TABLE OF CONTENTS

Content                                                                                                       Page

Title page                                                                                                              i

Certification                                                                                                         ii

Dedication                                                                                                     iii

Acknowledgements                                                                                           iv

Abstract                                                                                       v

Table of Contents                                                                               vi

List of Tables                                                                                              ix

List of Figures                                                                                             x

Abbreviations                                                                                                 xi

CHAPTER ONE: INTRODUCTION               

1.1       Background to the Study                                                                1

1.2       Statement of the Problem                                                             3

1.3       Objective of the Study                                                           4

1.4       Research Questions                                                                       4

1.5       Hypotheses                                                                                  4

1.6       Significance of the Study                                                           5

1.7       Scope of the Study                                                                           5

1.8       Operational Definition of Terms                                                5

CHAPTER TWO: REVIEW OF LITERATURE

2.1       Global overview of HIV/AIDS                                           6

2.2       Basic facts of HIV/AIDS                                                                 6

2.3       Disease Staging of HIV/AIDS                                                              6

2.4       Antiretroviral Therapy adherence and Quality of life                           8

2.5       Quality of life assessment                                                             9

2.6       Factors that influence Quality of life                                                      10

2.7       Relationship between perceived social support and Quality of life                           12

2.8       Relationship between socio-demographic variables and Quality of life                     14

2.9       Empirical studies on Quality of Life                                           16

2.10     Conceptual Model                                                                    17

CHAPTER THREE: METHODOLOGY

3.1       Research Design                                                                              21

3.2       Population                                                                                21

3.3       Sample size and sampling Technique                                                    21

3.4       Instrumentation                                                                             22

3.5       Validity and Reliability of Instrument                                       22

3.6       Method of Data Collection                                                             23

3.7       Method of Data Analysis                                                         23

3.8       Ethical Consideration                                                                  23

CHAPTER FOUR: DATA ANALYSIS, RESULTS

AND DISCUSSION OF FINDINGS

4.0.      Introduction                                                                                       25

4.1       Presentation of Results: Socio-demographic information of respondent                   24

4.2       Analysis of Research Questions                                                   26

4.3       Hypothses Testing                                                                              32

4.4       Discussion of Findings                                                     34

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.0       Introduction                                                                                             39

5.1       Summary                                                                                           39

5.2       Conclusion                                                                                           40

5.3       Recommendations                                                                   41

5.4       Contribution to Knowledge                                                                     42

5.5       Limitation of the Study                                                                      42

5.6       Suggestion for Further Studies                                                            42

REFERENCES                                                                                              44

APPENDICES                                                                                                50

LIST OF TABLES

Table                                                                                                   Page

4.1 Respondent’s Demographic characteristics                                                 25

4.2 Perceived social support of PLWHA                                                     26

4.3 Quality of life of People living with HIV/AIDS                                     28

4.4a Model Summary for the influence of Gender on Quality of life of PLWHA                30

4.4b Simple linear Regression showing influence of Gender on Quality of life                    30

4.5a Model Summary for the influence of educational level on Quality of life of PLWHA 31

4.5b Simple linear Regression showing influence of educational level on Quality of life     31

4.6a Model Summary for the influence of occupation on Quality of life of PLWHA          31

4.6b Simple linear Regression showing influence of occupation on Quality of life               31

4.7a Model Summary for the influence of HIV serostatus on Quality of life of PLWHA    32       

4.7b Simple linear Regression showing the influence of Gender on Quality of life              32

4.8 Pearson Product Moment Correlation (PPMC) showing relationship between social support and quality of life                                                                                                            33

4.9 PPMC showing relationship between Quality of life and socio-demographic variables  33

4.10PPMC showing relationship between social support and socio-demographic variables 34

LIST OF FIGURES

Figure                                                                                                  Page

2.1 Adapted Conceptual model of Quality of life among People Living with HIV/AIDS   19

ABBREVIATIONS

AIDS                          Acquired Immune Deficiency Syndrome

HIV/AIDS                  Human Immunodeficiency Virus

NACA                        National Action Committee on AIDS

OOUTH                      Olabisi Onabanjo University Teaching Hospital

PLWHA                      People Living with HIV/AIDS

QoL                             Quality of Life

WHO                          World Health Organisation

WHOQoL-HIV          World Health Organisation Quality of life for HIV

CHAPTER ONE

INTRODUCTION

1.1   Background to the study

            Human Immuno deficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) is a pandemic disease in which the body’s defense mechanism is weak and this makes the body unable to get rid of infection (NACA, 2001). HIV/AIDS is an incurable diseases that makes the casualty susceptible (Rajeev, 2012), and is associated with significant morbidity and mortality despite the availability of treatment and care. (Smeltzer, Bare, Hinkle & Cheever, 2010).  

            As at the end of 2015 – 36.7 million people probably were living with the virus, 2.1 million people were nearly infected; 1.1 million people died from the disease; and 18.2 million people were accessing ART as June 2016. Since the beginning of the epidemic, over 78 million people have become infected; and 3.5 million have died from AIDS related diseases thus challenging improvements to world health today (UNAIDS, 2016). In sub Saharan Africa about 21 million people are living with HIV/AIDS and 32% of this population are presently on ART as at 2012 (UNAIDS, 2013). Also, in Nigeria, estimated 3.1 % adults within the ages of 15 – 49 are living with HIV/AIDS which is equal to about 3.5 million people from about 141 million of the total population (UNAIDS, 2016).

            Nigeria is Africa most populous country with 140,4311,790 population figure as at the last census, and is also rated as tenth largest country in the world with the approximate estimation of 55% literate and 70% poor in the population (UNAIDS, WHO & Nigerian Population Comission 2009). Also, in Nigeria, estimated 3.1 % adults within the ages of 15 – 49 are living with HIV/AIDS which is equal to about 2.6 million people from about 141 million of the total population (UNAIDS, 2008). Another report from NACA (2009) statistics shows average 4.6% prevalence HIV rate among Nigerians (NACA, 2009). HIV/AIDS in Nigeria remains a vital public/ community health issue since Nigeria is a base or environment with many people living with HIV with South Africa prevalence 19.2% as at the end of 2015 (UNAIDS, 2016). The widespread of this disease has negative effect on the psychosocial, cultural, and developmental aspects of life, which makes the diseases a critical public health issue (UNAIDS, 2008).

            One of the variables to be measured in this study is social support which has been associated to better Quality of Life among PLWHA in different studies (Khumaseen, Aoup-por & Thammachak, 2012). Social support is defined as “the view or experience that one is loved and cared for by others, esteemed and valued, and part of a social network of mutual assistance and obligations” (Taylor, 2007, p. 145). Social support assistance, user fees friendly, good patient – health workers relationship can help to curb non-adherence. An in-depth knowledge of the multifaceted interrelationship of the biological sociological factors is required to understand non-adherence, and Quality of life thus creating avenue for more effective non-adherence intervention programs (Olowookere, et al, 2012). Also, Adedimeji & Odutolu (2007) in a quantitative research to determine the extent to which certain factors contribute to improvement in QoL of PLWHA reported that availability of care and social support from spouse friends and family members yielded good QoL with 93%. Social support services is limited and lacking in this country and this makes evaluation of the wellbeing and longetivity of PLWHA important as to how individual perceive their own health using different instrument such as WHOQOL HIV BREF version instrument. (Folasire, Irabor & Folasire 2013).

            The incurable and pandemic nature of HIV/AIDS calls for mobilization of resources such as human, money & material resources to improve quality of life among PLWHA. HIVAIDS is a serious humanitarian problem that could affect the physical, psychological, social status of PLWHA. The Quality of Life (QoL) of HIV/AIDS patient is crucial as well as the disease progression because of their need for adaption to changes in their lives which include financial & societal changes. Therefore, consideration for improving their quality of life is paramount (Fan, Kuo, Kao, Morisky & Chen 2011). According to World Health Organization (2005) quality of life is described as individual’s perceptions of their position in the life in the context of culture and value systems in which they live and in relation to their goals, standards, expectations, and concerns.

            The indicator of physical, mental, social, and spiritual, wellbeing is Health Related Quality of life and this could serve as means of measuring the total wellbeing of PLWHA which include their functions and perceptions based on life experiences (Malucclo, Palemo, Kadliyala, & Rawat, 2015).  However, the HRQOL is regarded as non-medical aspect of living example psychosocial, socio economic aspect etc (Trana, Ohinmaaa, Nguyen, Nguyen & Nguyen, 2011).  Advances in the management of HIV/AIDS makes it a chronic condition thereby causing reduction in morbidity and mortality thus improves QoL (Millard, Elliott, Slavin, McDonald, Rowell, & Girdler 2014).  As HIV treatment and care worldwide is moving from emergency to longer term strategies management, there are structural and contextual factors that influence the outcome of this intervention. The factors include individual, facility based, environmental/cultural etc (Aidala, Wilson, Shubert, Gogolishvili, Globerman, Rueda, et al, 2016).                               

            The changes that result from HIV care and Management conote that individual with the diseases should take responsibility for themselves since it is now a chronic condition. Thus this will help to prevent disability and improve QoL (Millard et al, 2014).  In the care and management of HIV/AIDS wholistic approach is needed to promptly address issues since it remains a chronic diseases. The stress and fear that accompany the diseases has been reduced since it has been addressed in relation to other aspects of life. Focus should now be shifted or adjusted to how individual adjusts to symptoms (Buseh, Kelber, Stevens, & Park, 2008), and Health related QOL which is a determinant of overall personal health (Krause, Butler, & May, 2013).

            According to United States Department of Health and Human Services (HHS) (2011), The two overarching goals of Healthy people 2020 include (1.) Improving the overall quality of life (2.) Improving the health of all groups.  The QoL of PLWHA can be traced to the increase in life span of infected individuals due to availability and access to ART. Socio economic conditions of individuals with HI/AIDS can alter QoL thereby affecting health-seeking behaviours (Mawar, Katendra, Bagul,.Bembalker, Vedamurthachar,  Tripathy, et al., 2015). Another variable of interest in this study is demographic factors which have been proven to improve quality of life and are seen as determinant of quality of life. Socio demographic charasteristics  like income level, Marital status, educational level, occupation when investigated among PLWHA in China was found to influence quality of life which means people with higher income and are married tend to show positive quality of life.( Rajeev etal.., 2012). The explanation for this could be as a result of the knowledge gained from the exposure in the workplace which could impact quality of life. Also employment among other demographic factors like gender, higher income, and gender are associated with improved quality of life as seen among PLWHA in India (Basavaraj etal.., 2010). The reason for the employment may be a source of income, care  and social support to the individual that are affected which means having a good job may directly or indirectly improve QoL.

1.2   Statement of the Problem

            In Nigeria, Joint United Program on HIV/AIDS (2014) reported estimated National HIV prevalence of 4.6% and Nigeria is said to be the  2^nd in Africa in terms of People Living with HIV/AIDS (PLWHA) Africa with over 3.2 million (UNAIDS, 2014). Compounding the lack of cure for HIV/AIDS is the fact that PLWHA are still faced with social support issues even being a predictor of QoL. PLWHA are also faced with Poor Quality of Life which has been attributed to certain socio demographic variables like lack of social support system or dissatisfaction with the perceived social support given. Kehinde, Fatiregun, & Osagbemi (2013) reported that certain sociodemographic/ economic factors like occupation, income, educational level have been proven to impact QoL where low income and low educational level brings about poor QoL among the HIV/AIDS patient in Kogii state of Nigeria (Kehinde, Fatiregun & Osagbemi, 2013). Also, gender difference has been documented to influence QoL being a major predictor of QoL where statistical result revealed lower score of QoL among men (Sanyang, 2011) People still struggle with coping with AIDS and related diseases in the recent times and this called for evaluating QoL among PLWHA (Oliveira, Moura, Araujo, & Andrade, 2015). Moreover, limited information about QoL is a major problem in African setting even with ART in place for PLWHA. Little or no information on QoL has been documented in Ogun state despite the high prevalence of 6.1 % which is believed to be one of the highest in the south west Geopolitical zone in Nigeria (NACA, 2014).

            It is in the light of these that the researcher is carrying out this study to explore perceived social support, and socio demographic variables as correlates of Quality of life among Human Immunodeficiency Syndrome patients in a teaching hospital, Ogun State.       

   1.3   Objective of the Study