Date of Award

Fall 8-2020

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

CHARLES DARKOH

Second Advisor

STACIA DESANTIS

Third Advisor

SHERYL MCCURDY

Abstract

During the last decade, HIV in sub-Saharan Africa has shifted from a fatal disease to a chronic condition thanks to the expansion of antiretroviral therapy (ART). As a result, the focus of care has transitioned from survival to quality of life (QoL), and the latter has become a significant outcome measure during patient follow up. Yet, the determinants of QoL among HIV patients in western and central Africa are not well known. The objective of this dissertation was to determine the main factors associated with QoL among ART-treated HIV adult patients in western and central Africa to ensure healthcare providers and stakeholders use the most relevant, up-to-date evidence when designing and implementing interventions that help patients effectively stay in care and remain asymptomatic. We first performed a systematic review to synthesize known determinants of QoL in sub- Saharan Africa. Leveraging the findings of the systematic review, we conducted a crosssectional survey at Espoir Vie Togo (EVT), a patient-oriented community health clinic in Lomé, Togo, to measure QoL and determine which factors previously identified in the systematic review were associated with physical and mental domains of QoL in this population. We also interviewed EVT patients to better understand their life experiences and potentially uncover novel factors associated with QoL. The systematic review included 41 observational studies conducted in 14 countries and we found that QoL was most frequently influenced by sociodemographic factors such as age, education, gender, employment, social or family support, as reported in nine or more studies; by clinical factors including mental health and CD4 count; and treatment-related factors such as treatment duration. At EVT, the mean (SD) physical health summary (PHS) and mental health summary (MHS) scores of 147 ART-treated patients were 80.7 (13.9) and 66.7 (11.1), respectively, on a 0-100 scale. Younger age, male gender, food security, the absence of side effects and self-evaluated “excellent” or “very good” health status were associated with higher PHS scores. Male gender, a higher level of education, food security, family or social support and self-evaluated “excellent”, “very good” and “good” health status were associated with higher MHS scores. Finally, in qualitative interviews with 12 ART-treated EVT patients, patients described good QoL as being in good health and being physically and mentally functional. Family, social and community support, the presence of a supporting individual, being on ART and food security were factors influencing QoL. In this cohort, participants experienced difficulties accepting their positive status, and often faced perceived or enacted stigma. The QoL of people living with HIV in western and central Africa is driven by multiple sociodemographic, clinical and treatment-related factors that have been summarized in this dissertation. These findings provide stakeholders with valuable evidence to optimize patient care and management. Future research will focus on pediatric populations and compare treatment satisfaction between patients receiving care in non-governmental organizations and in public healthcare facilities.

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