SSR Inst. Int. J. Life Sci., 8(3): 3010-3016, May 2022

Hope and Quality of the Life of People Living with HIV: A Cross-Sectional Study at ART Center, Bagalkot, Karnataka

 

Kavita Patil¹, Shriharsha C^2*, Deelip S Natekar³

¹M.Sc Nursing, Department of Psychiatric Nursing, BVVS Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka, India

²Professor & HOD, Department of Psychiatric Nursing, BVVS Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka, India

³Principal, BVVS Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka, India

 

^*Address for Correspondence: Dr. Shriharsha C, Professor  & Head, Deptartment of Psychiatric Nursing, BVVS Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka- 587102, India

E-mail: kavita.kp47@gmail.com   

ABSTRACT Background: HIV/AIDS emerged as the most important public health issue of the late twentieth and early twenty-first centuries. Hope & Quality of life (QoL) of People living with HIV/AIDS are affected by multiple socio-demographic variables as a major predictor of Hope & QoL.

Methods: This cross-sectional descriptive survey research design included a sample of 430 PLHIV attending the ART centre, District Government Hospital, Bagalkot. Data were collected using the self-report method and Hospital records by socio-demographic questionnaire, Herths Hope Scale and WHO QOLHIV-BREF scale. Pearson's Correlations, chi-square test and multiple linear regression analysis were used.

Results: A significant positive association was found between Hope and QoL among PLHIV (r= 0.483, p<0.001). A significant regression equation (F_{429, 42=} 1.842, R²=0.167, p<0.01). Married status i.e. married, Occupation i.e. doing Labor work has positively and 3^rd and 4^th clinical-stage have negatively predicted Hope of PLHIV. A Non significant regression equation (F_429,42=1.37, R²=0.13, p<0.05). Being a private employee had positively and Heterosexual had negatively predicted and remained determinants have not predicted QoL among PLHIV and there was a significant association found between marital status and remained variables are not associated with Hope. There was a significant negative relationship found between Family monthly income and a positive relationship found between the duration of HIV and QoL. Marital status is significantly associated with QoL.

Conclusions: The overall findings reveals that a significant positive correlation between Hope and QoL among PLHIV. There was a significant association found between marital status with Hope. There was a significant negative relationship found between Family monthly income and positive relationship found Duration of HIV and QoL.

 

Keywords: ART Centre, Hope, Heterosexual, PLHIV, Predictors and Quality of life

 

INTRODUCTION Human immunodeficiency virus (HIV) infection /Acquired immunodeficiency syndrome (AIDS) is one of the serious public health problems with a severe impact on various facets of human life.^[1] At present, in the world, around 36.9 million people are suffering from HIV/AIDS. ^[2] Every year around 2 million people are infected by this virus.^[2] With an HIV prevalence of 0.3% in the adult population, India has an estimated 2.1 million people living with HIV.^[3] In Karnataka 2.5 lakh people are living with HIV. Out of which 65,053 are undergoing antiretroviral therapy (ART) at 47 ART centres in the State.^[4]

An estimated 38·6 million people living with HIV-1 worldwide, while about 25 million have died already.^[5] Most of the studies from the country have found that HIV is prevalent at about 2% in prisoners which is much higher than the prevalence in the general population.^[6,7] These estimates mask the dynamic nature of this evolving epidemic about temporal changes, geographic distribution, magnitude, viral diversity, and mode of transmission. Today, there is no region of the world untouched by this pandemic.^[8]

Since the availability of antiretroviral treatments (ART), HIV has been turned from a fatal disease to a manageable chronic disease. Hence, People Living with HIV (PLHIV) have longer life spans, which creates new challenges for health care systems.^[9]  A person living with HIV has to cope with a range of HIV-related symptoms for their entire life. Symptoms may be related to the infection itself, co-morbid illnesses or iatrogenic effects from HIV-related medications.^[10,11] Many HIV patients struggle with numerous social problems such as stigma, discrimination, poverty, depression, substance abuse, and cultural beliefs which can affect their QOL.^[12] Depression is most prevalent in people living with HIV. Stressful life events experienced by PLHIV again increase the risk of development of depression by three to five times more. Hence HIV/AIDS infection compromises the quality of life in PLHIV.^[13]

Assessing hope and quality of life (QOL) and its predictors are useful for documenting the patients' perceived burden of chronic disease, tracking changes in health over time, and assessing the effects of treatment. Because many socio-demographic and clinical variables influence the Hope & QOL of People with HIV/AIDS, the present study aims at assessing the Hope & Quality of life of people living with HIV/AIDS at the ART centre, Bagalkot.

 

MATERIAL AND METHODS

Study Design and Participants- It is a descriptive cross-sectional study that was conducted between 07 February 2019 to 20 February 2019. A convenient sample of 430 people living with HIV (PLHIV) coming for follow up counseling at ART Centre, District Government Hospital, Bagalkot were selected for the study. PLHIV, who meet inclusion criteria were included in the study. PLHIV, who were not on ART within the last 3 months were excluded because the information from them was asked based on their last 1-2 months of experience. PLHIV with severe opportunistic infection were also excluded from the study.

 

Instruments

Herth’s Hope Scale- The level of hope was measured by using the Hearth’s Hope Scale. This is a 30- item scale and it is 4 point scale. Response options range from 0 to 3 for each item (0= Never applies to me, 1= Seldom applies to me, 2= Sometimes applies to me and 3= Often applies to me.

Note following items need to be reverse scored; 6, 10, 13, 17, 22 & 26. Overall scores range between 0 (min) and 90 (max), hence higher the score better the level of hope. The scale was translated to Kannada and then back-translated to English. Cronbach’s α of 0.792 was obtained by administering the scale to 30 PLHIV.

 

Quality of Life (WHO Quality of Life–HIV BREF)- Quality of life was measured using the World Health Organization (WHO) Quality of Life (QOL) HIV short version (WHOQOL-HIV BREF)⁹, a 31-item scale that assesses the quality of life of PLHIV in six domains: physical quality of life, psychological quality of life, independence, social relationships, environment quality of life, and spirituality/religion/personal beliefs.  Overall scores range between 31 (minimum) and 155 (maximum), hence higher the score, better the quality of life. The scale was validated in various settings across the globe including in India ^[10,11]. The scale was translated to Kannada and then back-translated to English. Cronbach’s α of 0.891 was obtained by administering the scale to 30 PLHIV.

 

Socio-demographic Variables and Clinical characteristics- Socio-demographic and clinical variables included age, gender (male/female/transgender), religion, occupation, educational status, no. of children, monthly income of the family, current marital status, type of family, family history of HIV, area of Residence, CD4 count, HIV status of spouse, duration of time with HIV infection, duration of time on ART, history of suicidal attempts, history of alcohol abuse.

 

Data collection procedures- Prior permissions were taken from relevant institutions before the beginning of the data collection procedure. The study participants were identified during the study period at the ART centre, District Government Hospital, Bagalkot. Every HIV infected person who fulfilled the inclusion criteria was approached for data collection. Consent was obtained by the interviewers before participants underwent the structured interview, which lasted approximately 20 to 30 minutes.  All the information collected was based on the patient's self-report, but the information related to CD4 count and clinical staging were obtained from the medical records.

 

Inclusion Criteria- The study includes the People living with HIV/AIDS:

ü  Who is with a current diagnosis of HIV/AIDS

ü  Who is aged between 18- 50 years and who can read and write Kannada/ English

ü  Who is on ART and whose CD4 count has been done during the last month

 

Exclusion criteria- The study excludes the People living with HIV/AIDS:

ü  Who is suffering from severe illness and unable to provide data

ü  Who is not on ART within the last 3 months and who is not willing to give written consent

 

Statistical Analysis- Data analyses were performed using SPSS v25. Descriptive univariate statistics such as frequencies and percentages were used for categorical variables and means (M) and standard deviations (SD) were used for continuous variables. Associations between Hope and QOL were assessed using Pearson’s correlation coefficients. Multiple regression models were used to find the significant predictors of Hope and QOL. All significance levels reported are two-sided.

 

Ethical consideration- The study was approved by the Institutional Ethical Clearance Committee and permission was taken from the Karnataka State AIDS Prevention Society, Bangalore. Informed consent was obtained from each participant.

 

RESULTS

Description of Sample in terms of their socio-demographic and clinical characteristics- Table 1 depicts that the maximum score of Hope among PLHIV is 90, and the minimum score is 34. The mean and SD of Hope score is 67.01 (SD= 14.044). The result shows that the maximum score of QoL among PLHIV is 144, and the minimum score is 52. The mean and SD of the QoL score is 109.68 (SD= 14.11). 

 

Table 1: Socio-demographic and clinical characteristics of PLHIV (N=430)

 

M= Mean, SD= Standard deviation, N= Number of PLHIV, %= Percentage of PLHIV, ART= Antiretroviral treatment, PLHIV= People living with HIV/AIDS

 

Since the population was not normally distributed with respect to both Hope score (Shapiro- Wilk value= 0.96, p<0.05) and Quality of life score (Shapiro- Wilk value= 0.98, p<0.05). Non-parametric test i.e. Spearman's Rank order test was used to find the correlation between Hope and Quality of life. Findings reveal that there exists a significant positive correlation between Hope and Quality of life scores (r=0.0483, p<0.01) (Table 2).

        

Table 2: Correlation between Hope and Quality of life Scores of PLHIV (N=430)           

Correlation between Hope and Quality of life
Spearman’s Rho	0.483**

**p<0.01

 

Multiple linear regression analysis- Socio-demographic and clinical characteristics of PLHIV were entered into the multiple linear regression models as independent variables with Hope and Quality of Life as dependent variables.

The multiple linear regression carried out to find the determinants (Predictors) of hope among PLHIV revealed a significant regression equation (F_{429, 42=} 1.842, R²=0.167, p<0.01). Married status i.e. married (t= 2.113, p<0.05) and Occupation i.e. being Coolie or doing Labour work (t= 2.310, p<0.05) has positively predicted the hope of PLHIV. Third clinical stage (t= -2.433, p<0.05) and Fourth clinical stage (t= -2.211, p<0.05) have negatively predicted Hope of PLHIV (Table 3).

 

Table 3: Multiple linear regression model of Hope of PLHIV (N=430)      

S.No	Determinants (Predictors)	Standardized Coefficients ( β)	t value	P-value
1	Married	0.336	2.113	0.035*
2	Cooli	0.238	2.310	0.021*
3	HIV Stage 3	-0.122	-2.433	0.015*
4	HIV Stage 4	-0.108	-2.211	0.028*

*p<0.05

 

The Multiple Linear Regression carried out to find the determinants (predictors) of Quality of life among PLHIV revealed a Non-significant regression equation (F_{429, 42=} 1.37, R²=0.13, p<0.05). Being private Employee, (t= 2.099, p<0.05) had positively predicted Quality of life among PLHIV. Heterosexual (t= -1.985, p<0.05) had a negatively predicted Quality of life among PLHIV (Table 4).

 

Table 4: Multiple linear regression model of quality of life of PLHIV (N=430)

S. No	Determinants (Predictors)	Standardized Coefficients ( β)	T-value	P-value
1	Private Employee	0.138	2.099	0.036*
2	Heterosexual	-0.457	-1.985	0.048*

*p<0.05

 

DISCUSSION- This cross-sectional study included a sample of 430 PLHIV attending the ART centre, District Government Hospital, Bagalkot to assess the Hope & QoL of PLHIV and its predictors. Most of the PLHIV (68.0%) were females. This study is consistent and supported by Huang et al. ^[14] in China. Similar findings were observed where most of the PLHIV (65%) were Females. This study was supported by Shriharsha and Rentela ^[15] at Bagalkot, where most of the PLHIV (64.7%) were females. This study is supported by Jonas et al. ^[16] in South Africa, where most of the PLHIV (74%) were females. The majority (93.0%) of PLHIV was belonging to the Hindu religion. This study is consistent and supported by Shriharsha and Rentela ^[17] at Bagalkot, where the majority of PLHIV (76%) were Hindu.^[17] Most (80.93%) of PLHIV were educated Up to 7^th standard. Results revealed that most of them (80.5%) PLHIV were married. This study is consistent and supported by Charles et al. ^[18] at Chennai, where most of the PLHIV (69%) were married. Findings revealed that the majority of the PLHIV (81.9%) were from rural areas. This study is consistent and supported with the study conducted by Somashekar and Vijaykumar ^[19] Results show that 36% of people are from rural areas.

This study is consistent and supported with the study conducted by Weldsilase et al. ^[20] in Southwest Ethiopia. Results show that 54.7% of people are from rural areas findings revealed that the mean and SD of Hope score is 67.01±14.04. This is consistent with that found in many other Indian studies. Findings revealed that the majority of the PLHIV 73.1% had Good Quality of life. This is consistent and supported with the study conducted by Nyamathi et al. ^[21]. The results showed that low QOL score; on a scale from 0 to 3, the mean QOL score was 0.38 (SD=0.30).

Findings reveal that there exists a significant positive correlation between Hope and Quality of life scores (r=0.0483, p<0.01). The findings are consistent and supported with the study conducted by Fang et al. ^[22]. The results showed that resilience mediating the associations between life stress and physical, emotional, and functional/global well-being among PLHIV. Assessment of levels of QoL among PLHIV reveals that the majority of PLHIV (73.1%) had good QoL. The findings of the present study are consistent and supported with the study conducted by Ossei-Yeboah et al. ^[23]. The result showed that 79.75% of PLHIV had good QoL.

The findings of the present study are consistent with the study conducted by Yadav ^[24] in Nepal. The results showed that a positive correlation exists between hope and quality of life. A significant regression equation (F_429,42= 1.842, R²=0.167, p<0.01). Married status i.e. married, Occupation i.e. doing Labor work has positively and 3^rd and 4^th clinical-stage have negatively predicted Hope of PLHIV. A Non significant regression equation (F_429,42=1.37,R²=0.13, p<0.05).

A Non significant regression equation (F_429,42=1.37, R²=0.13, p<0.05). Being private Employee had positively and Heterosexual had negatively predicted and remained determinants have not predicted QoL among PLHIV. There was a significant association found between marital status and remained variables that are not associated with Hope. There was a significant negative relationship found between Family monthly income and a positive relationship found between duration of HIV and QoL. Marital status is significantly associated with QoL.

The findings of the present study are consistent with the study conducted by Wani and Sankar ^[25] in Jammu and Kashmir, India. The results showed that two demographical variables gender and marital status are negatively significant correlated with social support and quality of life. There was a significant association found between marital status and remained variables that are not associated with Hope. There was a significant negative relationship found between Family monthly income and a positive relationship found between the duration of HIV and QoL. Marital status is significantly associated with QoL.

 

CONCLUSIONS- Hope and QoL of People living with HIV/AIDS have been affected by several variables. Efforts should be made for comprehensive treatment of PLHIV to enhance their Hope quality of life, especially by primary care providers.

Intervention can be provided to improve the Hope and Quality of life among PLHIV. As the Hope improves the Quality of life strategies can be implemented to inculcate hope in PLHIV that in turn improves the Quality of life among PLHIV and presents a study basis for future experimental studies.

 

CONTRIBUTION OF AUTHORS

Research concept- Kavita Patil, Dr. Shriharsha C

Research design- Kavita Patil, Dr. Shriharsha C

Supervision- Dr. Shriharsha C, Dr. Deelip S Natekar.

Materials- Kavita Patil

Data collection- Kavita Patil

Data analysis and interpretation- Kavita Patil, Dr. Shriharsha C

Literature search- Kavita Patil

Writing article- Kavita Patil

Critical review- Dr. Shriharsha C, Dr. Deelip S Natekar

Article editing- Kavita Patil, Dr. Shriharsha C

Final approval- Dr. Shriharsha C, Dr. Deelip S Natekar

 

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