HIV/AIDS Treatment And Health-Related Quality Of Life: Patients’ Perspective And Impact Of Adverse Drug Reactions Among Hiv/Aids Patients
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Date
2015-05
Authors
Ahmed, Syed Imran
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Abstract
Advancements in antiretroviral treatment (ART) and shift of HIV as a chronic infection, presents challenges, including adverse drug reactions (ADRs) affecting adherence and retention to care as well as health related quality of life (HRQoL); thus evaluation of ADRs and measures of HRQoL is imperative to maximize the overall treatment outcomes. In addition, greater involvement of the patients in their medical care can benefit treatment outcomes, thus understanding patients’ knowledge and beliefs towards disease, treatment and related issues are essential elements in overall HIV care.
The present study was carried out at Hospital Sungai Buloh. Four hundred and forty three Malaysian HIV/AIDS patients, using Antiretroviral Therapy (ART) for at least three months, participated in this study. The data were analyzed using the Statistical Package for Social Sciences (SPSS®) version 18 and STATA IC® version 12. Qualitative methodology was used to explore patients’ perspectives on the disease, treatment and care with the help of a semi structured interview guide. A saturation point was reached after the 13th interview. All interviews were audio-recorded and subjected to a standard content analysis framework.
About 44% (n=194) of the total 443 HIV patients reported ADR, among them weight loss (12.6%), lipodystrophy (12.4%), peripheral neuropathy (12%), were frequently found ADRs. Poor CD4 counts (OR 1.72, 95% CI: 1.04 — 2.86), and poor viral suppression (OR 1.87, 95% CI: 1.04 — 3.36) did increase the odds of experiencing ADRs,
consequently patients experiencing ADRs had a 2.28 (95% CI: 1.25 – 4.18) fold greater risk of poor CD4 control. As for QoL, participants with no formal education had significantly lower scores for physical composite scores (PCS) in comparison to those with secondary education (p=0.049) and graduates (p=0.003). Similarly unemployed patients had significantly lower scores under the PCS domain against laborers (p=0.003) and professionals (p=0.006). ADRs were also found significantly associated with lower HRQoL in various domains and overall physical (p=0.001) and mental (p=0.013) quality of life. A number of important themes and subthemes emerged showing patients’ perspectives on HIV/AIDS treatment. Generally, participants had acceptable understandings towards the cause of disease; however elements of spirituality were also noted. Though strong beliefs existed towards the benefits of knowing HIV status, fear of stigma and discrimination, social consequences and family emotions were found important elements linked to status non-disclosure and refusal to get screened. Most participants believed in ARTs as the only available treatment; fear of side effects, lack of support system, gross hopelessness, and negative values were found reasons for non-adherence. In addition, strong believes and use of complementary and alternative medicines were found linked to disease treatment. Doctors’ hierarchy, appointment waiting time, respect and confidentiality were seen as vital elements affecting patients’ satisfaction. Uninformed and unpredictable ADRs continue to challenge HIV/AIDS patients, requiring focus on pharmacovigilance in HIV care. A real life insight about patients’ perspectives towards disease, treatment and care is inevitable in designing and improvising existing strategies to enhance areas in HIV care that requires more attention. Such strategies are important to withstand with the country’s efforts in meeting global objectives of HIV care.
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HIV , AIDS