Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe

Abstract

Little is known about the psychosocial impact of antiretroviral therapy (ART) among women in sub-Saharan Africa. Therefore, we conducted a cross-sectional study in Zimbabwe to assess the impact of ART on HIV-positive women's health-related quality of life, using the Medical Outcomes Study-HIV Quality of Life (QOL) questionnaire. Additionally, we assessed socio-demographics, reproductive and sexual health, HIV-related history, disclosure, social stigma, self-esteem, and depression. Structured interviews were conducted with 200 HIV-positive women and categorized into three groups by treatment: (1) Group 1 (n=31) did not meet clinical or laboratory criteria to begin treatment; (2) Group 2 (n=73) was eligible to begin treatment but awaiting initiation of treatment; and (3) Group 3 (n=96) was on ART for a median of 13 months. The women had similar socio-demographic characteristics but varied significantly in clinical characteristics. Women on ART reported fewer AIDS-related symptoms in the last week and year and had higher current and lower baseline CD4 counts compared to women not on ART. On most QOL domains women on ART reported higher mean scores as compared to women not on ART (p<0.01). Additionally, women on ART reported less depression compared to women not on ART (p<0.001). Between the two groups of women not on ART, unexpectedly, there were no significant differences in their scores for QOL or depression. Thus, Zimbabwean women living with HIV experience better overall QOL and lower depression on ART. Altogether, our findings suggest that ART delivery in resource-poor communities can enhance overall QOL as well as psychosocial functioning, which has wide-ranging public health implications.

Figure 1

Participant recruitment.

Figure 2

(a) Physical health summary (PHS) and mental health summary (MHS) scores as functions of duration on antiretroviral (ARV) treatment for the treated group only (n = 96). *Spearman rank correlation coefficients, both p > 0.05. (b) Mean QOL scores as a function of duration on antiretroviral (ARV) treatment for the treated group only (n = 96). *Spearman rank correlation coefficients, p > 0.05.

Figure 3

Change in CD4 counts (current minus baseline) as a function of duration on antiretroviral (ARV) treatment for the treated group only (n = 96). *Spearman rank correlation coefficients, p<0.0001.