HRQoL studies in Uganda, Kenya, South

Africa and Ghana

Dr. Antonieta Medina Lara 

ABBA Partners Meeting 20th – 21st May 2010

BOCCONI

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Health Economics• ECHOUTCOME

Methodological work on assessment of Health Outcomes in particular Quality of Life Adjusted Years (utilities) in 27 European countries

Global Health• HRQoL assessment for the ARROW trial• Economic analysis of implementing DART• Methodological work on costing HIV/AIDS interventions with UNAIDS, WHO & Global Fund• Methodological work on costing interventions for OVC with UNICEF

Centre for Research in Healthcare Management

BACKGROUND

• HIV/AIDS is recognised to affect both the life expectancy and the quality of life of individuals

• Evidence from clinical trials has demonstrated that ART is an effective intervention for improving the quality of life of HIV infected individuals

• What is the impact of ART on quality of life beyond clinical markers?

• Are there emerging topics from country comparisons?

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HRQoL IMPACT BEYOND CLINICAL MARKERS

• Physical improvement – more energy and strength, ability to take for oneself, less time bed ridden

• Better mental health – hope for longer and better life, seeing children grow up

• Psychological well-being – ability to share with others receiving treatment experiences, desires, fears

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QUALITY OF LIFE MEANING

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QUALITATIVE METHODS

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Focus Group Discussions and In-Depth Interviews have been used to obtain data on how ART has affected individual’s quality of life and have provided in-depth understanding of situations, beliefs, attitude and behavior of individuals receiving ART in order to prepare summary research briefs

Ken

ya

Ug

an

da

Emerging topics

KEY THEMES UGANDA

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The analyses are taking into account: gender, receiving and not receiving ART, onset of ART and a year after ART• Stigma• Poverty and other socio economic constraints • Adherence – currently working on it• Coping with HIV/AIDS and with ART • Sexual and reproductive needs (partner preferences, contraception, pregnancy, condom use, abortion)• Disclosure• Dealing with the future (fear of death, orphaning of children, investing for the future

KENYA HRQOL STUDY OBJECTIVES

• To describe the perceptions of QoL and HRQoL from the perspectives and experiences of PLHIV, community members and policy makers

• To identify factors that enhance and /or constrain HRQoL within the context of HIV infection

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KENYA HRQOL

Category of Participants FGDsKey

InformantInterviews

In-depthInterviews Narratives

PLHIV1. PLHIV - men on ART2. PLHIV – men not on ART3. PLHIV - women on ART4.PLHIV - women not on ARTCommunity members5. Caregivers of PLHIV6.CHWs6. Men7. Women8. Youth(Female 2, male 2)

223311224

9. Service providers10.Policy/programme managers

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11. PLHIV on ART12. PLHIV not on ART

40 7

33

Total 20 6 47 6

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GHANA HRQOL

A qualitative study on: The Impact of HIV/AIDS and ART on the Health Related Quality of Life of Persons living with HIV/AIDS in Ghana

Study objectives: 1. To assess the perceptions and concepts of health

and quality of life among PLHA2. To determine factors that affect the HRQoL of

PLHA3. To compare the impact of ART on the HRQoL of

PLHA   10

GHANA TIMETABLE

• Ethical approval received on the third week of May

• Data collection end of June – mid Sept

• Analysis mid Dec

• Writing up and first draft mid Feb   

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FURTHER WORK

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Ken

ya

Ug

an

da Emerging

topics

Ghana

QUANTITATIVE ANALYSES

• Longitudinal analysis of the MOS-HIV and the WHOQOL-HIV - Uganda

• Quality Adjusted Life Years in Uganda and South Africa

• Cost-effectiveness analysis of different models of care• Health states analysis in order to obtain utilities

• Longitudinal analysis using Preference Elicitation Methods - Uganda

UGANDA OUTPUTS

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Nyanzi Wakholi, B; Medina Lara, A; Munderi P, Gilks C and Grosskurth Heiner on behalf of the DART Trial Team. Coping with ART: Challenges of ART and their implications for adherence among HIV infected Ugandans

Medina Lara, Jesse Kigozi, Jovita Amurwon, Lazarus Muchabaiwa, Barbara Nyanzi Wakholi, Sarah Walker, Ronnie Kasirye, Francis Ssali, Heiner Grosskurth, Abdel Babiker, Cissy Kityo, Paula Munderi, James Hakim, Peter Mugyenyi, Di Gibb, Andrew Reid, Janet Darbyshire and Charlie Gilks on behalf of the DART Trial. Cost Effectiveness Analysis Of Routine Laboratory Or Clinically Driven Strategies For Monitoring Anti-Retroviral Therapy In Uganda And Zimbabwe (under review)

UGANDA HOUSEHOLD HRQOL STUDY SOCIAL

MAPPINGEight social mapping exercises (four with women and four with men) were conducted in four villages within a 20km radius from the 3 major HIV/AIDS treatment institutionsGender differences were observed in:

- education levels with men having higher education than the females - perceptions of socio-economic activities. Women categorised more

domestic related activities while men were more commercial orientated. 2. High levels of unemployment and poverty were reported by all participants3. Poverty was blamed to be the reason for people to indulge in unsafe sex in

order to meet their economic needs4. Few health facilities existed in the area5. The fear to test for HIV/AIDS, lack of information on HIV/AIDS and the lack

of condoms were commonly reported to contribute to the spread of HIV/AIDS

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