated HRQoL scores were moderate.ConclusionThis study highlights the need to enhance ART adherence in order to improve the HRQoL of people living with HIV and/or AIDS.

Determinants of health-related quality of life in young adults living with perinatally acquired HIV infection in Botswana

“…The findings are consistent with the findings of a study on the HRQOL of PLWH in Botswana by Ndubuka et al, which found the highest mean score in the Physical domain (15.3) and the lowest in the Environment domain (11.9). 30 The high mean scores of HRQOL in the Physical domain could be as a result of the fact that the majority of participants in our study were clinically stable on ART, resulting in good physical functioning and Level of Independence. In general, the effects of ART on HRQOL include viral suppression, enhanced immune system functioning, and reduction in AIDS-related illnesses.…”

“…Finally, the Spirituality domain assesses forgiveness and blame, concerns about the future, and fear of death and dying. 24 , 32 Before this study, the WHOQOL-HIV BREF was used to assess HRQOL in adult PLWH in Botswana by Ndubuka et al 30 …”

“…Few studies have assessed HRQOL in PLWH in Botswana. 29 , 30 , 31 However, there is no published research on the HRQOL of YALPH, possibly because this is still an emerging population. Consequently, it is unknown what factors affect the HRQOL of YALPH in Botswana and what policies and programmes are needed to enhance their well-being.…”

Challenges influencing nurse-initiated management of antiretroviral therapy training and implementation in Ngaka Modiri Molema district, North West province

“…Several studies reviewed have revealed similar challenges; however, in this study, the shortage of treatment and equipment was not raised. The lack of management to support the HIV and TB programme affected its performance and this was supported by Ndubuka et al (2016) that clinical role model is necessary to improve implementation.…”

Strategies to improve the implementation of nurse-initiated management of antiretroviral therapy (NIMART) training: a systematic review

“…Inadequate security poses a risk to staff, drugs and equipment. Poor clinical leadership role models, support and supervision by unit managers in developing student nurses also exist [34,35].…”