Quality of Life Research

, Volume 26, Issue 9, pp 2397–2408 | Cite as

Quality of life among perinatally HIV-affected and HIV-unaffected school-aged and adolescent Ugandan children: a multi-dimensional assessment of wellbeing in the post-HAART era

  • A. K. Nkwata
  • S. K. Zalwango
  • F. N. Kizza
  • J. N. Sekandi
  • J. Mutanga
  • M. Zhang
  • P. M. Musoke
  • A. E. Ezeamama
Article
First Online:
Accepted:

Abstract

Objective

To examine quality of life (QOL) in perinatally HIV-infected (PHIV) or HIV-exposed uninfected (PHEU) vs. healthy HIV-unexposed uninfected (HUU) children during school-age/adolescence.

Methods

PHIV infection was diagnosed via DNA PCR. Current HIV status was confirmed by HIV rapid diagnostic test. Three HIV groups were defined: PHIV, PHEU, and HUU. QOL was assessed with proxy and self-report versions of the PedsQL™ 4.0 instrument at 6–18 years of age. QOL scores ranged from zero (least QOL) to 100 (highest QOL) in the following dimensions: combined QOL inventory (CQOLI), multi-dimensional vigor (MDV), general wellbeing (GWB), present functioning, and general cognitive functioning (CF). Multivariable linear regression models estimated HIV-related percent differences (β) in QOL scores and 95% confidence intervals (CI).

Findings

Compared to HUU CQOLI deficits ranged from 6.5 to 9.2% (95% CI −15.4, −1.6), GWB deficit ranged from 6.5 to 10.5% (95% CI −16.0, −1.3), MDV deficit ranged from 6.8 to 11.6% (95% CI −14.5, 0.9), and CF deficit ranged from 9.7 to 13.1% for PHIV children. QOL deficits of similar magnitude and direction in most domains were observed for PHIV compared to PHEU. However, self-reported indicators of GWB (β = −3.5; 95% CI −9.0, 2.0) and present functioning (β = 4.0; 95% CI −4.6, 12.5) were similar for PHIV compared to PHEU. QOL scores were generally similar for PHEU compared to HUU.

Conclusion

PHEU and HUU had similar QOL profile but PHIV predicted sustained deficits in multiple QOL domains. PHIV and PHEU children were similar with respect to general wellbeing and present functioning. Psychosocial and scholastic interventions in combination with HIV care are likely to improve QOL in PHIV.

Keywords

Quality of life Perinatally acquired HIV infection Perinatally HIV-exposed uninfected Healthy unexposed uninfected controls School-age Adolescence 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

We acknowledge with thanks the kind indulgence of study participants and the diligence of our field research staff.

Funding

Data collection for this work was supported by a faculty research grant to AEE from the University of Georgia Research Foundation (Grant#: 2523) and 2013 seed funding support from the University of Georgia School of Public Health to AEE. Support for AEE time spent on analysis and manuscript development was provided with support from the International AIDS Society (Grant#: 327-EZE).

Author contributions

AKN led data analysis, data interpretation and manuscript development, critique, and revision for important intellectual content. SKZ contributed to study design, led data collection, and contributed to manuscript development. FNK and JNS contributed to data collection, data interpretation, and manuscript critique and revision for intellectually important content. JM, MZ, and PM contributed to data interpretation, critique, and revision of the manuscript for important intellectual content. All authors reviewed drafts of the manuscript, provided suggestions for refinement, and were involved in the final approval of the version for peer-review. AEE designed the study, contributed to data collection, data analysis, interpretation, and manuscript development and refinement.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

11136_2017_1597_MOESM1_ESM.docx (45 kb)
Supplementary material 1 (DOCX 45 kb)

References

  1. 1.
    WHO. (2014). WHO: Global update on the health sector response to HIV. Geneva: WHO.Google Scholar
  2. 2.
    UNAIDS. (2015). HIV and AIDS estimates. Geneva: UNAIDS.Google Scholar
  3. 3.
    Kuntawee, C., Fungladda, W., Kaewkungwal, J., Chanthavanich, P., & Chotpittayasunon, T. (2010). Social factors related to quality of life among HIV infected children in ubon Ratchathani Province, Thailand. The Southeast Asian Journal of Tropical Medicine and Public Health, 41(5), 1136–1144.PubMedGoogle Scholar
  4. 4.
    Bomba, M., Nacinovich, R., Oggiano, S., et al. (2010). Poor health-related quality of life and abnormal psychosocial adjustment in Italian children with perinatal HIV infection receiving highly active antiretroviral treatment. AIDS Care, 22(7), 858–865.CrossRefPubMedGoogle Scholar
  5. 5.
    Wiznia, A., Stanley, K., Krogstad, P., et al. (2000). Combination nucleoside analog reverse transcriptase inhibitor(s) plus nevirapine, nelfinavir, or ritonavir in stable antiretroviral therapy-experienced HIV-infected children: week 24 results of a randomized controlled trial-PACTG 377. Pediatric AIDS Clinical Trials Group 377 Study Team. AIDS Research and Human Retroviruses, 16(12), 1113–1121.CrossRefPubMedGoogle Scholar
  6. 6.
    McKinney, R. E., Jr., Johnson, G. M., Stanley, K., et al. (1998). A randomized study of combined zidovudine-lamivudine versus didanosine monotherapy in children with symptomatic therapy-naive HIV-1 infection. The pediatric AIDS clinical trials group protocol 300 study team. The Journal of Pediatrics, 133(4), 500–508.CrossRefPubMedGoogle Scholar
  7. 7.
    Kline, M. W., Blanchard, S., Fletcher, C. V., et al. (1999). A phase I study of abacavir (1592U89) alone and in combination with other antiretroviral agents in infants and children with human immunodeficiency virus infection. AIDS Clinical Trials Group 330 Team. Pediatrics, 103(4), e47.CrossRefPubMedGoogle Scholar
  8. 8.
    Kline, M. W., Van Dyke, R. B., Lindsey, J. C., et al. (1999). Combination therapy with stavudine (d4T) plus didanosine (ddI) in children with human immunodeficiency virus infection. The Pediatric AIDS Clinical Trials Group 327 Team. Pediatrics, 103(5), e62.CrossRefPubMedGoogle Scholar
  9. 9.
    Kline, M. W., Van Dyke, R. B., Lindsey, J. C., et al. (1998). A randomized comparative trial of stavudine (d4T) versus zidovudine (ZDV, AZT) in children with human immunodeficiency virus infection. AIDS Clinical Trials Group 240 Team. Pediatrics, 101(2), 214–220.CrossRefPubMedGoogle Scholar
  10. 10.
    Nachman, S. A., Stanley, K., Yogev, R., et al. (2000). Nucleoside analogs plus ritonavir in stable antiretroviral therapy-experienced HIV-infected children: A randomized controlled trial. Pediatric AIDS Clinical Trials Group 338 Study Team. JAMA, 283(4), 492–498.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee, G. M., Gortmaker, S. L., McIntosh, K., Hughes, M. D., & Oleske, J. M. (2006). Quality of life for children and adolescents: Impact of HIV infection and antiretroviral treatment. Pediatrics, 117(2), 273–283.CrossRefPubMedGoogle Scholar
  12. 12.
    Ganz, P. A., Coscarelli Schag, C. A., Kahn, B., Petersen, L., & Hirji, K. (1993). Describing the health-related quality of life impact of HIV infection: Findings from a study using the HIV overview of problems-evaluation system (HOPES). Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 2(2), 109–119.CrossRefGoogle Scholar
  13. 13.
    Nordenfelt, L. (1993). Quality of life, health and happiness. Avebury: Aldershot.Google Scholar
  14. 14.
    Levi, R., & Drotar, D. (1998). Critical issues and needs in health-related quality of life assessment of children and adolescents with chronic health conditions. In D. Drotar (Ed.), Measuring health-related quality of life in children and adolescents: Implications for research and practice (pp. 3–24). Mahwah: Lawrence Erlbaum Associates Publishers.Google Scholar
  15. 15.
    UNAIDS. (2013). Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva: UNAIDS.Google Scholar
  16. 16.
    Banerjee, T., Pensi, T., & Banerjee, D. (2010). HRQoL in HIV-infected children using PedsQL 4.0 and comparison with uninfected children. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 19(6), 803–812.CrossRefGoogle Scholar
  17. 17.
    Bunupuradah, T., Kosalaraksa, P., Vibol, U., et al. (2013). Impact of antiretroviral therapy on quality of life in HIV-infected Southeast Asian children in the PREDICT study. AIDS Patient Care STDS, 27(11), 596–603.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ezeamama, A. E., Kizza, F. N., Zalwango, S. K., et al. (2016). Perinatal HIV status and executive function during school-age and adolescence: A comparative study of long-term cognitive capacity among children from a high HIV prevalence setting. Medicine, 95(17), e3438.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Zalwango, S. K., Kizza, F. N., Nkwata, A. K., et al. (2016). Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children: A retrospective cohort study. Journal of the International AIDS Society, 19, 20694.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL 4.0: Reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Medical Care, 39(8), 800–812.CrossRefPubMedGoogle Scholar
  21. 21.
    Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL: Measurement model for the pediatric quality of life inventory. Medical Care, 37(2), 126–139.CrossRefPubMedGoogle Scholar
  22. 22.
    Zalwango, S. K., Kizza, F. N., Nkwata, A. K., et al. (2016). Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children: A retrospective cohort study. Journal of the International AIDS Society, 19(1), 20694.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86(2), 420–428.CrossRefPubMedGoogle Scholar
  24. 24.
    Cronbach, L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.CrossRefGoogle Scholar
  25. 25.
    Tibshirani, R. (2011). Regression shrinkage and selection via the lasso: A retrospective. Journal of the Royal Statistical Society: Series B, 73, 273–282.CrossRefGoogle Scholar
  26. 26.
    Groenwold, R. H., White, I. R., Donders, A. R., Carpenter, J. R., Altman, D. G., & Moons, K. G. (2012). Missing covariate data in clinical research: When and when not to use the missing-indicator method for analysis. CMAJ, 184(11), 1265–1269.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Mast, T. C., Kigozi, G., Wabwire-Mangen, F., et al. (2004). Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care, 16(1), 81–94.CrossRefPubMedGoogle Scholar
  28. 28.
    Hays, R. D., Cunningham, W. E., Sherbourne, C. D., et al. (2000). Health-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV cost and services utilization study. The American journal of medicine, 108(9), 714–722.CrossRefPubMedGoogle Scholar
  29. 29.
    Arpinelli, F., Visona, G., Bruno, R., De, Carli G., & Apolone, G. (2000). Health-related quality of life in asymptomatic patients with HIV. Evaluation of the SF-36 health survey in Italian patients. PharmacoEconomics, 18(1), 63–72.CrossRefPubMedGoogle Scholar
  30. 30.
    Miners, A. H., Sabin, C. A., Mocroft, A., Youle, M., Fisher, M., & Johnson, M. (2001). Health-related quality of life in individuals infected with HIV in the era of HAART. HIV Clinical Trials, 2(6), 484–492.CrossRefPubMedGoogle Scholar
  31. 31.
    Cohen, S., Ter Stege, J. A., Weijsenfeld, A. M., et al. (2015). Health-related quality of life in perinatally HIV-infected children in the Netherlands. AIDS Care, 27(10), 1279–1288.CrossRefPubMedGoogle Scholar
  32. 32.
    Franck, L. S., Johnson, L. M., Lee, K., et al. (1999). Sleep disturbances in children with human immunodeficiency virus infection. Pediatrics, 104(5), e62.CrossRefPubMedGoogle Scholar
  33. 33.
    Foster, S. B., Lu, M., Glaze, D. G., et al. (2012). Associations of cytokines, sleep patterns, and neurocognitive function in youth with HIV infection. Clinical Immunology (Orlando, Fla), 144(1), 13–23.CrossRefGoogle Scholar
  34. 34.
    Punpanich, W., Gorbach, P. M., & Detels, R. (2012). Impact of paediatric human immunodeficiency virus infection on children’s and caregivers’ daily functioning and well-being: A qualitative study. Child: Care, Health and Development, 38(5), 714–722.Google Scholar
  35. 35.
    Swendeman, D., Rotheram-Borus, M. J., Comulada, S., Weiss, R., & Ramos, M. E. (2006). Predictors of HIV-related stigma among young people living with HIV. Health Psychology, 25(4), 501–509.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Punpanich, W., Boon-Yasidhi, V., Chokephaibulkit, K., et al. (2010). Health-related quality of life of Thai children with HIV infection: a comparison of the Thai quality of life in children (ThQLC) with the pediatric quality of life inventory version 4.0 (PedsQL 4.0) generic core scales. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 19(10), 1509–1516.CrossRefGoogle Scholar
  37. 37.
    UBoSUaIII. (2012). Uganda demographic health survey (p. 2012). Kampala: UBOS and Calverton.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • A. K. Nkwata
    • 1
  • S. K. Zalwango
    • 2
  • F. N. Kizza
    • 3
  • J. N. Sekandi
    • 1
    • 4
  • J. Mutanga
    • 1
  • M. Zhang
    • 1
  • P. M. Musoke
    • 5
    • 6
  • A. E. Ezeamama
    • 7
  1. 1.Department of Epidemiology and BiostatisticsThe University of GeorgiaAthensUSA
  2. 2.Directorate of Public Health and EnvironmentKampala Capital City AuthorityKampalaUganda
  3. 3.Division of Health Protection, Office of HIVGeorgia Department of Public HealthAtlantaUSA
  4. 4.School of Public HealthMakerere University College of Health SciencesKampalaUganda
  5. 5.Makerere University-Johns Hopkins University Research CollaborationKampalaUganda
  6. 6.Department of Pediatrics and Child Health, School of Medicine, College of Health SciencesMakerere UniversityKampalaUganda
  7. 7.Department of Psychiatry, College of Osteopathic MedicineMichigan State UniversityEast LansingUSA

Personalised recommendations