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Short-term physical and emotional health outcomes of public sector ART in the Free State province of South Africa

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Abstract

Introduction

In order to assess the health outcomes of the South African public sector antiretroviral treatment (ART) programme, it is important to gain a better understanding of the complex relationship between ART and the multidimensional construct quality of life (QoL). Because of the gap between supply and demand, equity issues arise concerning the provisioning of ART.

Objective

The aim of this paper is to examine how and to what extent public sector ART is related to the physical and emotional health of people living with HIV/AIDS (PLWHA).

Methods

The stratified random sample consisted of 371 AIDS patients on ART or medically certified for ART, but still awaiting treatment. A model of the relationships between patient characteristics (age and gender) and socio-economic position (educational level, income, type of dwelling, number of rooms), ART duration, and physical and emotional QoL was tested using structural equation modelling.

Results

Patients with a higher personal income (β = .19, P < .05) and a larger dwelling (β = .45, P < .01) were significantly more likely to enter the programme at this early stage. The model showed that the initial months of ART have been associated with significant improvements in the physical QoL (β = .21, P < .01). Furthermore, patients on ART reported significantly higher levels of emotional well-being than patients awaiting treatment (β = .10, P < .01). Finally, the results indicate that ART is not only directly associated with emotional QoL, but is also indirectly associated with emotional QoL via the mediating variable physical QoL (β = .30, P < .01).

Conclusions

The study suggests that the poorest of the poor are not the first beneficiaries of the public programme. Most importantly, the present findings demonstrate the positive physical and emotional health outcomes of the first 6 months of ART in the Free State, South Africa.

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Notes

  1. Lejweleputswa, Motheo, Thabo Mofutsanyana, Fezile Dabi and Xhariep.

Abbreviations

ART:

Antiretroviral treatment

ARV:

Antiretroviral

PLWHA:

People living with HIV/AIDS

QoL:

Quality of life

RMSEA:

Root mean square error of approximation

SEM:

Structural equation model

UFS:

University of the Free State

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Acknowledgements

We are indebted to the Research Foundation—Flanders, the Canadian International Development Agency, the Development Cooperation Ireland, the Department for International Development, the Joint Economics AIDS and Poverty Programme, the United States Agency for International Development, the Australian Agency for International Development and the South African National Research Foundation for their financial support. We also sincerely thank the patients in the ART programme for their time and energy. This study would have been impossible without their views and experiences. The authors thank Prof Dr Anne Buvé (Dept. of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium) for her insightful review of the manuscript. We are grateful to Kobus J. Meyer, the data manager and to Corrie Le Roux, Bridget Smit and Mariette Van Rensburg, the field work managers, for collecting, cleaning and providing the data.

Author information

Authors and Affiliations

  1. Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium

    Edwin Wouters, Herman Meulemans & Dimitri Mortelmans

  2. Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa

    H. C. J. Van Rensburg & J. C. Heunis

Authors
  1. Edwin Wouters
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  2. Herman Meulemans
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  3. H. C. J. Van Rensburg
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  4. J. C. Heunis
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  5. Dimitri Mortelmans
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Corresponding author

Correspondence to Edwin Wouters.

Appendix

Appendix

Correlations among all variables

 

ARV treatment duration

Mobility

Usual activities

Pain

Self-care

Lafe satisfaction

Pleasant affect

Absence of unpleasant affect

Age

Gender

Education

Income

Type of dwelling

Rooms

ARV treatment duration

1.000

             

Mobility

0.213

1.000

            

Usual activities

0.195

0.837

1.000

           

Pain

0.222

0.841

0.876

1.000

          

Self-care

0.238

0.805

0.915

0.831

1.000

         

Life satisfaction

−0.017

0.168

0.150

0.145

0.071

1.000

        

Pleasant affect

0.099

0.262

0.259

0.236

0.262

0.635

1.000

       

Absence of unpleasant affect

0.106

0.365

0.325

0.222

0.238

0.512

0.730

1.000

      

Age

0.071

−0.072

0.017

0.038

0.001

0.030

0.039

0.113

1.000

     

Gender

−0.029

−0.188

−0.243

−0.033

−0.222

0.057

−0.016

−0.033

0.306

1.000

    

Education

0.122

0.121

0.117

0.094

0.236

−0.038

0.061

−0.047

−0.420

−0.086

1.000

   

Income

0.189

0.071

0.068

0.177

0.082

0.239

0.090

0.111

0.179

0.178

−0.010

1.000

  

Type of dwelling

0.009

−0.112

−0.108

−0.099

−0.108

−0.061

0.101

−0.107

0.169

0.045

0.121

0.059

1.000

 

Rooms

0.287

0.011

0.002

0.042

−0.020

0.004

0.002

−0.109

0.151

−0.030

0.165

0.029

0.642

1.000

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Wouters, E., Meulemans, H., Van Rensburg, H.C.J. et al. Short-term physical and emotional health outcomes of public sector ART in the Free State province of South Africa. Qual Life Res 16, 1461–1471 (2007). https://doi.org/10.1007/s11136-007-9260-y

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  • DOI: https://doi.org/10.1007/s11136-007-9260-y

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