Health-related quality of life of HIV infected adults with and without Visceral Leishmaniasis in Northwest Ethiopia

Sexual dysfunction among Nigerian women living with HIV infection

INTRODUCTION

Sexual dysfunction in women with HIV is a necessary but understudied aspect of HIV complications in women living with HIV. This study reports the prevalence, pattern, and risk factors for sexual dysfunction in women living with HIV in southwest Nigeria.

METHODS

A validated Female Sexual Function Index was used to determine sexual dysfunction in a cross-sectional study design involving 2926 adult women living with HIV in a large, publicly funded tertiary HIV treatment centre in Lagos, Nigeria. A score of less than 26.5 indicated sexual dysfunction. Multivariate logistic regression analysis was performed to identify risk factors for sexual dysfunction. P<0.05 was considered statistically significant at a 95% confidence interval (CI).

RESULTS

The prevalence of sexual dysfunction was 71.4%. The types of dysfunctions detected included disorder of desire (76.8%), sexual arousal (66.0%), orgasm (50.0%), pain (47.2%), lubrication (47.2%), and satisfaction (38.8%). Multivariate analysis showed that menopause (aOR: 2.0; 1.4-4.1), PHQ score of 10 and above (aOR: 2.3; 1.7-3.2), co-morbid medical conditions (aOR: 1.8; 1.4-2.7), use of protease inhibitor-based antiretroviral therapy (aOR: 1.3; 1.2-2.1) and non-disclosure of HIV status (aOR: 0.7; 0.6-0.8) were factors associated with sexual dysfunction.

CONCLUSIONS

Sexual dysfunction is common among Nigerian women living with HIV. Menopause, use of protease inhibitor-based regimens, PHQ score of at least 10, co-morbid medical condition, and non-disclosure of HIV status were associated with sexual dysfunction. National HIV programmes, in addition to incorporating screening and management of sexual dysfunction in the guidelines, should sensitise and train health workers on the detection and treatment of sexual dysfunction.

Time to death and its determinant factors of visceral leishmaniasis with HIV co-infected patients during treatment period admitted at Metema hospital, Metema, Ethiopia: a hospital-based cross-sectional study design

BACKGROUND

Visceral leishmaniasis is caused by the parasites Leishmania donovani spices complex that can spread to internal organs and the disease is fatal with a fatality rate of nearly 100% if left untreated. Visceral Leishmania-HIV (HIV1) coinfection disease is a new clinical form of leishmaniasis very serious disease in the endemic part of the world. It also served as the primary cause of death in the lowlands of Ethiopia with the endemic Humara and Metema that are located near the Sudanese border.

METHODS

A total of 153 visceral leishmaniases with HIV co-infection secondary data was taken from the medical chart of patients from January 2015 to January 2021 and a hospital-based cross-sectional study design was carried out to retrieve relevant information. The data entered by SPSS and analysed using STATA version 14 and R4.2.1 statistical software packages using a non-parametric Model, semi-parametric Cox proportional hazard survival models at 5% significance level.

RESULT

Among the total visceral leishmaniasis with HIV co-infected patients 3.27% were females and 96.73% were males, 19 (12.42%) patients died and 134(87.58%) patients were censored. The Cox proportional hazard model result indicates that severe acute malnutrition, baseline CD4+ cell count ≥100, and underweight significantly contributed to the survival time of a patient. Cox proportional hazard model shows that severe acute malnutrition (HR=4.40027, 95% CI= 2.455061 262.7934, P-value=0.007), baseline CD4+cell count ≥100 (HR=0.2714623, 95% CI= 0.0764089 0.9644395, P-value=0.044), and Underweight (HR=4.678169, 95% CI= 1.970097 11.10872, P-value=0.040) significantly contributed to a shorter survival time.

CONCLUSION

Visceral leishmaniases with HIV co-infected patients show a large number of deaths occurred in the earlier days of treatment this implies that Visceral leishmaniasis accelerates HIV replication and disease progression death. The researcher suggests that people be aware of the burden posed by those risk factors and knowledgeable about the diseases. So, the researcher recommended that to health workers implement primary health care in those patients and careful consideration of a neglected parasitic disease.

Behavioral and psychosocial factors of quality of life among adult people living with HIV on Highly Active Antiretroviral Therapy, in public hospitals of Southwest Ethiopia

Despite the availability of Highly Active Antiretroviral Therapy, the quality of life (QOL) of People Living with HIV/AIDS (PLWHIV) has continued to be affected. However, previous studies focused on the magnitude and clinical determinants which lacks behavioral and psychosocial factors of QOL. Thus, this study aimed to identify behavioral and psychosocial determinants of QOL among Adult PLWHIV on HARRT, in Public Hospitals of Jimma Zone, South West, Ethiopia, 2018. A cross-sectional study design was conducted in Public Hospitals of Jimma Zone, Southwest Ethiopia from March 10 to April 10/2018. QOL of was measured using WHOQOL-HIV BREF instrument. A simple random sampling technique was employed to enroll study participants. A pretested interviewer-administered structured questionnaire was used to collect data. Then, data were entered into Epi-Data version 3.1 and analyzed using SPSS version 20. Bivariate and multiple variable logistic regression analyses were also performed. A total of 300 respondents were enrolled into the study yielding a response rate of 97.7%. The majority of respondents were from urban residence and between 35-44 years of age. About 47% of respondents have ever used substances, and 58.3% have obtained social support. Nearly 80% and 26.3% of the study participants were stigmatized and severely depressed. More than half of the study participants had good overall QoL with the highest domain QOL in level of independence and lowest in social relations. Factors associated with poor physical health include being government employee AOR 0.33 95%CI (0.15, 0.69), from private business AOR 0.33 95%CI (0.14, 0.79), being 1st wealth quintile AOR 2.44 95%CI (1.16, 5.14), and not obtaining financial support AOR 4.27 95%CI (1.94, 9.42). Lower wealth index has been associated with almost all domain scores of poor QOL except spiritual domain. More than half of the respondents had good overall QoL with the highest domain score in level of independence and lowest in social relations domain. Several factors have contributed to poor domain QOL of PLWHIV. Therefore, it will become all the most important to develop effective strategies, policies and programs targeting people living with HIV. Emphasis should be given to the socio-economic factors that affect their QOL on HAART. Professional counseling and guidance with life skill packages should be strengthened to cope up with adverse behavioral factors. Finally, psychosocial support should be provided from all responsible bodies.

Relationship between spiritual well-being and Health-Related Quality of Life and some related factors in patients with AIDS/HIV

Objective

The study of effective factors on the quality of life (QoL), as an important criterion, in the outcome of new therapeutic and preventive strategies in human immunodeficiency virus (HIV) has been considered by researchers. To study the relationship between spiritual well-being and Health-Related Quality of Life (HRQoL) and some related factors in patients with Acquired Immunodeficiency Syndrome ([AIDS]/HIV).

Methods

In this cross-sectional study, 224 people were selected as the study population (112 were male and 112 were female) from patients with AIDS/HIV at the Behavioral Counseling Center of Shiraz with available sampling method. The research tool was Palutzian & Ellison well-being scale and QoL Questionnaire (SF-36). Data were analyzed using Pearson correlation test.

Results

There was a significant direct relationship between physical function dimensions (P = 0.003). There was a significant relationship between general well-being, mental well-being, and total spiritual well-being (P < 0.001). There was a statistically significant relationship between the dimensions of QoL and spiritual well-being with some age section of the patients, and their occupation and education (P < 0.001).

Conclusions

Spirituality has an impact on the QoL dimensions. Therefore, HIV positive people's quality of life could be improved by the possibility of the spiritual well-being promotion as a method of adaptation with the disease.

Translation and psychometric evaluation of chronic illness anticipated stigma scale (CIASS) among patients in Ethiopia

Background

Stigma is common among patients with chronic illnesses. It affects the delivery of healthcare for not addressing the psychological components and may interfere with the patient’s attendance to necessary health care services. Therefore, a valid and reliable instrument to measure anticipated stigma related to chronic illness is vital to inform possible interventions. This study aimed to translate the Chronic Illness Anticipated Stigma Scale (CIASS) into the Amharic language and evaluate its psychometric properties in Ethiopia.

Methods

The CIASS was translated into Amharic language using standard procedures. The Amharic version was completed by 173 patients (response rate 96%) with chronic illness from three referral hospitals in the Amhara region. Internal consistency was examined through Cronbach’s alpha. Construct validity was evaluated by confirmatory factor analysis and convergent validity by using a Pearson correlation of P-value less than or equal to 0.05.

Results

The internal consistency was estimated at Cronbach alpha of 0.92. By using a structural equation model, and modification indices a model fitness testing was run and shows a root mean squared error of approximation 0.049 (90% CI, 0.012–0.075). The structural validity results in 78.8% of confirmatory factor analysis showed from the extraction of the three-dimension (components). Validity tests for convergent by using Pearson correlation positively correlated with common mental distress and negatively correlated with quality of life–BREF, and the construct validity shows a good valid tool to CIASS.

Conclusion

The Amharic language version of the chronic illness anticipated stigma scale shows a satisfactory level of reliability and validity on different psychometric measures of assessment. The tool may be useful for future researchers and patients with chronic illness in the Amharic-speaking population. Moreover, it will be used to see the psychological burden related to chronic illness and for comparison among international population groups.

Knowledge, attitude and practices towards visceral leishmaniasis among HIV patients: A cross-sectional study from Bihar, India

Background

In the Indian state of Bihar, visceral leishmaniasis (VL) is a major public health issue that has been aggravated by the rising incidence of new Human immunodeficiency virus (HIV) infections. In endemic areas, the risk of VL infections in patients living with HIV (PLHIV) is higher. It is important to investigate the disease-related knowledge, attitude, and practices (KAP) of PLHIV in Bihar in order to monitor HIV/VL co-infection. Adequate knowledge, a positive attitude, and good practices for VL control are essential to stamp out the disease. This study investigated the KAP towards VL in HIV patients attending antiretroviral therapy (ART) clinic at ICMR-RMRIMS, Patna.

Methods

A questionnaire based cross-sectional study was performed among 120 HIV patients aged ≥18 years, to evaluate their KAP regarding visceral leishmaniasis. For the KAP indicators, each correct answer received a score of 1, while unsure and incorrect responses received a score of 0. Descriptive statistics and logistic regression were used for the analysis. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.

Results

The study population had a male (68.30%) preponderance with a mean age of 37.03 years ± 9.80 years of standard deviation. The majority (93.30%) of the study participants had previously heard about VL. Only 32.10% of those who had heard about VL knew that the disease was transmitted by the sandfly. Most (80.40%) of the study respondents were ignorant of the sandfly breeding grounds. The vast majority (75.90%) had no idea how to recognize sandflies and were unaware of their biting time, leishmaniasis transmission season, and preventive practices. Although PLHIV are vulnerable to VL, only 27.70% of them agreed that VL is a fatal disease if untreated, and 42.90% believed they wear not at risk of developing the disease. Regarding the control methods of sandflies, 28.60% of participants did not use any methods to avoid sandfly bites. The multivariable analysis revealed that occupation and family history were the two independent predictor variables of the knowledge index. Age and gender were significantly associated with attitude towards VL. Participants working as laborers had significantly lesser odds (AOR: 0.248, 95% CI: 0.073–0.844) to follow good preventive practices. There were significantly higher odds of having good practice among participants aged 18–40 years (AOR: 6.866, 95% CI: 1.694–27.834) and those residing in urban areas (AOR: 4.159, 95% CI: 1.317–13.139) than their peers. Overall, 27.7% of respondents were knowledgeable, 41.1% had a positive mindset, and 33.9% had strong VL preventive habits, according to the study.

Conclusion

The study determined a remarkable gap in the knowledge attitude and practices towards VL among PLHIV. This underscores the need of augmented health education initiatives for PLHIV in endemic areas for good VL awareness and preventive practices.

Tissue/Biofluid Specific Molecular Cartography of Leishmania donovani Infected BALB/c Mice: Deciphering Systemic Reprogramming

Pathophysiology of visceral leishmaniasis (VL) is not fully understood and it has been widely accepted that the parasitic components and host immune response both contribute to the perpetuation of the disease. Host alterations during leishmaniasis is a feebly touched area that needs to be explored more to better understand the VL prognosis and diagnosis, which are vital to reduce mortality and post-infection sequelae. To address this, we performed untargeted metabolomics of Leishmania donovani (Ld) infected, uninfected and treated BALB/c mice’s tissues and biofluids to elucidate the host metabolome changes using gas chromatography–mass spectrometry. Univariate and multivariate data treatments provided numerous significant differential hits in several tissues like the brain, liver, spleen and bone marrow. Differential modulations were also observed in serum, urine and fecal samples of Ld-infected mice, which could be further targeted for biomarker and diagnostic validations. Several metabolic pathways were found to be upregulated/downregulated in infected (TCA, glycolysis, fatty acids, purine and pyrimidine, etcetera) and treated (arginine, fumaric acid, orotic acid, choline succinate, etcetera) samples. Results also illustrated several metabolites with different pattern of modulations in control, infected and treated samples as well as in different tissues/biofluids; for e.g. glutamic acid identified in the serum samples of infected mice. Identified metabolites include a range of amino acids, saccharides, energy-related molecules, etcetera. Furthermore, potential biomarkers have been identified in various tissues—arginine and fumaric acid in brain, choline in liver, 9-(10) EpOME in spleen and bone marrow, N-acetyl putrescine in bone marrow, etcetera. Among biofluids, glutamic acid in serum, hydrazine and deoxyribose in urine and 3-Methyl-2-oxo pentanoic acid in feces are some of the potential biomarkers identified. These metabolites could be further looked into for their role in disease complexity or as a prognostic marker. The presented profiling approach allowed us to attain a metabolic portrait of the individual tissue/biofluid modulations during VL in the host and represent a valuable system readout for further studies. Our outcomes provide an improved understanding of perturbations of the host metabolome interface during VL, including identification of many possible potential diagnostic and therapeutic targets.

Health-related quality of life and associated factors among people living with human immunodeficiency virus on highly active antiretroviral therapy in North East Ethiopia: Cross-sectional study

INTRODUCTION

HIV/AIDS remains a public health concern affecting millions of people across the world. Although the health-related quality of life (HRQoL) of patients living with HIV has significantly improved after treatment, its chronicity makes the HRQoL uncertain. This study assessed factors associated with the health-related quality of life among people living with HIV/AIDS on HAART in North-East Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from March to April 2018, and systematic random sampling was used to select 235 participants who were on HAART. HRQoL was assessed using the Medical Outcomes Study HIV Health Survey. Descriptive and multiple linear regression analysis were computed using the statistical package for social sciences version 20.

RESULTS

The study revealed one-factor structure and had good overall internal consistency (78.5). Over one-third (42.6%; 95% CI; 36.2%, 48.9%) of participants had good HRQoL. The least HRQoL mean score was found for cognitive functioning 32.21(±19.78), followed by social functioning 40.58(±29.8). Factors associated with the overall HRQoL were 25-45 years of age (β = - 3.55, 95% CI;-6.54, -0.55), working in private sector (β = -5.66, 95% CI;-9.43, -1.88), government (β = -4.29, 95% CI;-7.83, -0.75) and self-employment (β = -8.86, 95% CI;-13.50, -4.21), 100-200 (β = - 4.84, 95% CI;-9.04, -0.63) and 201-350 CD4 at the time of diagnosis (β = - 7.45, 95% CI;-11.73, -3.16), 351-500 current CD4 level (β = 8.34, 95% CI;5.55, 11.41), 6-10 years of disease duration (β = -8.28, 95% CI;-12.51, -4.04), WHO stage II (β = -4.78, 95% CI;-8.52, -1.04) and III (β = 3.42, 95% CI;0.06, 6.79) during treatment initiation and not taking of Cotrimoxazole prophylaxis (β = -5.79, 95% CI;-8.34, -3.25).

CONCLUSIONS

High proportion of participants had a poor HRQoL. Routine assessment and appropriate interventions at each visit is recommended to improve HRQoL.

Health-related quality of life of patients with HIV/AIDS at a tertiary care teaching hospital in Ethiopia

Background

Patients’ health-related quality of life (HRQoL) and health state utility values are critical inputs in the clinical and economic evaluation of treatments for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). However, information on health state utility values is lacking in the context of Ethiopia. Here, we aimed to assess HRQoL and determine health state utility values and factors that influence the values among HIV/AIDS patients in Ethiopia.

Methods

A cross-sectional study was conducted among 511 HIV/AIDS patients at Tikur Anbessa Specialized Hospital in Ethiopia. Patients aged 18 years or older were eligible for the interview and those who were mentally unstable and with hearing impairment were excluded from the study. We performed face-to-face interviews using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) in combination with EuroQol-Visual Analog Scales (EQ-VAS). Level-specific disutility coefficients obtained from the general population were used for computing utility values. Patients’ health profiles were described using percentages and different statistical analysis were conducted to determine factors associated with the EQ-5D index and EQ-VAS scores.

Results

A total of 511 patients participated in the study. A higher proportion of patients reported slight or more severe problems on the anxiety/depression (55.2%) and pain/discomfort (51.3%) dimensions. The overall median utility value of HIV/AIDS patients was 0.94 (IQR = 0.87, 1) from the EQ-5D index and 80% (IQR = 70%, 90%) from the EQ-VAS scores. Demographic characteristics including age, occupational status, and household monthly income significantly affected patient’s utility values. Moreover, statistically significant (p < 0.001) differences were seen between the EQ-5D index values of patients with different CD4 count intervals. Furthermore, number of medicines that the patients were taking at the time of the study and comorbidities were significantly associated with the EQ-5D utility index and EQ-VAS score, p < 0.001.

Conclusions

The anxiety/depression and pain/ discomfort dimensions were identified to have critical influence in reducing the HRQoL of adult HIV/AIDS patients in the context of Ethiopia. The study is also the first to use the EQ-5D-5L tool to identify health state utility values for Ethiopian adult HIV/AIDS patients. Future economic evaluations of HIV/AIDS interventions are encouraged to employ the identified utility values.

Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia

BACKGROUND

Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia.

METHOD

A cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients' adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL.

RESULT

Of the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (β = 0.29; 95%CI = 0.21,0.36; p < 0.001).

CONCLUSION

The relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.

Multivariate multilevel modeling of quality of life dynamics of HIV infected patients

BACKGROUND

Longitudinal quality of life (QoL) is an important outcome in many chronic illness studies aiming to evaluate the efficiency of care both at the patient and health system level. Although many QoL studies involve multiple correlated hierarchical outcome measures, very few of them use multivariate modeling. In this work, we modeled the long-term dynamics of QoL scores accounting for the correlation between the QoL scores in a multilevel multivariate framework and to compare the effects of covariates across the outcomes.

METHODS

The data is from an ongoing prospective cohort study conducted amongst adult women who were HIV-infected and on the treatment in Kwazulu-Natal, South Africa. Independent and related QoL outcome multivariate multilevel models were presented and compared.

RESULTS

The analysis showed that related outcome multivariate multilevel models fit better for our data used. Our analyses also revealed that higher educational levels, middle age, stable sex partners and higher weights had a significant effect on better improvements in the rate of change of QoL scores of HIV infected patients. Similarly, patients without TB co-infection, without thrombocytopenia, with lower viral load, with higher CD4 cell count levels, with higher electrolytes component score, with higher red blood cell (RBC) component score and with lower liver abnormality component score, were associated with significantly improved the rate of change of QoL, amongst HIV infected patients.

CONCLUSION

It is hoped that the article will help applied researchers to familiarize themselves with the models and including interpretation of results. Furthermore, three issues are highlighted: model building of multivariate multilevel outcomes, how this model can be used to assess multivariate assumptions, involving fixed effects (for example, to examine the size of the covariate effect varying across QoL domain scores) and random effects (for example, to examine the rate of change in one response variable associated to changes in the other).

Health-Related Quality of Life and Associated Factors Among Adult HIV Mono-Infected and TB/HIV Co-Infected Patients in Public Health Facilities in Northeast Ethiopia: A Comparative Cross-Sectional Study

PURPOSE

This study was conducted to assess the health-related quality of life and associated factors among adult human immunodeficiency virus (HIV) mono-infected and tuberculosis (TB) and HIV co-infected patients in the public health facilities of northeast Ethiopia.

METHODS

A comparative facility-based cross-sectional study was conducted from February 01 to May 30, 2019. A total of 434 HIV mono-infected and 143 TB/ HIV co-infected patients were randomly selected for the study. The data were collected using an interviewer-administered structured questionnaire. The health-related quality of life of patients was measured using the World Health Organization quality of life HIV instrument which contains physical, psychological, social relationships, environmental, level of independence, and spiritual domains. The validated version of the Kessler scale was used to assess depressive symptoms. Linear regression analysis was performed to identify factors associated with the outcome variables, and a p-value < 0.05 with 95% CI was used to measure the degree of association between health-related quality of life and independent variables.

RESULTS

The mean scores of health-related quality of life among HIV mono-infected patients in terms of thephysical, psychological, level of independence, social relationships, environmental, and spiritual health domains were 63.9, 65.0, 60.5, 59.0, 56.4, and 63.9, respectively; whereas the mean scores among TB/HIV co-infected patients were 46.6, 48.5, 42.7, 43.5, 39.3, and 51.3, respectively. Among HIV mono-infected patients, being married improved the quality of social relationships by 6.7 compared with unmarried patients (β = 6.7, 95% CI = 3.24, 10.11); whereas among the TB/HIV co-infected patients, being educated increased the quality of social relationships by 10.6 compared with being uneducated (β=10.6, 95% CI=3.70, 17.51).

CONCLUSION

The study revealed that the TB/HIV co-infected patients had poor health-related quality of life in all domains compared with HIV mono-infected patients. Besides, depression and stigma were more prevalent among co-infected patients. Therefore, designing and implementing specific management that focuses on psychiatric centers for TB/HIV co-infected patients will be necessary as their quality of life is lowered.

Determinants of Poor Quality of Life Among Adults Living with HIV and Enrolled in Highly Active Anti-Retroviral Therapy at Public Health Facilities of Arba Minch Town Administration in Southern Ethiopia

Background

The human immunodeficiency virus (HIV) continues to be a major global public health problem with more than 35 million people worldwide infected so far. Evidence shows that HIV has been compromising the quality of life of people living with HIV (PLWH) even in this era of highly active anti-retroviral therapy (HAART). There has been little research into the quality of life of PLWH receiving HAART in Ethiopia.

Purpose

The aim of this study was to assess the quality of life among PLWH attending anti-retroviral therapy at public health facilities of Arba Minch town, Southern Ethiopia, in 2019.

Patients and methods

We conducted a cross-sectional study design on 391 randomly selected PLWH who were attending HAART. We used a systematic random sampling technique to select participants in public health facilities of Arba Minch town from February 16 to April 26, 2019. The interviewers administered a structured questionnaire consisting of the WHOQOL-HIV BREF tool to measure the quality of life. Socio-demographic variables of study participants were collected, together with variables related to their clinical status extracted from their clinical records. Percentage mean scores were calculated and the mean of percentage mean scores was taken as the cutoff to categorize participants into two groups representing poor and good quality of life. Simple binary logistic regression and multivariable logistic regression analyses were used to determine significant variables. All variables with p-value ≤ 0.25 in simple binary logistic regression were considered as eligible variables for multivariable logistic regression. Variables with p-value ≤ 0.05 in multivariable logistic regression were considered as predictor variables.

Results

Out of the 391 enrolled adult PLWH, 184 of them (47.1%) had poor of overall quality of life status, as estimated by the WHOQOL-HIV BREF tool. Good quality of life was positively associated with recent CD4 count greater than or equal to 500 cell/mm³ (AOR=1.96, 95% CI; 1.18-3.27), absence of depression (AOR=10.59, 95% CI; 6.16-18.21), normal body mass index (AOR=2.66, 95% CI; 1.18-3.27), social support (AOR= 6.18, 95% CI; 3.56-10.75) and no perceived stigma (AOR=2.75, 95% CI; 1.62-4.67).

Conclusion

Nearly half of the adult PLWH receiving HAART at Arba Minch town had poor quality of life. High CD4 count, lack of social support, depression, and perceived stigma were associated with poor quality of life of PLWH. PLWH should be encouraged to be part of structured social support systems, such as associations of people living with HIV and mother support groups, in order to improve their social and psychological health. The health system should give attention to counseling on chronic care adherence and nutritional support to improve the quality of life of PLWH receiving HAART.

The impact of leishmaniasis on mental health and psychosocial well-being: A systematic review

BACKGROUND

Leishmaniasis is a neglected tropical parasitic disease endemic in South Asia, East Africa, Latin America and the Middle East. It is associated with low socioeconomic status (SES) and responsible for considerable mortality and morbidity. Reports suggest that patients with leishmaniasis may have a higher risk of mental illness (MI), psychosocial morbidity (PM) and reduced quality of life (QoL), but this is not well characterised. The aim of this study was to conduct a systematic review to assess the reported impact of leishmaniasis on mental health and psychosocial wellbeing.

METHODS

A systematic review of the literature was carried out. Pre-specified criteria were applied to identify publications including observational quantitative studies or systematic reviews. Two reviewers screened all of the titles, abstracts and full-studies and a third reviewer was consulted for disagreements. Data was extracted from papers meeting the criteria and quality appraisal of the methods was performed using the Newcastle-Ottawa Scale or the Risk of Bias in Systematic Review tool.

RESULTS

A total of 14 studies were identified from 12,517 records. Nine cross-sectional, three case-control, one cohort study and one systematic review were included. Eleven assessed MI outcomes and were measured with tools specifically designed for this; nine measured PM and 12 measured QoL using validated measurement tools. Quality appraisal of the studies showed that six were of good quality. Cutaneous leishmaniasis and post kala-azar dermal leishmaniasis showed evidence of associated MI and PM including depression, anxiety and stigma, while all forms of disease showed decreased QoL. The findings were used to inform a proposed model and conceptual framework to show the possible links between leishmaniasis and mental health outcomes.

CONCLUSION

There is evidence that leishmaniasis has an impact on MI, PM or QoL of patients and their families and this occurs in all the main subtypes of the disease. There are however large gaps in the evidence. Further research is required to understand the full extent of this problem and its mechanistic basis.

Effect of Health Care on Quality of Life among Human Immunodeficiency Virus Infected Adults With and Without Visceral Leishmaniasis in northwest Ethiopia: A Longitudinal Follow-Up Study

There has been a scarcity of data on the effect of health care on the quality of life (QoL) of human immunodeficiency virus (HIV)- and visceral leishmaniasis (VL)- coinfected patients over time. We sought to assess the change that health care brings about in the QoL of HIV patients with and without VL and its predictors in 6 months. A total of 465 HIV patients without VL and 125 HIV-VL-coinfected patients were enrolled in the longitudinal follow-up study from October 2015 to September 2016. Data on QoL at baseline and in 6 months were collected by trained nurses through face-to-face interviews using a short Amharic version of World Health Organization QoL instrument for HIV clients. Multiple linear regressions were used to assess the predictors of health-related QoL. There was an improvement in all of the domains of QoL at the sixth month follow-up compared with the baseline for both groups of patients (P < 0.001). Lack of social support and income were associated with the low improvement in QoL in most of the domains in both groups. Compared with patients having severe acute malnutrition, patients having moderate acute malnutrition and normal nutritional status were better in most of the QoL domains in both groups of patients. Both antiretroviral and anti-VL treatments showed improvement in all dimensions of QoL. Income, social support, and nutritional status were the predictors for most of the QoL domains.