TY - BOOK
T1 - Quality of Life Among People Living with HIV in Jimma, Ethiopia: the Role of Mental Health, Food and Nutrition
AU - Woldeyohannes, Markos Tesfaye
N1 - CURIS 2017 NEXS 082
PY - 2016
Y1 - 2016
N2 - Background: The availability of antiretroviral treatment (ART) for people living with HIV
(PLHIV) in sub-Saharan has led to greatly improved survival over the last decade.
However, PLHIV in low-income country settings continue to experience a variety of
socio-economic, social and health issues which might affect their quality of life. Among
others, food insecurity is a common problem among PLHIV, and HIV programs in lowincome
settings often provide food support and nutritional counselling. However, the
effect of nutritional intervention on quality of life of PLHIV has not been adequately
investigated. Furthermore, food insecurity has been linked to poor mental health. Poor
mental health is in turn associated with poor quality of life. The potential relationship
among food security, mental health and quality of life needs to be investigated so as to
inform programs aimed to address quality of life of PLHIV in low-income settings. On
the other hand, the assessment of quality of life among PLHIV in Africa requires tools to
be adapted to ensure cultural validity in the setting.
Objectives: The primary objective of this project was to investigate the effect of lipidbased
nutrient supplements (LNS) on the quality of life of PLHIV initiating ART. The
secondary objectives were to conduct cultural adaptation of the short version of World
Health Organization Quality of Life assessment tool for HIV (WHOQOL-HIV BREF), and
to investigate the independent association of food insecurity and mental health with
quality of life of PLHIV.
Methods: Aspects of quality of life relevant in Ethiopian context were incorporated into
the WHOQOL-HIV BREF. Semantic equivalence of the tool was achieved through
translation and back-translation. Cognitive interviewing was carried out to test the
relevance and meaning of items in context. After pilot testing on 100 PLHIV on
treatment and testing for known-group validity, a new tool namely, WHOQOL-HIVBREF-
ETH was produced. The new tool was then tested for construct validity on 348
PLHIV using confirmatory factor analysis. Data on quality of life, mental health, and
level of food insecurity from 348 PLHIV initiating ART at three health facilities in Jimma
zone, southwest Ethiopia was collected. Using multiple linear regression, the
independent associations of poor mental health and food insecurity with quality of life
were investigated. Data from a sub-sample of the 348 PLHIV who had BMI>17 kg/m2
(n=282), and who were enrolled in the nutritional intervention trial, were analyzed to
assess the effects of three months of supplementation upon quality of life. Nutritional
supplementation was given either during the first three months or during the fourth to
sixth months after initiation of ART. Comparison of quality of life at the six month
assessment time point was made using mixed linear regression to investigate whether
timing of supplementation had different effects on quality of life.
Results: Problems encountered in the semantic, item and measurement equivalences
of WHOQOL-HIV-BREF, which might limit its use in clinical settings, were addressed
through a rigorous adaptation process. The Ethiopian version, WHOQOL-HIV-BREFETH,
demonstrated an excellent known groups validity in all domains for asymptomatic
PLHIV and advanced HIV. Furthermore, the WHOQOL-HIV-BREF-ETH includes
aspects of quality of life in social and environment domains that were not represented
within the original tool. Confirmatory factor analysis fit indices were close to, although
not within, the recommended range.
Analysis of the baseline data showed that both moderate (β= -2.52, 95% CI:-5.55; 0.51)
and severe (β=-3.24, 95% CI:-6.19; -0.29) food insecurity were associated with lower
quality of life. A higher burden of symptoms of common mental disorders was
associated with lower quality of life (β=-1.72, 95% CI: -1.94; -1.49). In addition,
advanced HIV disease (β=-3.80, 95% CI: -6.18; -1.42), and having mild malnutrition
(BMI=17.0-18.5 kg/m2) were associated with lower quality of life scores (β=-3.45, 95%
CI: -6.18; -0.71). Furthermore, severe food insecurity (β=2.40, 95% CI: 1.05; 3.74) had a
significantly stronger association with symptoms of common mental disorders than
moderate food insecurity (β=2.31, 95% CI: 0.92; 3.71, p=0.001).
After three months, participants who received LNS during the first three months
following ART initiation showed better quality of life than those who only received ART
without LNS [β=6.2, 95% CI: 2.9: 9.6]. At the six month assessment, there was no
difference in total quality of life score between the early and delayed supplementation
groups [β=3.0, 95% confidence interval: -0.4: 6.4]. However, at the six month
assessment, the early supplementation group showed higher scores on the social and
spirituality domains than the delayed group.
Conclusions: Access to adequate food and nutrition is an important aspect of quality of
life among PLHIV in low-income settings. Supplementation with LNS for PLHIV initiating
ART has a beneficial effect on quality of life in the short term. Food insecurity and poor
mental health are independently associated with lower quality of life among PLHIV.
Food support in HIV programs need to consider the food security status of PLHIV in
addition to their nutritional status. The long-term effects of early supplementation with
LNS on quality of life need further investigation. Future studies are needed to establish
causal association between food insecurity and poor mental health among PLHIV.
AB - Background: The availability of antiretroviral treatment (ART) for people living with HIV
(PLHIV) in sub-Saharan has led to greatly improved survival over the last decade.
However, PLHIV in low-income country settings continue to experience a variety of
socio-economic, social and health issues which might affect their quality of life. Among
others, food insecurity is a common problem among PLHIV, and HIV programs in lowincome
settings often provide food support and nutritional counselling. However, the
effect of nutritional intervention on quality of life of PLHIV has not been adequately
investigated. Furthermore, food insecurity has been linked to poor mental health. Poor
mental health is in turn associated with poor quality of life. The potential relationship
among food security, mental health and quality of life needs to be investigated so as to
inform programs aimed to address quality of life of PLHIV in low-income settings. On
the other hand, the assessment of quality of life among PLHIV in Africa requires tools to
be adapted to ensure cultural validity in the setting.
Objectives: The primary objective of this project was to investigate the effect of lipidbased
nutrient supplements (LNS) on the quality of life of PLHIV initiating ART. The
secondary objectives were to conduct cultural adaptation of the short version of World
Health Organization Quality of Life assessment tool for HIV (WHOQOL-HIV BREF), and
to investigate the independent association of food insecurity and mental health with
quality of life of PLHIV.
Methods: Aspects of quality of life relevant in Ethiopian context were incorporated into
the WHOQOL-HIV BREF. Semantic equivalence of the tool was achieved through
translation and back-translation. Cognitive interviewing was carried out to test the
relevance and meaning of items in context. After pilot testing on 100 PLHIV on
treatment and testing for known-group validity, a new tool namely, WHOQOL-HIVBREF-
ETH was produced. The new tool was then tested for construct validity on 348
PLHIV using confirmatory factor analysis. Data on quality of life, mental health, and
level of food insecurity from 348 PLHIV initiating ART at three health facilities in Jimma
zone, southwest Ethiopia was collected. Using multiple linear regression, the
independent associations of poor mental health and food insecurity with quality of life
were investigated. Data from a sub-sample of the 348 PLHIV who had BMI>17 kg/m2
(n=282), and who were enrolled in the nutritional intervention trial, were analyzed to
assess the effects of three months of supplementation upon quality of life. Nutritional
supplementation was given either during the first three months or during the fourth to
sixth months after initiation of ART. Comparison of quality of life at the six month
assessment time point was made using mixed linear regression to investigate whether
timing of supplementation had different effects on quality of life.
Results: Problems encountered in the semantic, item and measurement equivalences
of WHOQOL-HIV-BREF, which might limit its use in clinical settings, were addressed
through a rigorous adaptation process. The Ethiopian version, WHOQOL-HIV-BREFETH,
demonstrated an excellent known groups validity in all domains for asymptomatic
PLHIV and advanced HIV. Furthermore, the WHOQOL-HIV-BREF-ETH includes
aspects of quality of life in social and environment domains that were not represented
within the original tool. Confirmatory factor analysis fit indices were close to, although
not within, the recommended range.
Analysis of the baseline data showed that both moderate (β= -2.52, 95% CI:-5.55; 0.51)
and severe (β=-3.24, 95% CI:-6.19; -0.29) food insecurity were associated with lower
quality of life. A higher burden of symptoms of common mental disorders was
associated with lower quality of life (β=-1.72, 95% CI: -1.94; -1.49). In addition,
advanced HIV disease (β=-3.80, 95% CI: -6.18; -1.42), and having mild malnutrition
(BMI=17.0-18.5 kg/m2) were associated with lower quality of life scores (β=-3.45, 95%
CI: -6.18; -0.71). Furthermore, severe food insecurity (β=2.40, 95% CI: 1.05; 3.74) had a
significantly stronger association with symptoms of common mental disorders than
moderate food insecurity (β=2.31, 95% CI: 0.92; 3.71, p=0.001).
After three months, participants who received LNS during the first three months
following ART initiation showed better quality of life than those who only received ART
without LNS [β=6.2, 95% CI: 2.9: 9.6]. At the six month assessment, there was no
difference in total quality of life score between the early and delayed supplementation
groups [β=3.0, 95% confidence interval: -0.4: 6.4]. However, at the six month
assessment, the early supplementation group showed higher scores on the social and
spirituality domains than the delayed group.
Conclusions: Access to adequate food and nutrition is an important aspect of quality of
life among PLHIV in low-income settings. Supplementation with LNS for PLHIV initiating
ART has a beneficial effect on quality of life in the short term. Food insecurity and poor
mental health are independently associated with lower quality of life among PLHIV.
Food support in HIV programs need to consider the food security status of PLHIV in
addition to their nutritional status. The long-term effects of early supplementation with
LNS on quality of life need further investigation. Future studies are needed to establish
causal association between food insecurity and poor mental health among PLHIV.
UR - https://rex.kb.dk/primo-explore/fulldisplay?docid=KGL01010310098&context=L&vid=NUI&search_scope=KGL&isFrbr=true&tab=default_tab&lang=da_DK
M3 - Ph.D. thesis
SN - 978-87-93476-82-0
BT - Quality of Life Among People Living with HIV in Jimma, Ethiopia: the Role of Mental Health, Food and Nutrition
PB - Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen
CY - Copenhagen
ER -
