Health Related Quality of Life presentation_london_20-21_may_2010a[1]

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Health Related Quality of Life studies in Uganda, Kenya, South Africa and Ghana

Health Related Quality of Life studies in Uganda, Kenya, South Africa and Ghana

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  • 1. HRQoL studies in Uganda, Kenya, South Africa and Ghana Dr. Antonieta Medina Lara ABBA Partners Meeting 20th – 21st May 2010
  • 2. BOCCONI Centre for Research in Healthcare Management 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 2
  • 3. 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? 3
  • 4. 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 4
  • 5. QUALITY OF LIFE MEANING ? 5
  • 6. QUALITATIVE METHODS 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 Uganda Kenya Emerging topics 6
  • 7. KEY THEMES UGANDA 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 7
  • 8. 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 8
  • 9. KENYA HRQOL Key Informant In-depth Category of Participants FGDs Interviews Interviews Narratives PLHIV 1. PLHIV - men on ART 2 2. PLHIV – men not on ART 2 3. PLHIV - women on ART 3 4.PLHIV - women not on ART 3 Community members 1 5. Caregivers of PLHIV 1 6.CHWs 2 6. Men 2 7. Women 4 8. Youth(Female 2, male 2) 9. Service providers 3 10.Policy/programme managers 3 11. PLHIV on ART 40 3 12. PLHIV not on ART 7 3 Total 20 6 47 6 9
  • 10. 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 PLHA 2. To determine factors that affect the HRQoL of PLHA 3. To compare the impact of ART on the HRQoL of PLHA 10
  • 11. 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 11
  • 12. FURTHER WORK Ghana Emerging Uganda Kenya topics 12
  • 13. 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
  • 14. UGANDA OUTPUTS 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) 14
  • 15. UGANDA HOUSEHOLD HRQOL STUDY SOCIAL MAPPING Eight 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 institutions Gender 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 participants 3. Poverty was blamed to be the reason for people to indulge in unsafe sex in order to meet their economic needs 4. Few health facilities existed in the area 5. 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 15