Abstract
This paper reports on the quality of life of patients enrolled in the public sector antiretroviral treatment programme in the Free State province of South Africa. Statistical analysis of cross-sectional data reveals that it is not access to treatment per se that enhances the quality of life of those who have come forward for ART. Rather, it is the health benefits associated with treatment, levels of stigmatisation, quality health care services, and the ability of persons to access support and care, both from within and outside the health care sector, that are independently associated with improvements in and differences in levels of quality of life.
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Abadía-Barrero, C. and A. Castro: 2006, ‚Experiences of stigma and access to HAART in children and adolescents living with HIV/AIDS in Brazil’, Social Science & Medicine 62(5), pp. 1219–1228
Alexandrova A., 2005. Subjective well-being and Kahneman’s ‚objective happiness’ Journal of Happiness Studies 6: 301–324
Alubo O., Zwandor A., Jolayemi T., Omudu E., 2002. Acceptance and stigmatisation of PLWA in Nigeria AIDS Care 14(1): 117–126
Biswas-Diener R., Diener E., 2001. Making the best of a bad situation: satisfaction in the slums of Calcutta Social Indicators Research 55: 329–352
Bowling A., 2005. Measuring Health: A Review of Quality of Life Measurement Scales. Open University Press, New York
Brecht J.R., Breitbart B., Galietta M., Krivo S, Rosenfeld B., 2001. The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: Impact on Medical, Palliative Care, and QoL outcomes Journal of Pain and Symptom Management 21(1): 41–51
Burgoyne R., Renwick R., 2004. Social support and quality of life over time among adults living with HIV in the HAART era Social Science & Medicine 58: 1353–1366
Busza J.R., 2001. Promoting the positive: responses to stigma and discrimination in Southeast Asia AIDS Care 13(4): 441–456
Carrieri P., Spire B., Duran S., Katlama C., Peyramond D., Francois C., Chêne G., Lang J.M., Moatti J.P., Leport C., APROCO Study Group 2003. Health-related quality of life after 1 year of highly active antiretroviral therapy Journal of Acquired Immune Deficiency Syndromes 32(1): 38–47
Chen J., Choe M.J., Chen S., Zhang S., 2005. Community Environment and HIV/AIDS-related Stigma in China AIDS Education and Prevention 17(1): 1–11
Cleary, S., A. Boulle, D. McIntyre and D. Coetzee: 2004. Cost-effectiveness of antiretroviral treatment for HIV-positive adults in a South African township (Cape Town, Health Systems Trust, MSF and University of Cape Town)
Cobb M., De Chabert T., 2002. HIV/AIDS and care provider attributions: Who’s to blame? AIDS Care 14(4): 545–548
Coetzee D., Hildebrand K., Boulle A., Maartens G., Louis F., Labatala F., Reuter H., Ntwana N., Goemaere E., 2004. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa AIDS 18: 887–895
Council for Medical Schemes, 2003. Annual report of the Registrar of Medical Schemes 2002–2003. Council for Medical Schemes, Pretoria
Creese A., Floyd K., Alban A., Guiness L., 2002. Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence The Lancet 359: 1635–1642
Crook J., Browne G., Roberts J., Gafni A., 2005. Impact of support services provided by a community-based AIDS service organization on persons living with HIV/AIDS Journal of the Association of Nurses in AIDS Care 16(4): 39–49
D’Angelo L.J., Abdalian S.E., Sarr M., Hoffman N., Belzer M., The Adolescent Medicine HIV/AIDS Research Network, 2001. Disclosure of serostatus by HIV infected youth: The experience of the REACH study Journal of Adolescent Health 29S: 72–79
Delate T., Coons S.J., 2001. The use of 2 health-related quality-of-life measures in a sample of persons infected with human immunodeficiency virus Clinical Infectious Diseases 32: E47–E52
Dorrington R.E., Bradshaw D., Johnson L., Budlender D., 2004. The Demographic Impact of HIV/AIDS in South Africa: National Indicators for 2004. Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa, Cape Town
Drummond M., Pang F., 2001. Transferability of economic evaluation results. In: Drummond M., McGuire A. (eds) Economic Evaluation in Health Care: Merging Theory with Practice. Oxford University Press, Oxford
Echteld M.A., Deliens L., Ooms M.E., Ribbe M.W., Van der Wal G., 2005. Quality of life change and response shift in patients admitted to palliative care units: A pilot study Palliative Medicine 19: 381–388
Eriksson L.E., Nordström G., Berglund T., Sandström E., 2000. The health-related quality of life in a Swedish sample of HIV-infected persons Journal of Advanced Nursing 32(5): 1213–1223
Essink-Bot M.L., Krabbe P.F., Bonsel G.J., Aaronson N.K., 1997. An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the Euroqol instrument Medical Care 35: 522–537
Evans S., Huxley P., 2005. Adaptation, response-shift and quality of life ratings in mentally well and unwell groups Quality of Life Research 14(7): 1719–1732
Forman L., Pillay Y., Sait L., 2004. Health Legislation 1994–2003. South African Health Review 2003/2004. Health Systems Trust, Durban
Forsythe S., Gilks C., 1999. Economic issues and antiretroviral therapy in developing countries Transactions of the Royal Society of Tropical Medicine and Hygiene 93: 1–3
Freedberg K.A., Losina E., Weinstein M., Paltiel A.D., Cohen C.J., Seage G.R., Craven D.E., Zhang H., April D., Kimmel A.B., Goldie S.J., 2001. The cost effectiveness of combination antiretroviral therapy for HIV disease New England Journal of Medicine 344(11): 824–831
Free State Department of Health, 2005. Implementation of the Comprehensive Care, Management and Treatment of HIV and AIDS patients: Outcomes of the first year, 2004. Free State Department of Health, Bloemfontein
Free State Department of Health, 2006. Monthly Update on Antiretroviral Treatment Programme. Free State Department of Health, Bloemfontein
Gielen A.C., McDonnell K.A., Wu A.W., O’Campo P., Faden R., 2001. Quality of life among women living with HIV: The importance of violence, social support, and self care behaviors Social Science & Medicine 52: 315–322
Hajiran H., 2006. Toward a quality of life theory: net domestic product of happiness Social Indicators Research 75: 31–43
Hughes J., Jelsma J., Maclean E., Parder M., Tinise X., 2004. The health-related Quality of life of people living with HIV/AIDS Disability and Rehabilitation 26(6): 371–376
Hurst N.P., Kind P., Ruta D., Hunter M., Stubbings A., 1997. Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D) British Journal of Rheumatology 36: 551–559
Ijumba P., Poole C., George G., Gray A., 2004. Access to Antiretroviral Therapy. South African Health Review 2003/04. Health Systems Trust, Durban, pp 319–338
Jack W., 1999. Principles of Health Economics for Developing Countries. World Bank, Washington, DC
Jefferson T., Demicheli V., Mugford M., 2000. Elementary Economic Evaluation in Health Care. BMJ Books, London
Jelsma J., Ferguson G., 2004. The determinants of self-reported health-related quality of life in a culturally and socially diverse South African Community Bulletin of the World Health Organisation 82: 206–212
Jelsma J., Mkoka S., Amosun L., Nieuwveldt J., 2004. The reliability and validity of the Xhosa version of the EQ-5D Disability and Rehabilitation 26: 103–108
Kalichman S.C., Simbayi L., 2004. Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa AIDS Care 16(5): 572–580
Kim-Prieto C., Diener E., Tamir M., Scollon C., Diener M., 2005. Integrating the diverse definitions of happiness: A time-sequential framework of subjective well-being Journal of Happiness Studies 6: 261–300
Kind P., Dolan P., Gudex C., Williams A., 1998. Variations in population health status: Results from a United Kingdom national questionnaire survey British Medical Journal 316: 736–41
Klein S.J., Karchner W.D., O’Connell D.A., 2002. Interventions to prevent HIV-related stigma and discrimination: Findings and recommendations for public health practice Journal of Public Health Management Practice 8(6): 44–53
Klitzman R.L., Kirshenbaum S.B., Dodge B., Remien R.H., Ehrhardt A.A., Johnson M.O., Kittel L.E., Daya S., Morin S.F., Kelly J., Lightfoot M., Rotheram-Borus M.J., the NIHM Health Living Trial Group 2004. Intricacies and inter-relationships between HIV disclosure and HAART: A qualitative study AIDS Care 16(5): 628–640
Krabbe P., Weijnen T., 2003. Guidelines for analysing and reporting EQ-5D outcomes. In: Brooks R., Rabin R., de Charro F. (Eds) The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective. Kluwer Academic Publisher, DordrechtLondon, pp 7–19
Lau J.T.F., Tsui H.Y., Li C.K., Chung R.W.Y., Chan M.W., Molassiotis A., 2003. Needs assessment and social environment of people living with HIV/AIDS in Hong Kong Aids Care 15(5): 699–706
Laurent C., Kouanfack C., Koulla-Shiro S., Nkoué N., Bourgeois A., Calmy A., Lactuock B., Nzeusseu V., Mougnutou R., Peytavin G., Liégeois F., Nerrienet F., Tardy M., Peeters M., Andrieux-Meyer I., Zekeng L., Kazatchkine M., Mpoudi-Ngolé E., Delaporte E., 2004. Effectiveness and safety of a generic fixed-dose combination of nevirapine, stavudine, and lamivudine in HIV-1-infected adults in Cameroon: Open-label multicentre trial The Lancet 364: 29–34
Lavalle C., Aguilar J.C.D., Peña F., Estrada-Aguilar J.L., Aviña-Zubieta J.A., Madrazo M., 2000. Reduction in hospitalization costs, morbidity, disability, and mortality in patients with AIDS treated with protease inhibitors Archives of Medical Research 31: 515–519
Louwagie, G., K. Meyer, M. Bachmann, F. le R. Booysen, L. Fairall and C. Heunis: 2006. ‚Health-related Quality of Life in patients selected for antiretroviral treatment in a South African Province: A cross-sectional analytical study’, Mimeo. Bloemfontein, University of the Free State
Makoae L.N., Seboni S.M., Molosiwa K., Moleko M., Human S., Sukati N.A., Holzemer W.L., 2005. The symptom experience of people living with HIV/AIDS in Southern Africa Journal of the Association of Nurses in AIDS Care 16(3): 22–32
Marseille E., Hoffman P.B., Kahn J.G., 2002. HIV prevention before HAART in sub-Saharan Africa The Lancet 359: 1851–1856
Messeri P.A., Abramson D.M., Aidala A.A., Lee F., Lee G., 2002. The impact of ancillary HIV services on engagement in medical care in New York City AIDS Care 14(Supplement 1): S15–S29
Michalos A.C., 2004. Social indicators research and health-related quality of life research Social Indicators Research 65: 27–72
Miners A.H., Sabin C.A., Trueman P., Youle M., Mocroft A., Johnson M., Beck E.J., 2001. Assessing the cost-effectiveness of highly active antiretroviral therapy for adults with HIV in England HIV Medicine 2: 52–58
Møller V., 1998. Quality of life in South Africa: Post-apartheid trends Social Indicators Research 43(1): 27–68
Møller V., 1999. South African quality of life trends in the late 1990s: Major divides in perceptions Society in Transition 30(2): 93–105
Møller V., Dickow H., 2002. The role of quality of life surveys in managing change in democratic transitions: The South African case Social Indicators Research 58(3): 267–292
Møller V., Schlemmer L., 1983. Quality of life in South Africa: Towards an instrument for the assessment of quality of life and basic needs Social Indicators Research 12(3): 225–279
Moore R.D., 2000. Cost effectiveness of combination HIV therapy: 3 Years later Pharmacoeconomics 17(4): 325–330
Murri R., Fantoni M., Del Borgo C., Visona R., Barracco A., Zambelli A., Testa L., Orchi N., Tozzi V., Bosco O., Wu A.W., 2003. Determinants of health-related quality of life in HIV-infected patients AIDS Care 15(4): 581–590
National Department of Health, 2003. Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa. National Department of Health, Pretoria
National Department of Health, 2004. National Antiretroviral Treatment Guidelines. National Department of Health, Pretoria
Ogden J., Nyblade L., 2005. Common at its Core: HIV-Related Stigma Across Contexts. International Centre for Research on Women, Washington, DC
Paxton S., 2002. The paradox of public HIV disclosure AIDS Care 14(4): 559–567
Paxton S., Gonzales G., Uppakaew K., Abraham K.K., Okta S., Green C., Nair K.S., Parwati-Merati T., Thephthien B., Marin M., Quesada A., 2005. Aids-related discrimination in Asia AIDS Care 17(4): 413–424
Pearmain D., 2000. Impact of Changes to the Medical Schemes Act. South African Health Review 2000. Health Systems Trust, Durban
Poundstone K.E., Strathdee S.A., Celentano D.D., 2004. The social epidemiology of human immunodeficiency virus/acquired immunodeficiency syndrome Epidemiologic Reviews 26: 22–35
Préau M., Leport C., Salmon-Ceron D., Carrieri P., Portier H., Chene G., Spire B., Choutet P., Raffi F., Morin M., the APROCO Study Group 2004. Health-related quality of life and patient-provider relationships in HIV-infected patients during the first 3 years after starting PI-containing antiretroviral treatment AIDS Care 16(5): 649–661
Reidpath D.D., Chan K.Y., 2005. A method for the quantitative analysis of the layering of HIV-related stigma AIDS Care 17(4): 425–432
Sendi P.P., Bucher H.C., Harr T., Craig B.A., Schwietert M., Pfluger D., Gafni A., Battegay M., 1999. Cost effectiveness of highly active antiretroviral therapy in HIV-infected patients AIDS 13: 1115–1122
Sendi P., Schellenberg F., Ungsedhapand C., Kaufmann G.R., Bucher H.C., Weber R., Battegay M., Swiss HIV Cohort Study 2004. Productivity costs and determinants of productivity in HIV-infected patients Clinical Therapeutics 26(5): 791–800
Siegel K., Schrimshaw E.W., 2005. Stress, appraisal, and coping: A comparison of HIV-infected women in the pre-HAART and HAART eras Journal of Psychosomatic Research 58: 225–233
Stein, A., H. McLeod and Z. Achmat: 2002. The cover provided for HIV/AIDS benefits in medical schemes in 2002. CARE Monograph No. 10. University of Cape Town: Centre for Actuarial Research
Stewart K.E., Cianfrini L.R., Walker J.F., 2005. Stress, social support and housing are related to health status among HIV-positive persons in the Deep South of the United States AIDS Care 17(3): 350–358
Stewart R., Loveday M., 2005. The Operation Plan: Implementation of the Antiretroviral Therapy Component. South African Health Review 2005. Health Systems Trust, Durban
Sugimoto N., Ichikawa M., Siriliang B., Nakahara S., Jimba M., Wakai S., 2005. Herbal medicine use and quality of life among people living with HIV/AIDS in northeastern Thailand AIDS Care 17(2): 252–262
Teixeira P.R., Vitoria M.A., Barcarolo J., 2004. Antiretroviral treatment in resource-poor settings: the Brazilian experience AIDS 18(3): S5–S7
The EuroQol Group, 1990. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 16: 199–208
Tramarin A., Campostrini S., Postma M.J., Calleri G., Tolley K., Parise N., De Lalla F., 2004. A multicentre study of patient survival, disability, quality of life and cost of care among patients with AIDS in Northern Italy Pharmacoeconomics 22(1): 43–53
Van Praag B.M.S., Ferrer-I-Carbonell A., 2004. Happiness Quantified: A Satisfaction Calculus Approach. Oxford University Press, New York
Veenhoven R., 2000. The four qualities of life: ordering concepts and measures of the good life Journal of Happiness Studies 1: 1–39
Weidle P.J., Malamba S., Mwebaze R., Sozi C., Rukundo G., Downing R., Hanson D., 2002. Assessment of a pilot antiretroviral drug therapy programme in Uganda: Patients’ response, survival, and drug resistance The Lancet 360: 34–40
Williams P., Narciso L., Browne G., Roberts J., Weir R., Gafni A., 2005. Characteristics of people living with HIV who use community-based services in Ontario, Canada: Implications for service providers Journal of the Association of Nurses in AIDS Care 16(4): 50–63
WHO, 2005. “3 × 5” Progress Report. WHO and UNAIDS, Geneva
Wood E., Braitstein P., Montaner J.S.G., Schechter M.T., Tyndall M.W., O’Shaughnessy M.V., Hogg R.S., 2000. Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa The Lancet 355: 2095–100
Wu A.W., Jacobson K.L., Frick K.D., Clark R., Revicki D.A., Freedberg K.A., Scott-Lennox J., Feinberg J., 2002. Validity and responsiveness of the Euroqol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial Quality of Life Research 11: 273–82
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The generous material and moral support of CIDA, DCI, DfID, IDRC, JEAPP, USAID, AUSAID and the NRF is gratefully acknowledged. In addition, those patients in the ART programme who were (and are still) willing to act as respondents in the study are sincerely thanked for sacrificing time and energy, and for frankly sharing views and experiences with the researchers. In similar vain, we wish to acknowledge the management and health care staff of the Free State Department of Health and of several local municipalities, who facilitated this research.
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Booysen, F.L.R., Van Rensburg, H.C.J., Bachmann, M. et al. The Heart in Haart: Quality of Life of Patients Enrolled in the Public Sector Antiretroviral Treatment Programme in the Free State Province of South Africa. Soc Indic Res 81, 283–329 (2007). https://doi.org/10.1007/s11205-006-9011-4
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DOI: https://doi.org/10.1007/s11205-006-9011-4