The health-related quality of life of people living with HIV/AIDS

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Abstract
Purpose: The prevalence of people living with HIV/AIDS (PLWA) in South Africa is estimated to be approximately 14.2% of the total population. In the absence of anti-retroviral therapy, PLWA are likely to experience a steady decline in function, as their immune systems become increasingly compromised. However, there is limited information available to determine the potential role of rehabilitation interventions in the management of PLWA in a resource-poor community. Subjects: Subjects were recruited from the population of beneficiaries of HIV/AIDS clinics run by Medecins Sans Frontières, which provides anti-retroviral therapy to PLWA within a resource poor community. The subjects, who were either in WHO Stage 3 or 4 of the disease and/or had a CD4 count of less than 200, were interviewed after enrolment on the anti-retroviral programme and before treatment was initiated. They were therefore not yet receiving anti-retroviral therapy. The control group consisted of a community sample randomly selected from the same area and who were in the same age range. Methods: As all participants were Xhosa speaking, the Xhosa version of the EQ-5D measure of HRQoL was utilized. Analysis: The Mann – Whitney U-test was used to determine whether there was a difference in the rank ordering of responses to the five different domains of the EQ-5D and the Visual Analogue Scale of Health Status scores. Results: There were 123 and 108 subjects in the experimental and control groups, respectively. In the domain of mobility 30.9% of the subjects reported some or severe problems, compared to 14.8% of the control group (p < 0.001). The corresponding figures for the other domains were: self-care 14.8% and 4.6% (p = 0.016), usual activity 31.7% and 10.2% (p < 0.001), pain/discomfort 69.1% and 33.3% (p < 0.001) and anxiety/depression 33.4% and 24.2% (p = 0.123) for the experimental and control groups respectively. PLWA reported a VAS score of 60.4 (SD 22.1), which was significantly lower than that of the community sample (80.13, SD 20.4, p < 0.001). Conclusion: Self-reporting indicates that Health Related Quality of Life is severely comprised in PLWA in Stages 3 and 4 and limitations in the four domains of mobility, usual activities, pain/discomfort and anxiety/depression constitute major problems for PLWA. There is an obvious need to provide a continuum of care, encompassing not only medical but also physical and mental rehabilitation services as well. In an area of high HIV prevalence, the provision of appropriate, multi-disciplinary health care services to PLWA presents a major challenge to the health services.