Prevalence of Comorbidities, AIDS related symptoms and Associated Factors among Workers

Living With HIV/AIDS Attending ARV Clinics in Health Institutions in Enugu, Nigeria

By

Sussan U. Arinze-Onyia, Emmanuel N. Aguwa and Ifeoma Modebe

Background:•Opportunistic infections and AIDS related cancers → death for PLWHA (Cahill and Valadez , 2013)

•Care aimed at:• Preventing the spread of infection

•Palliative care.

• ART and HAART → improved management and mortality reduction (Lyons et al, 2010).

• Expected life spans of PLWHA almost equal to those of uninfected persons (Samji et al, 2013).

• With ageing came comorbidities hitherto uncommon in PLWHA (Stewart et al, 2012).

• Common comorbidities seen among PLWHA are: cardiovascular, renal, pulmonary, hepatic, mental diseases and non-AIDS defining malignancies.

• Features:• Earlier age• Greater extent (Stewart et al, 2012).

• Reasons:

• Reduced immunity

• ART and HAART toxicity and

• Tobacco and alcohol use (Justice et al, 2010).

• For HIV workers, comorbidity is a huge challenge.

• Workers do not disclose their HIV status for fear of stigma and discrimination (Bashir, 2011).

• Presence of comorbidities means:• Worsening of clinical conditions (Ndu et al, 2011)• Frequent hospital visits• Exposure of a failing health• Economic threat.

• SPECIFIC OBJECTIVES:• Demographic characteristics of HIV positive

workers attending HIV clinics in Enugu.

• Prevalence of AIDS-related symptoms

• Presence of comorbidities

• Factors affecting workers living with HIV.

• Methods:• A descriptive cross-sectional study in Enugu

between March and June 2014.

• There are two government tertiary hospitals (UNTH and ESUTH) and

• Two mission hospitals (Annunciation Specialist Hospital and Mother of Christ Hospital) that run major anti-retroviral (ARV) clinics.

• ESUTH and Annunciation Specialist Hospital By simple random sampling.

• In both hospitals ARV clinics are run three times weekly by different departments:

• Community Medicine, Paediatrics, Internal Medicine and O & G.

• An average of 150 PLWHA are seen in each of these clinics every week.

• A sample size of 480 was calculated but this was increased to 500 (250 selected from each of the two clinics) to take care of incomplete or wrongly filled data.

• Ethical permit was obtained from the Ethics Committee of University of Nigeria Teaching Hospital Committee and informed consent obtained from each participant.

• Inclusion criteria were:

• Patient, 18 years or older, who gave written informed consent, must have attended care at either of the two clinics within the study period and must have had working experience.

• Participants who met the inclusion criteria were then enrolled consecutively until the sample size was reached

• Data management:

• Data were collected using a pre-tested semi-structured self administered questionnaire that gave information on demography, AIDS’ symptoms and presence comorbidities.

• Pre-test was at NAUTH, Nnewi

• Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 13.

• Results are presented as tables and cross-tabulations. Chi square was used to test for significance.

• Table 1 - Socio-Demographic variables of respondents

Variables Frequency (N = 489) Percent

Sex distributionFemalesMales

255234

52.147.9

Age range21 – 3031 – 4041 – 5051 – 6061 – 7071 and above

10418911867101

21.338.724.113.72.00.2

Marital statusSingleMarriedWidowedDivorced/separated

1262914824

25.859.59.84.9

Similar:Laah and Ayiwulu, 2010. Contrast: Iliyasu, 2004

Negin et al, 2012

• Table 2 - Socio-Demographic variables Contd

Variables Frequency (N = 489)

Percent

Present/past occupation:Government employeePrivate employeeSelf employed

23792

160

48.518.832.7

Total years of working:1 – 910 – 1920 – 2930 – 3940 - 49

28313751126

57.928.010.42.51.2

Range of working years in present job = 1 – 45 years

Table 3: Co-morbid conditions and AIDS-related symptoms at time of study

Variable Frequency PercentPresence of co-morbid conditions or AIDS-related symptoms:YesNo

N = 489

119370

24.375.7

AIDS-related symptoms:Persistent febrile illness Generalized muscle painsPersistent diarrheaGeneralized rash Extreme fatigueAnorexiaInsomniaTuberculosisCancerEpilepsy

N = 1191066752383127251521

89.156.343.731.926.122.721.012.61.70.8

Denue et al, 2012: higher prevalence

• Table 4: Co-morbid conditions at time of study

Variable Frequency PercentNon-AIDS Related ComorbiditiesHypertensionArthritisTyphoid feverDiabetesHepatitisPeptic ulcer diseaseRenal problem

5344139643

44.537.010.97.65.03.42.5

Gazzola et al, 2012- multi-morbidities

Table 5 – Demographic variables and co-morbid conditions

Variables Co-morbid conditions Total 2 (P value)

PresentN=119 (%)

AbsentN=370 (%)

N=489

Sex Female Male

55(21.6)64(27.4)

200 (78.4)170(72.6)

255(100.0)234(100.0)

2.22 (0.14)

Age group < 50 years ≥50 years

89(22.4)30(32.6)

308(77.6)62(67.4)

397(100.0)92(100.0)

4.21 (0.04)*

Marital Status Single Married Widowed Divorced/Separated

33(26.2)62(21.3)13(27.1)11(45.8)

93(73.8)229(78.7)35(72.9)13(54.2)

126(100.0)291(100.0)48(100.0)24(100.0)

7.91 (0.05)

Negin et al, 2012

Porter et al, 2004

Table 6 – Demographic variables and co-morbid conditions Contd

Variables Co-morbid conditions Total 2 (P value)

PresentN=119 (%)

AbsentN=370 (%)

N=489

Employment record Government employee Private employee Self employed

53(22.4)29(31.5)37(23.1)

184(77.6)63(68.5)

123(76.9)

237(100.0)92(100.0)

160(100.0)

3.21 (0.20)

Table 7 – Period of diagnosis and associated challenges Variables Frequency

N = 119Percent

Period of diagnosing the co-morbidity: Before developing HIV/AIDSAfter developing HIV/AIDSI do not know

49628

41.252.16.7

Challenges in managing the co-morbiditiesToo many drugs to takeMore side effectsIncreased cost of medicationDifficulties with controlling the co-morbid conditionNothing

113986726

6

95.082.456.321.8

5.0

Monroe et al, 2013

• Table 8 – Workplace Social factors affecting PLWHA with co-morbid conditions

Ways in which the management has affected treatment of HIV and co-morbid illnesses

FrequencyN = 119

Percent

They do not give day off to go to hospitalThey complain that PLWHA do not give enough time to my workThey are indifferentThey give me moral supportOthers

95

49

20103

79.8

41.2

16.88.42.5

Warren-Jeanplere et al, 2014

• Critical Issues• Comorbidities and AIDS symptoms are prevalent

among HIV workers in our environment.• Comorbidities are higher among those 50 years

and above.• Higher in the younger age group than general

population (Stewart et al, 2012)• Challenges:– Drug-related– Workplace-related

• Recommendations:• HIV workplace policy should include assistance for

management of comorbidities.

• Research in drug development.

• Thank you