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HEALTH OUTCOMES OF PATIENTS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) ON THE PEPFAR PROGRAMME OF THE FEDERAL MEDICAL CENTRE (FMC), MAKURDI BENUE
Abstract
Introduction: A fuller appreciation of the impact of highly active antiretroviral therapy (HAART) on HIV-positive patients requires the assessment of a comprehensive set of outcomes which include immunologic and virologic measures (laboratory), disease progression (clinical), and health-related quality of life (HRQL). Thus, this survey sought to: assess immunologic and virologic response to HAART, describe HIV-related clinical events and determine patients’ HRQL; and to identify predictors of these outcomes.
Methodology: The study was a cross-sectional survey which included a review of electronic medical records (EMRs). A systematic sampling technique was used to recruit adults receiving first-line HAART on the PEPFAR programme of the Federal Medical Centre, Makurdi, Benue State. Phase I was conducted between May and July, 2013 and a modification of the SF-36v2 questionnaire was used to assess respondents’ HRQL in 8 dimensions: physical functioning, role-physical, role-emotional, social functioning, bodily pain, vitality, mental health, and general health. Phase II was conducted between August and October, 2013 and only respondents who had complete EMRs without missing data out those interviewed in phase I were enrolled. Information were also obtained on respondents’ socio-demographic, clinical and laboratory characteristics. Data were analyzed using SPSS 17. Descriptive statistics were generated and associations tested using Pearson chi-square, Fisher’s exact test, Wilcoxon signed-rank test, McNemar chi-square and multivariate logistic regression. Statistical significance was set at 5%.
Results: In phase I, 546 respondents were interviewed and their mean ± SD age was 38.1 ± 10.6 years. Good HRQL ratings were: physical functioning (98.9%), role-emotional (98.7%), social
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functioning (98.2%), vitality (96.9%), role-physical (96.5%), mental health (96.3%), bodily pain (94.1%) and general health (93.4%). Predictors of good HRQL were: age <40 years (OR = 4.26, CI = 1.49-12.11) and being currently employed (OR = 3.20, CI = 1.08-9.49) [role-physical] ; having a care-giver (OR = 4.94, CI =1.33-18.27) and disclosing ones HIV-positive status (OR = 5.75, CI =1.27-26.09) [vitality] ; improvement in health transition (OR = 6.51, CI =1.83-23.23; OR = 4.37, CI = 1.71-11.19) [vitality; mental health] ; and satisfaction with care (OR = 6.05, CI = 2.78-13.17) [general health] . Predictors of less likelihood of good HRQL were: enjoying social support (OR = 0.12, CI = 0.03-0.55; OR = 0.24, CI = 0.07-0.86) [role-physical; mental health] ; being without spouse/partner (OR = 0.43, CI = 0.21-0.91) [general health] ; and experiencing ARV side effects (OR = 0.11, CI = 0.03-0.41; OR = 0.42, CI = 0.18-0.95) [vitality; general health] . In phase II, EMRs of 264 respondents were analysed. Predictors of clinical and laboratory response were: AIDS-defining illnesses (OR = 3.53, CI = 1.15-10.82; OR = 2.42, CI = 1.15-5.06) [virologic response; weight gain] ; and HBV co-infection (OR = 3.02, CI = 1.16-7.86) and TDF-containing regimens (OR = 2.7, CI = 1.05-6.97) [weight gain] . Predictor of less likelihood of weight gain was prior ARV experience (OR = 0.46, CI = 0.25-0.91).
Conclusions and recommendations: This study adds to the body of knowledge that HAART improves the health outcomes of HIV patients in terms of HRQL, immunologic response, virologic response and HIV-related clinical events. ART clinicians need to be responsive to factors related to the clinic; and to encourage patients to address issues of disclosure, having a care giver and social support as a means of improving HRQL. ART programmes that use EMRs need to ensure completeness and regular update of data in order to better monitor the clinical and laboratory outcomes of patients on HAART.
