Predictors of quality of life
In the bivariate analysis, participants of rural residents, marital status, Muslim and Protestant Religions, and employment status, alcohol drinking, frequency of chat chewing and alcohol drinking, lack of supports (social, emotional, from friends, from a non-government organization, from the workplace, family), dissatisfaction with the verbal support, being stigmatized, moderate depression, severe depression were associated with quality of life of the PLWHA. Among the clinical and treatment-related, Baseline functional status, current opportunistic infection baseline, and current ART adherence), less than 36 months on ART duration, base-line WHO stage II, IV, current WHO stage III, IV, being underweight (in current BMI), most recent CD4 count below 500/not mg/dl, most recent hemoglobin level were selected candidates into multivariate analysis at a p-value of 0.25.
To assess the socio-economic predictors’ wealth index was determined by computing Principal Component Analysis (PCA). Out of a total of 24 variables used the wealth index score was made by 8 variables with 3 components that explained a total variance of 66.862% and Kaiser Meyer Olkin measure of sampling adequacy 0.755 with Bartlett’s test of sphericity at a significant level of 0.001.
The PCA result showed that three variables were highly loaded on the first and second PCA components namely own mobile, bed with a sponge, fuel charcoal, household farm land, own household, sheep, goats, and two variables in the third component namely having refrigerator and fuel electricity. The final rotated components were converged in four iterations using Varimax with Kaiser Normalization. These standardized scores were then used to create points that define the wealth index from lowest quintile (poorest) to highest quintile (wealthiest). These index variables were run in the bivariate logistic regression but were not considered a statistically significant candidate for multivariate logistic regression analysis. However, it was speculated by (36 years old female from an urban area) in the interview.
You better leave asking such a question! Because my body is wasted thinking of food. e.g. I frequently encounter missing powder for injera; due to high cost and low capacity to accommodate for the demand family.” ---you know, my husband is employed as a guard for 1000 birr. It can’t pay for the cost of food, house rent, and other demands for the family. Therefore missing meal frequency patterns is a common pattern in our house due to poor socioeconomic status. It also leads to free sex work and other problems.
Multivariate analysis in the final model showed that the odds of poor quality of life was almost 4.3 times more likely among participants who chew Khat occasionally AOR 4.26, 95% CI(1.01, 17.83) and those chewing at weekly intervals were nearly 6.4 times more likely than those who never chew AOR 6.348, 95% CI(2.00, 20.07). An interview supports that the use of stimulates is a common problem, particularly in urban settings.
“Some individuals say no HIV transmission after 4 o‟ clock at night. It’s a means to expose themselves to risky sexual activity; after once they had been excited by different stimulants and substances such as chat, shisha, alcohol, and cigar-ate.” (34 years old female patient).
The odds of poor quality of life were almost 9.2 times more likely among stigmatized respondents than not stigmatized AOR 9.23, 95%, CI (3.50, 24.33). Stigma and discrimination still exist even in a church which was explored from the qualitative finding as speculated by, 42 years old, female urban participants.
----Last week, I and my friend went to church to follow a program. Eventually, she took her ART treatment while on the way to sleep. Later on, those who were beside moved away and left us alone.
At the same time,
About 85 % of the participants reported that they had experienced at least one type of stigma and discrimination.
Severely depressed were about 16 times more likely to ha have a poor quality of life than those with mild depression [AOR 16.13, 95% CI (5.24, 49.64)].
Of the clinical and treatment-related factors, the odds of poor quality of life was about 10.4 times more likely among fair baseline ART adherence [AOR 10.37(2.40, 44.82)], and baseline line ART adherence about 6.4 times AOR6.35, CI(1.95, 20.66) than good baseline ART adherence. This idea is supported by the qualitative finding speculated from a 36 years old female.
Previously, my husband has discontinued the drug for about 8 months including rarely after. Due to this, we have conflicted and finally, divorced each other. After I told him repeatedly, he sustained to follow.
Likewise, the likely hood of poor quality of life among participants of less than 36 months of duration on ART was nearly 65% less likely as compared to those greater than or equal to 36 months of duration on ART AOR 0.34, 95%CI (0.12, 0.9Baselineline WHO stage III, IV were nearly 5 times AOR 4.88 95% CI (2.07, 11.50), and current WHO stage III, IV nearly 4 times AOR 3.86, 95% CI (1.10, 13.52) more likely poor quality than respondents base line and current WHO stage I, II.
“The majority of patients did, however, take their ART regardless of the trepidations due to adverse effects and insufficient food. -----right that time, getting drugs easily was highly valued and patients described ART as „ a new hope for the future.” (Male health care provider).
The presence of ART has brought bright future for PLWHIV during their stay at bed for several weeks of admission. The interview from 42 years old man confirmed that,
My happiest moment was when I heard about the drug on my way to die. I used to think that I wouldn’t get up from that bed; rather, I would have died.
The likelihood of poor quality of life was 2.4 times higher among individuals of being underweight in the current body mass index AOR 2.37, 95% CI (1.01, 5.62), whereas almost 4 times among low most recent hemoglobin level AOR 4.11, 95% CI(1.73, 9.74) [Table 2].
Table 2
Binary and multiple logistic regression model showing independently associated with poor quality of life among PLWHA on ART in Jimma zone Public Hospitals, South West Ethiopia 2018.
Variables
|
Cases
(N=81)(%)
|
Control
(N=242)(%)
|
COR(95% CI)
|
AOR(95%CI)
|
Chat chewing
|
Never
|
54(66.7)
|
190(78.7)
|
1.000
|
1.000
|
Occasionally
|
6(7.4)
|
14(5.8)
|
1.508((0.55, 4.11)
|
4.26(1.01, 17.83) **
|
Weakly
|
13(16)
|
25(10.3)
|
1.830(0.87, 3.81)
|
6.34(2.00, 20.07) **
|
Daily
|
8(9.9)
|
13(5.4)
|
2.165(0.853, 5.494)
|
|
Stigma
|
Stigmatized
|
42(51.9)
|
32(13.2)
|
7.06(3.985,12.534)*
|
9.23(3.50, 24.33) **
|
Not stigmatized
|
39(48.1)
|
210(86.8)
|
1.000
|
1.000
|
Depression
|
Minimal
|
15(18.5)
|
101(41.7)
|
1.000
|
1.000
|
Mild
|
8(9.9)
|
39(16.1)
|
1.381(0.543, 3.516)
|
|
Moderate
|
17(21.0)
|
52(21.5)
|
2.201(1.019,4.751)*
|
|
Severe
|
41(50.6)
|
50(20.7)
|
5.521(2.79, 10.91)*
|
16.13(5.24, 49.64) **
|
Baseline drug Adherence
|
Good
|
58(71.6)
|
221(91.3)
|
1.000
|
1.000
|
Fair
|
9(11.1)
|
8(3.3)
|
4.287(1.58, 11.59)*
|
10.37(2.40, 44.82) **
|
Poor
|
14(17.3)
|
13(5.4)
|
4.103(1.828,9.209)*
|
6.35(1.95, 20.66) **
|
Duration on ART
|
<36 months
|
10(12.3)
|
63(26.0)
|
0.400(0.194,0.823)*
|
0.34(0.12, 0.93) **
|
>=36 months
|
71(87.7)
|
179(74.0)
|
1.000
|
1.000
|
Baseline WHO
|
I, II
|
19(23.5)
|
128(52.9)
|
1.000
|
1.000
|
III, IV
|
62(76.5)
|
114(47.1)
|
3.664(2.067,6.495)*
|
4.88(2.07, 11.50) **
|
Current WHO
|
I, II
|
64(79.0)
|
230(95.0)
|
1.000
|
1.000
|
III, IV
|
17(21.0)
|
12(5.0)
|
5.091(2.312,11.209)*
|
3.86(1.10, 13.52) **
|
Current BMI
|
<18.5 kg/m2
|
25(30.9)
|
47(19.4)
|
1.852(1.049, 3.272)*
|
2.37(1.00, 5.62) **
|
>=18.5 kg/m2
|
56(69.1)
|
195(80.6)
|
1.000
|
1.000
|
Most recent HGB level
|
<12.8 mg/dl
|
34(42.0
|
54(22.3)
|
2.519(1.475, 4.300)*
|
4.11(1.73, 9.74) **
|
47(58.0)
|
188(77.7)
|
1.000
|
1.000
|
COR = crude odds ratio, CI = confidence interval, AOR= Adjusted Odds Ratio
* Variables which shown significant association during the bivariate analysis.
** Variables which shown significant association during the multivariate analysis.