An Assessment Of The Quality Of Life Of HIV/AIDS … Assessment Of The Quality Of Life Of HIV/AIDS...
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An Assessment Of The Quality Of Life Of
HIV/AIDS Patients And Their Families In Ghana
During the Scale Up of Delivery of Antiretroviral
Treatment
J.Amponsah2, C. Machingauta3, B. Ocran2, S. A. Addo1, S. Ahmed2, B.Dornoo1, H. Kazianga5, R.A.Selby2, S. Sory2, M. Over4,
N.A. Addo1, D. deWalque3, J. O.Gyapong2
1NACP -Ghana, 2Research &Development Division-Ghana Health Service, 3World Bank Development Research Group,4Center for Global
Development, 5Oklahoma State University
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Overview
Background
Hypothesis
Findings
Ghana TAP Survey
Quantitative Analysis
Results
Conclusions
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Background
Globally,
Africa’s AIDS burden;
67% of all PLWHA in SSA
72% of all AIDS related deaths in 2008(WHO,2010)
Absenteeism, Limited healthcare facilities;
2000-2009 : Average 2 physicians per 10000 people
9 hospital beds per 10000 people (WHO,2010)
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Background
Country level;
Limited access to ART,
46% estimated coverage in Ghana 2009, 15.6% in 2007 (WHO,2010)
Effect on Households;
Without ART, untrained/constrained family likely to play significant caregiving role
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Hypothesis
Impact on households and individuals?
Patient : HIV+ individual
Family: Household members residing with HIV+ individual
HIV/AIDS on patient health :Direct & negative
HIV/AIDS on family member health : negative Spillover
ART intake : patient health improves
Family member health ?
We hypothesize that antiretroviral therapy, to the extent that it improves the patient’s health, will also improve the mental well-being of caregivers 5
Findings
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Our novel empirical findings are that, in comparison to neighbors, family caregivers of AIDS patients;
Are indistinguishable on measures of physical health
Suffer a deficit in mental well-being
Benefit psychologically in relation to the time the patient spends on ART
Ghana TAP Survey
Rand Medical Outcomes Survey Instrument
507 identified patients on ART, 415 family members and 387 neighbors, all 15yrs+
5 month intervals between 2007 and 2008
Patients recruited from health facilities from 9/10 regions in Ghana
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Ghana TAP Survey
e.g. of Survey Questions:
“How much bodily pain have you generally had during the past 4 weeks ?”
“How often have you felt like crying in the past month”
8 physical and 8 mental health indexes ranging from 0-100 (100 for optimal health)
Cronbach’s Reliability : 0.92
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Physical and Mental Health IndexesPhysical Health Indexes Mental Health Indexes
Physical Functioning Anxiety
Satisfaction with physical functioning Mental Health Index
Role limitations due to physical health Psychological Wellbeing
Mobility Psychological Distress
Pain Severity Depression/Behavioral Emotional Control
Pain Role limitations due to emotional problems
Effects of pain Positive Affect
Cognitive functioning Feelings of belonging
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Quantitative Analysis
Bivariate Analysis
Multivariate cross section regressions Controls: HIV Status age, marital status, household
head, education, Greater Accra region
Multivariate panel regression Controls: HIV Status, survey round and individual fixed
effects
Standard errors clustered at health facility level
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Results
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Table 1: Physical Health Bivariate Statistics At
Baseline
Neighbor
mean
Family
mean
Patient
mean p1(N&F) p2(F&P) p3(N&P)
Physical
Functioning 91.43 89.62 80.76 0.234 0.000 0.000
Satisfaction with 90.08 89.80 83.28 0.799 0.000 0.000
physical Functioning
Mobility 96.47 94.45 92.86 0.061 0.162 0.001
Effects of Pain 84.32 83.75 79.76 0.430 0.000 0.000
Pain Severity 86.46 87.63 78.44 0.432 0.000 0.000
Pain 90.24 89.85 82.37 0.752 0.000 0.000
Role Limitations
due to 87.96 87.63 73.58 0.862 0.000 0.000
physical health
Role Limitations
(s.f) 86.50 86.44 71.18 0.976 0.000 0.000
Patients report the lowest physical health indexes
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Table 2: Physical Health Bivariate
Statistics At Follow up
Neighbor
mean
Family
mean
Patient
mean p1 (N&F) p2(F&P) p3(N&P)
Physical Functioning 92.87 92.58 87.34 0.830 0.000 0.000
Satisfaction with 92.97 92.19 87.73 0.422 0.000 0.000
physical Functioning
Mobility 96.15 96.93 95.51 0.441 0.129 0.524
Effects of Pain 86.02 85.58 83.14 0.394 0.000 0.000
Pain Severity 93.95 93.02 88.35 0.405 0.000 0.000
Pain 94.44 93.86 90.81 0.550 0.003 0.001
Role Limitations due to 93.96 92.01 84.70 0.206 0.000 0.000
physical health
Role Limitations (s.f) 92.99 90.66 82.99 0.184 0.000 0.000
No significant difference between family and neighbor physical health
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Table 3: Mental Health Bivariate Statistics At Baseline
Neighbor
mean
Family
mean
Patient
mean p1 (N&F) p2(F&P) p3(N&P)
Cognitive Functioning 84.42 83.83 77.57 0.577 0.000 0.000
Mental Health 85.61 82.77 75.55 0.001 0.000 0.000
Psychological Distress 89.76 86.82 79.26 0.001 0.000 0.000
Depression/Behavioral 89.66 86.86 79.03 0.002 0.000 0.000
emotional control
Anxiety 89.25 85.56 78.86 0.001 0.000 0.000
Psychological Wellbeing 76.61 73.70 67.33 0.007 0.000 0.000
Positive Affect 74.92 71.82 64.93 0.007 0.000 0.000
Feelings of Belonging 80.17 78.62 73.12 0.251 0.000 0.000
Families psychologically burdened at baseline
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Table 4: Mental Health Bivariate Statistics At
Follow up
Neighbor
mean
Family
mean
Patient
mean p1 (N&F) p2(F&P) p3(N&P)
Cognitive Functioning 86.97 86.52 83.20 0.647 0.001 0.000
Mental Health 85.63 84.94 80.33 0.381 0.000 0.000
Psychological Distress 90.70 89.84 85.05 0.265 0.000 0.000
Depression/Behavioral 90.57 89.50 84.66 0.160 0.000 0.000
emotional control
Anxiety 90.27 89.58 84.89 0.465 0.000 0.000
Psychological
Wellbeing 74.40 74.30 70.02 0.932 0.000 0.000
Positive Affect 72.56 72.80 67.74 0.845 0.000 0.000
Feelings of Belonging 78.92 77.34 75.17 0.272 0.097 0.006
Family psychological burden unobservable at follow up
Evolution of Physical Health75
8085
9095
Mea
n In
dex
1 2Phase
Patients Family of Patient Neighbors
95% CI Patients 95% CI Family 95% CI Neigh
Physical Functioning
Figure 1
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………………..About 6 Months of ART……………………..
Figure 2
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78
80
82
84
86
Mean Index
1 2Phase
Patients Family of Patient Neighbors
95% CI Patients 95% CI Family 95% CI Neigh
Effects of Pain
………………..About 6 Months of ART………………………
Evolution of Mental Health75
8085
90
Mea
n In
dex
1 2Phase
Patients Family of Patient Neighbors
95% CI Patients 95% CI Family 95% CI Neigh
Mental Health
Figure 3
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STATISTICAL SIGNIFICANCE
………………..About 6 Months of ART………………………
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75
80
85
90
95
Mean Index
1 2Phase
Patients Family of Patient Neighbors
95% CI Patients 95% CI Family 95% CI Neigh
Psychological Distress
Figure 4
STATISTICAL SIGNIFICANCE
………………..About 6 Months of ART………………………
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Table 5: Cross Sectional Analysis of Physical Health at Baseline
Physical
Functioning
Satisfaction
with
Physical
Functioning
Effects
of
Pain
Severity
of pain
Role Limitations
due to
Physical
Health VARIABLES Mobility
Family of Patient -2.642 1.72 -2.726 -1.425 1.374 4.916**
[2.715] [1.428] [2.025] [1.131] [1.802] [2.321]
Patient -8.035** -3.324** -2.014* -2.408** -0.847 -7.584
[3.908] [1.356] [1.038] [1.172] [3.553] [6.232]
Observations 1083 1083 1083 1081 1089 1085
R-squared 0.226 0.149 0.116 0.128 0.13 0.173
*** p<0.01, ** p<0.05, * p<0.1
Robust Standard errors in parentheses
Also controlling for HIV Status age, marital status, household head,
education, Greater Accra region
Physically, patients fare worse than neighbors
Families generally no different from neighbors
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At Baseline:
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Table 6: Cross Sectional Analysis of Mental Health at Baseline
Cognitive Functioning
Mental
Health
Index1 Psychological Distress 1
Depression-
Behavioral
/Emotional
control
Psychological Wellbeing 1
Positive Affect
Feelings
of Belonging VARIABLES Anxiety
Family of
Patient -0.178 -4.295*** -4.322*** -4.134*** -4.355*** -4.778*** -4.759*** -3.018
[0.926] [1.344] [1.272] [1.227] [1.359] [1.557] [1.484] [2.464]
Patient -2.195 -6.832*** -6.638*** -7.033*** -5.964** -7.393*** -8.199*** -5.064*
[1.945] [2.095] [1.920] [1.883] [2.529] [2.633] [2.767] [2.661]
Observations 1082 1082 1082 1082 1082 1082 1082 1082
R-squared 0.140 0.194 0.180 0.193 0.138 0.154 0.157 0.126
*** p<0.01,
** p<0.05, * p<0.1
Robust Standard errors in parentheses, age controls included
Also controlling for HIV Status age, marital status, household head, education, Greater Accra region
Mentally, patients and family members not as healthy as neighbors
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Table 7: Panel Regression, Individual Fixed effects –Physical Health
Physical
Functioning
Satisfaction. with
Physical
Functioning
Effects of
Pain
Severity
of pain
Role
Limitations
VARIABLES Mobility
due to Physical
Health
Follow up 1.997*** 2.765*** -0.676 1.787*** 8.186*** 6.806***
[0.379] [0.755] [0.798] [0.181] [0.536] [1.298]
Family at
Follow up 1.504 -1.095 3.800** -0.00548 -2.815 -4.883**
[3.156] [0.973] [1.574] [1.623] [1.745] [1.93]
Patient at
Follow -up 5.410*** 2.233** 2.005 0.894 -0.797 5.241
[1.954] [0.932] [1.506] [0.743] [1.818] [3.473]
Constant 48.97*** 98.50*** 129.8*** 81.98*** 53.13*** 87.72***
[12.49] [2.284] [2.424] [4.555] [12.45] [8.539]
Observations 2292 2292 2292 2290 2298 2294
R-squared 0.148 0.125 0.104 0.101 0.17 0.142
unique
observations 1200 1200 1200 1200 1200 1200 *** p<0.01, **
p<0.05, * p<0.1
Robust Standard errors in parentheses, age controls included
Standard Errors clustered at Health Facility level
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Family members improve more than neighbors in ‘Mobility’ and less in ‘Role Limitations’
Additional improvement for Patients in ‘Physical functioning’ and ‘Satisfaction with Physical Functioning’
At Follow up:
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Table 8 : Panel Regression, Individual Fixed Effects – Mental Health
Depression- Behavioral /Emotional
control
Cognitive Functioning
Mental Health
Index1 Psychological Distress 1
Psychological Wellbeing 1
Positive Affect
Feelings of Belonging VARIABLES Anxiety
Follow up
3.544*** 0.869** 1.952*** 1.614*** 2.520*** -1.690** -1.907*** -0.589
[0.998] [0.437] [0.361] [0.38] [0.354] [0.674] [0.59] [0.896]
Family (Follow up) 0.223 0.132 0.148 -0.312 0.813 0.754 1.18 -2.447
[0.684] [1.712] [1.763] [1.824] [1.59] [1.377] [1.3] [2.422]
Patient at
Follow -up 1.386** 2.982* 2.651** 3.510** 1.316 3.821* 4.096* 2.806
[0.531] [1.598] [1.309] [1.596] [1.049] [2.259] [2.22] [3.002]
Female Patient at Follow up 0.818 1.526* 1.819* 1.024 3.023** 1.157 1.49 -0.555
[1.487] [0.907] [0.963] [1.02] [1.274] [1.208] [1.36] [1.644]
Female Family
(Follow up) -0.0136 2.083*** 1.906*** 2.273*** 2.076*** 2.210*** 2.254*** 3.014***
[0.835] [0.576] [0.696] [0.659] [0.605] [0.661] [0.65] [0.871]
Constant
31.08*** 71.39*** 73.21*** 74.14*** 50.70*** 72.82*** 76.80*** 45.44***
[2.894] [1.508] [1.86] [2.214] [1.93] [3.025] [4.09] [3.82]
Observations 2291 2291 2291 2291 2291 2291 2291 2291 R-squared
0.143 0.112 0.138 0.13 0.132 0.071 0.07 0.085
Unique
Observations 1199 1199 1199 1199 1199 1199 1199 1199
*** p<0.01, ** p<0.05, * p<0.1
Additional improvement for female family compared to male family in 7 indexes
Additional improvement for Patients in 6 of the 8 indexes
Suggests psychological burden for patients at baseline, that wears off with ART
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At Follow up:
Conclusions
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As expected, time on ART alleviates the deficits in mental and physical well-being suffered by AIDS patients relative to their families and neighbors
Conclusions
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In comparison to neighbors, family caregivers of AIDS patients;
Are indistinguishable on measures of physical health
Suffer a deficit in mental well-being
Benefit psychologically in relation to the time the patient spends on ART
Acknowledgements
We are grateful for funding from the Dutch Government via the Bank Netherlands Partnership Program (BNPP) , and the Hewlett Foundation for grant support through Trust Fund TF070424 given to the World Bank.
Mead Over acknowledges the support of a grant to the Center for Global Development from the Bill and Melinda Gates Foundation
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