Health-related quality of life of people living with HIV receiving antiretroviral therapy in North-eastern Nigeria: A mixed methods study

Since the introduction of effective antiretroviral therapy (ART), persons living with human immunodeficiency virus (PLWHA) are living longer. Life longetivity among PLWHA makes quality of life (QoL) critically important for patients and providers of medical and social services. However, this issue has not been assessed systematically in North-eastern Nigeria. The purpose of the study was to assess health-related QoL of PLWHA receiving ART in North-eastern Nigeria using a mixed method approach. The study was based on the revised Wilson and Cleary conceptual model (RWCM) which integrates both biological and psychosocial aspects of QoL. The model has been widely applied to different population in high income countries but it has never been tested in PLWHA in resource limited countries such as Nigeria. A survey relating to various domains of QoL was completed by 443 PLWHA and path analysis was used to assess the associations between QoL domains. Structural equation modelling was used to assess the fit of the RWCM to PLWHA in North-eastern Nigeria. Furthermore, 14 in-depth interviews were conducted to explore the lived experience of PLWHA and throw light upon the associations identified in the quantitative analysis. Participants with better physical and cognitive functioning and better general health had significantly better overall QoL. General health perception and characteristics of the individual and the environment explained 87.1% of the variance in overall QoL. The results showed that the data adequately fit the the RWCM (CFI = 0.934; RMSEA = 0.055, 90% CI: 0.049 – 0.062, p = 0.089). The analysis of the qualitative data identified five themes which in part helped to explain the associations identified in the quantitative data. These include: QoL is more than being free of disease; impact of HIV on well-being; stigmatisation; coping with HIV; playing with ART. Additionally, the data examined the impact of insecurity on healthcare and QoL as during the course of the study there was presence of political insecurity in the area. The RWCM is applicable to PLWHA in North-eastern Nigeria and provides a useful framework to understand QoL in this context. Both the quantitative and qualitative data suggest that certain aspects, eg. spirituality, stigma and treatment impact have a pronounced impact on QoL of PLWHA in this area. Recommendations are made to improve psychosocial support services for HIV-infected people.