The document summarizes a study that assessed the effects of a self-management intervention on quality of life for people living with AIDS in Nepal. It found: 1) A self-management education program was provided to 30 experimental subjects over 6 weeks, focusing on quality of life domains like physical, psychological, social, and environmental factors. 2) Quality of life scores improved significantly in the physical, psychological, and social domains for the experimental group after the intervention, while there was no significant change for the control group. 3) Health problems like fever, diarrhea, vomiting, and cough decreased significantly more for the experimental group compared to the control group after the intervention.

1. Self-Management Intervention to
Improve the Quality of Life for People
Living with AIDS
Mehta RS, Karki P
B. P. Koirala Institute of Health Sciences, Nepal
www.bpkihs.edu
Welcome
1

2. Introduction:
• Estimated 40.3 million people are living with HIV-
Positive in World. 95% of all PLWHA are in low or
middle income countries.
- NCASC/UNAIDS
• Every 6 seconds, someone becomes HIV positive
- UNDP, 2004
• It is estimated that 70,000 PLWHA in Nepal. 46%
Seasonal Labour Migrants. 70% young age group of 20-
39 yrs
-NCASC/FHI
• In Nepal 6 New HIV +ve cases added per day.
- December 1, 2011, NCASC
2

3. 1981 First case detected in USA
1983 Virus identified and given name
1984 First case detected in Thailand
1986 First case detected in India
1988 First case detected in Nepal
Short History of HIV/AIDS
3

4. Cumulative HIV Situation of Nepal
(till July 2014)
• Male : 15,837
• Female : 9,344
• TG : 41
• Total : 25,222 (source: NCASC,2014)
• On ART : 9,818
In BPKIHS till April 2015:
- Pre-ART enrollment : >1500
- ART-enrollment : > 700
4

5. Quality of Life measurement
Multidimensional concept that
focuses on the impact of disease and
its treatment on the well-being of an
individual
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6. Quality of Life Dimensions:
• Physical domain: pain and discomfort, dependence on
substances or treatments, energy and fatigue, mobility, sleep
and rest, activities of daily living, and perceived working
capacity
• Psychological domain: patient’s affect, both positive and
negative, self-concept, higher cognitive functions; body image
and spirituality
• Social domain: social contacts, family support and the ability
to care for family, and sexual activity
• Environment domain: freedom, quality of home
environment, physical safety and security and financial status,
involvement in recreational activity, and health and social care
as applicable to the quality and accessibility
6

7. OBJECTIVE:
• The objective of this study was to assess
the effects of self-management
interventions for adults living with AIDS
in improving quality of life.
7

8. RESEARCH DESIGN AND METHODOLOGY:
• Quasi-experimental research design
was used to conduct the study
among the adults (≥18 yrs) living
with AIDS (PLWA) on ART for more
than three months enrolled in B. P.
Koirala Institute of Health Sciences
(BPKIHS) ART-clinic.
8

9. Methodology...
• Total 60 PLWA was randomly selected
and assigned in to two groups i.e. one
educational intervention group (n = 30)
and other control group (n = 30).
• First base line data was obtained from
both the control and educational
intervention group.
9

10. Methodology...
• The control group was left on usual care and
for the experimental group usual care with
self-management programme was introduced.
• The subjects were selected randomly on first
come basis on the ART-clinic days (Monday,
Wednesday and Friday) and first thirty PLWA
was selected as control. Then, similarly thirty
subjects were selected continuously as
experimental group.
10

11. Methodology...
• WHO Quality of Life-HIV instrument (WHOQOL
HIV SF-36) was used to assess the component
of quality of life and self-management
components having Cronbatch alpha 0.80.
• Self management intervention includes the
interaction with PLWA in ART-clinic using
booklet, leaflet, pamphlet, posters and DVD
shows, including Telephone Teaching
counseling to them at their home for Six weeks.
11

12. Methodology...
• After six weeks of education intervention
programme the post-test was conducted
among both the control and experimental
groups using same tool along with programme
evaluation questions and the collected data
was analyzed using SPSS-16 software package.
12

13. Table 1. Comparison of Socio-demographic Characteristics of
the Respondents in Pre-test
SN
Socio-demographic
Characteristics
Responses
P-value
Control group
(%)
Experimental group
(%)
n=30 n=30
1 Age Group (in years):
0.886
<26 4(13.3) 2(6.7)
26-30 4(13.3) 4(13.3)
31-35 6(20.0) 7(23.1)
36-40 8(26.6) 6(19.8)
41-45 4(13.3) 3(9.9)
46-50 2(6.7) 3(9.9)
>50 2(6.7) 5(16.5)
Mean ± SD 36.06±9.79 38.47±9.51
Range 18-60 24-64
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14. 2 Sex
0.088Male 13(56.7) 18(60.0)
Female 17(43.3) 12(40.0)
3 Educational status
0.543
a. Illiterate 4(13.3) 4(13.3)
b. Literate (can read
and write)
2(6.7) 7(23.3)
c. Primary 3(10.0) 3(10.0)
d. Secondary 12(40.0) 6(19.8)
e. Higher secondary
and above
9(30.0) 10(33.0)
14

15. Table 2. Comparison of the Economic Status of the
Respondents in Pre-test
SN
Economic Status of
the respondents
Responses
P-value
Control group
(%)
Experimental
group
(%)
n=30 n=30
1 Present occupation
of the respondents
0.736
a. Farmer 6(20.0) 8(26.7)
b. Business 8(26.7) 8(26.7)
c. Job/Service 7(23.3) 5(16.5)
d. Labour 2(6.7) 1(3.3)
e. Others 7(22.3) 8(26.4)
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16. 2 Total Numbers of
family members
0.753
<5 15(50.0) 17(56.1)
5-7 11(36.7) 12(39.6)
8-10 4(13.3) 1(3.3)
Mean ± SD:
Range:
4.70±2.
2-10
5.70±2.66
2-13
3 Economic Status
0.653
High 2(6.7) 0
Middle 3(10.0) 5(16.7)
Lower Middle 20(66.7) 22(73.3)
Poor 5(16.7) 3(10.0)
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17. Table 3. Comparison of the Disease Process and
Health Status of the Respondents in Pre-test
SN Disease process and health status
Responses
P-value
Control group
(%)
Experimental
group
(%)
n=30 n=30
1 Mode of Transmission of HIV
0.545
a. Sexual 27(90.0) 24(80.0)
b. IVDU 2(6.7) 6(20.0)
c. MTCT 1(3.3) 0 (0)
2 Total Duration on ART (in years)
0.615
<1 3(10.0) 2(6.7)
1-3 18(54.9) 12(39.6)
3-5 5(16.7) 9(29.7)
>5 3(10.0) 7(23.1)
Mean ± SD:
Range:
50.97±40.52
6-189
31.03±21.02
3-72
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18. 3 CD-4 on Start of ART
0.971
<50 1(3.3) 3(9.9)
50-350 27(89.0) 27(89.0)
>350 2(6.7) 0(0)
Mean ± SD:
Range:
35.60±34.22
5-189
175.47±107.07
3-282
4 Current Therapies or
Treatment (MR)
a. ART 30(100.0) 30(100.0)
0.856b. Bactrim 25(83.3) 26(86.7)
c. Fluconazole (anti-fungal) 1(3.3) 4(3.3)
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19. Table 4. Comparison of the Co-morbid Status of the
Respondents within Last Six Weeks in Pre-test
SN
Disease process and health
status
Responses
P-valueControl group
(%)
Experimental
group
(%)
n=30 n=30
1 Hypertension 2(6.7) 5(16.7) 0.001
2 Diabetes 3(10.0) 2(6.7) 0.001
3 Gastric 10(33.3) 12(40.0) 0.068
4 Cancer 2(6.7) 2(6.7) 1.000
5 Pulmonary TB 11(36.7) 11(36.7) 1.000
6 Palpable Lymph node 8(26.7) 2(6.7) 0.011
7 Oral Thrush 6(20.0) 6(20.0) 1.000
8 Hepatitis-B 1(3.3) 1(3.3) 1.000
9 Hepatis-C 5(16.7) 2(6.7) 0.001

20. Table 5. Health Problems among the Respondents before and
after Education Programme
SN
Health
Problems
Control group Experimental group
Pre-
Test
(%)
Post-Test
(%)
Difference
( %)
P-value
Pre-
Test
(%)
Post-
Test
(%)
Difference
( %)
P-
value
a Fever 86.7 46.7 40.0 0.886 53.3 36.7 16.6 0.001
b Anorexia 36.7 40.0 3.3 0.643 40.0 38.3 1.7 0.144
c Diarrhea 50.0 26.7 23.3 0.099 26.7 22.3 4.4 0.001
d Vomiting 50.0 23.3 26.7 0.666 29.7 23.3 6.4 0.001
e Constipation 53.3 50.0 3.3 0.464 50.0 48.5 1.5 0.133
f Cough 73.3 53.3 20.0 0.544 66.0 40.0 26.6 0.011
g Pain 56.7 43.3 13.4 0.225 53.3 51.3 2.0 0.456
h Insomnia 30.0 26.7 3.3 0.207 26.4 24.2 2.2 0.280

21. Table 6. Smoking, Alcohol & Exercise Habit among the
Respondents
SN Health Problems
Control group Experimental group
Pre-Test (%)
Post-Test
(%)
Difference
( %)
P-
value
Pre-
Test
(%)
Post-Test
(%)
Difference
( %)
P-
value
1 Smoking Habits
0.136 0.027
Present (Yes) 20.0 40.0 20 40 26.7 13.3
Not Present (No) 80.0 60.0 20 60 73.3 -13.3
2 Alcohol habit
0.333 0.593
Present (Yes) 20.0 33.3 13.3 33.3 13.3 20
Not Present (No) 80.0 66.7 13.3 66.7 86.7 -20
3 Frequency of
performing
exercise
a. Never 55.0 36.7 18.3
0.823
36.7 20.0 16.7
0.604
b. Rarely 45.0 20.0 25.0 20.0 3.3 16.7
c. Some times 0 36.7 36.7 36.7 53.3 -16.7
d. Usually 0 6.7 6.7 6.7 23.4 -7.2

22. Table 7. Distribution of Means and SD of transformed Quality of
Life Score obtained from WHOQOL SF-36 Questionnaire
SN
Quality of Life
Domains
Control group
(full score=5)
Experimental group
(full score=5)
Pre-
Test
(mean
Score)
Post-
Test
(mean
Score)
Differences
P-
value
Pre-Test
(mean
Score)
Post-
Test
(mean
Score)
Differences
P-
value
1 Physical 2.62 2.43 0.21 0.709 2.50 2.00 0.50 0.001
2 Psychological
2.56 2.43 0.13 0.992 2.48 2.10 0.38 0.001
3 Social 2.90 2.67 0.23 0.686 2.78 2.55 0.23 0.753
4 Environmental
2.67 2.54 0.13 0.998 2.67 2.31 0.36 0.126
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23. Table 8. Means transformed Quality of Life Score
obtained from WHOQOL SF-36 Questionnaire
Groups n Mean SD F-value Significance
Pre-test control 30 95.80 26.76
12.135 0.0001
Pre-test
experimental
30 93.53 20.71
Post-test control 30 90.23 19.52
Post-test
experimental
30 67.31 13.42
Overall 120 86.72 23.37
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24. Table 8. Means transformed Quality of Life Score
obtained from WHOQOL SF-36 Questionnaire
Group Categories n Mean SD Significance
Control
Group
Pre-test 30 95.80 26.76
0.361
Post-test 30 90.23 19.52
Experiment
al Group
Pre-test 30 93.53 20.71
0.0001
Post-test 30 67.31 13.42
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25. Discussion:
• Similar findings on QoL were reported by
Lechner (2003) in his study conducted on,
cognitive-behaviour interventions improves
QOL of people living with AIDS.
• Similar findings were also reported by Ogbuji
(2010) ,Imam (2012), Wringe (2010), Coleman
(2010), Huang (2013), Wootton (2006), Clarke
(2007), Nishigaki (2007), Cook (2009) and
Volthoven (2012) in the similar studies.
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26. Conclusion:
• High Quality of life scores after education
intervention programme in the Physical,
Psychological, Social and Environmental domains
may reflective of the effectiveness of planned
Education Intervention Programme.
• The PLWA; the users of telephone heath service
seems to be satisfied with the service and vast
majority followed the advice they were given.
• Since, the range of reasons for calling heath care
advice line are divergent, the telephone health
service provider needs knowledge on every aspects
of health care.
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27. Some Photographs of
Education Intervention
Programme

28. SMI QOL Programme at ART-Centre
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29. Posters Used
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30. SMI QOL Programme…
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31. SMI QOL Programme…
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32. 32

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34. The road towards Millennium
Development Goals may be long
and difficult…
… but together we can make it!
Thank you!
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