Effect of perceived stigma on health related quality of life growth curve for newly diagnosed HIV postive adults in Nairobi, Kenya
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Date
2014-08-12
Authors
Kinuthia, Gichuhi
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Abstract
Health related quality of life (HRQOL) is an assessment of how an individual's
quality of life may be affected by a disease, disability or a disorder. HRQOL is a
patient reported outcome that quantifies the extent to which of one's physical,
emotional, and social well-being are affected by a medical condition or treatment.
The desired HRQOL is conceptualized as the optimum levels of mental, physical role
functioning and social functioning. It is distinct from quality of life as a whole,
which would also include adequacy of housing, income and perceptions of
immediate environment. Low HRQOL has been shown to negatively affect
morbidity and mortality in both acute and chronic health conditions. Therefore
improvement of HRQOL in management of diseases would also improve the final
outcome and extend life expectancy. About 70% - 80% of HIV infected persons
have low HRQOL. HIV is a highly stigmatized disease with 50%-80% of HIV
patients reporting HIV related stigmatization further lowering their HRQOL.
Counseling for HIV related stigma is currently not included National AIDS & STI
Control Program's (NASCOP) protocol for HIV management. The aim of this study
is to quantify the magnitude and strength of the effect of HIV stigma on HRQOL
growth curve in newly diagnosed HIV adults in Nairobi County, Kenya. The study
will be a prospective longitudinal cohort design with four repeated measures of
HRQOL taken at enrollment, 3rd 6th and 9th months for each participant. The study
population will be consecutive newly diagnosed HIV infected persons, aged 18 years
and above in 10 out of 85 randomly selected Comprehensive Care Centers (CCC) in
Nairobi County and enrollment will stop when the sum of participants equals the
estimated sample size. The sample size of 288 is estimated to give 90% power to
detect any change in effect with 95% confidence however 20% participants will be
added to guard against loss of this power in case of inevitable losses during the
follow up. WHOQOL-HIV BREF and PLWHA [HASI-P] instruments will be used
to measure HRQOL and HIV stigma levels respectively. The participants' biomarker
data will be extracted from their medical files. The data will be entered into the
computer using EPIDATA 3.l™ then transferred to STATA-13™ for data
management and descriptive statistics. Confirmatory factor analysis and HRQOL
growth curve within multivariate structural equation modeling framework will be
done with Mplus" 7.2. The results from this study are expected to give evidencebased
guide for inclusion of counseling in management of patients with HIV
infection to improve their HRQOL since low HRQOL is associated with high nonadherence
antiretroviral therapy, hospitalizations, morbidity from opportunistic
infections, and overall mortality. Identification of the particular HIV stigma domains
affecting the HRQOL growth curve will also guide in designing a tailor made
psychotherapy-counseling module for HIV patients.