Eudemonia of People Living with HIV at an Anti-Retroviral Therapy Center, Ron, Gadag District - A Mixed Method Feasibility Study

Introduction

The optimum functioning of human body depends on organ and organ systems. Immune system is the body’s only defense system, protecting against bacterial, viral and fungal infections. Immunity refers to the ability of body to prevent any foreign invasions into the body systems. There are certain diseases like asthma, myasthenia gravis which alter immune system and compromise its functioning. The most distinct and life threatening immune compromised condition is caused by Human Immunodeficiency Virus leading to Acquired Immunodeficiency Syndrome (HIV-AIDS).¹ Eudemonia refers to the state of wellbeing, happiness or goodness which is completely distorted in the life of people affected with HIV/AIDS. Their existence is weak, challenging, critical and stigmatized.² Therefore, the researcher intended to design and test healthcare interventions to enhance and sustain eudemonia of people affected with HIV/AIDS.

Some of the health interventions that can be emulated in elevating the eudemonia of people affected with HIV/AIDS are effective, need based, health related counselling services and a balanced nutrition inclusive of macro, micro & trace nutrients.³ Zinc is one of the trace nutrients with virtue of anti-viral activity and cell regeneration.⁴

Effective counselling is an indispensable mode of holistic care which addresses psychological problems and challenges. Counselling among individuals affected with HIV or AIDS primarily aims to support the grieved and further limit the transmission of HIV through behavioral change. All the counselors in this area should have formal training in counselling and receive constant clinical supervision.⁵

A randomized controlled trial conducted with oral zinc supplementation for prevention of immunologic failure showed that continuous long term use of oral zinc supplementation slowed down the immunological compromise and reduced episodes of diarrhoea. Scientific evidences supported the use of zinc supplementation in HIV/AIDS patients with weak viral load control, as a novel adjunct therapy.⁶

In a study on HIV/AIDS investigating the health and wellbeing of transport workers, it was found that serious gaps occurred in delivery of healthcare services, knowledge of transmission of disease and high level stigma. Mental health was purely neglected and an urgent need to address it emerged distinctly.⁷ The findings of a community based cross sectional study conducted in rural India revealed that two fifth of youth in rural India lack general awareness on HIV/AIDS. Only media, health awareness and literacy are the factors that can enhance their knowledge on this lethal infectious condition for its prevention.⁸

The present study was conducted considering physical health status, mental temperament and social equity of individuals affected with HIV/AIDS as vital aspect contributing to their eudemonia. Therefore, the purpose of our study was to evaluate the eudemonia of people living with HIV/AIDS. The objectives of the study were:

Qualitative Objectives

• To describe lived experiences of people living with HIV/AIDS (PLHIV) at an Anti-retro viral therapy (ART) Center, RON, Gadag district.

Quantitative Objectives

• To compare the effectiveness of healthcare intervention in experimental group and control group (in terms of sense of positivity, viral load, serum zinc levels and CD4 cell count) among PLHIV at an ART Center, RON, Gadag district.

Mixed Method (MM) Objectives

• To integrate the findings of qualitative strand and quantitative strand of people living with HIV/AIDS (PLHIV) at an ART Center, RON, Gadag district.

Materials and Methods

A mixed method sequential exploratory design was adopted in this study. In notation, (qual quan), weightage was given to quantitative strand. After obtaining the Institutional Scientific & Ethics Committee approval from Gadag Institute of Medical Sciences, Gadag, the permission to conduct study at ART Center, Ron, Gadag district was applied and procured. Before data collection, administrative permission was obtained from KSAPS, Arogya Soudha, Bangalore and Chief Medical officer, ART Center, Taluk Hospital, RON, Gadag District. Informed consent was taken from participants and confidentiality of the data elicited was warranted.

As feasibility study, 10% of total sample size was included in the study, i.e. five samples in qualitative strand and 14 samples in quantitative strand. The samples of qualitative strand were different when compared to samples in quantitative strand. The below Figure 1 depicts the organizing framework of the present study which included Phase 01 (quali), Phase 02 (quanti) and Phase 03 (Integration).

Description of data collection tools

Reliability of Semi Structured Interview Schedule to describe the lived experience of PLHIV

After validation, the tool was subjected to test for its reliability. The reliability of Semi Structured Interview Schedule was computed using Spilt Half method. The reliability co-efficient of Semi Structured Interview Schedule was found to be 0.79. The reliability coefficient r >0.70 suggests the tool to be reliable.

Data collection

Data collection was done from 01.08.2022 to 10.09.2022. In depth, individualized, semi-structured interviews were conducted on lived experience of PLHIV in a secure facility and verbatim were developed to be subjected for qualitative analysis. Data saturation was reached at 5th sample due to repetition of similar data. Trustworthiness of data was affirmed by comparing the verbatim, i.e. different data sets and by checking and rechecking of data through data collection and analysis process and by participant validation. In quantitative strand, it was done using simple random sampling technique. The participants were allotted to experimental group and control group.

The pretest or first (O1) assessment of vital signs (TPR & BP), weight, height, BMI, Oximetry (SPo2 & PI), viral load, CD4 cell count and opportunistic infection was done. Further, the participants in the experimental group received oral zinc supplementation 20 mg per day for a period of 30 days (one month). Individualized health related counselling of one session per participant on physical, physiological, psychological, social, emotional & financial dimensions of health was done, while the participants in control group received standard care as per hospital policy. The second (O2) and third (O3) assessments were done on 15th and 30th day, respectively in the intervention period.⁹

Data analysis

The qualitative data was analyzed using QDA Miner lite 3.0 software. The quantitative data collected was analyzed using IBM SPSS 29.0 software for descriptive and inferential analysis and lastly, the integrated analysis of findings of both the strands was processed for affirmation related to concordance or divergence.

Results

The analyzed data is presented under the following headings.

Table 3 shows conceptual model developed on lived experiences of PLHIV which includes six themes (6) & twenty-one sub themes (21). The core with thick black solid circle shows that among PLHIV, physical aspect of health is strongest and purple dotted circle shows emotional aspect of health being most sensitive and easily penetrable. All the other aspects of health fall between the range of physical and emotional health.

The Table 4 depicts the findings of RM-ANOVA in hypothesis testing. The obtained Greenhouse-Geiser f-value was 39.52 (within subject) & 136.35 (between subjects) for oral zinc supplementation. The f-value for health-related counseling programme was 39.25 (within subject) and 141.35 (between subjects). The P value of 0.001 implies that there was statistically significant difference within and in between subjects. Therefore, H1 & H2 was accepted.

Discussion

In a qualitative phenomenological study conducted on lived experience of HIV infected patients in the face of positive diagnosis, five major themes and 12 major sub themes of importance to PLHIV were identified.^7,10 Similarly, six major themes emerged as base to develop phenomenological model depicting daily living experience of people affected with HIV and twenty one subthemes elaborated it. Health related counselling programme was developed based on the findings of qualitative strand, validated and tested in quantitative phase, in terms of sense of positivity.

The findings of a study undertaken on HIV counselling in a tertiary care hospital showed that constant and repeated counselling enhances treatment compliance, modifies behavior and elevates optimism, which concords with the findings of our study supporting inculcation of health-related counselling as supplemen- tary measure in treating HIV/AIDS.⁸

A study on zinc supplementation and inflammation in treated HIV cases reported that zinc as a trace element has impact on biological signature in HIV patients and regulated biomarkers associated with co-morbidities which synchronizes with findings of our study, supporting use of oral zinc as an adjunct therapy in treating HIV/AIDS.⁹

The integration of the findings of qualitative strand and quantitative strand complements and connects with each other, synergizing the total effect in prevention and control of HIV/AIDS and improving the eudemonia of people living with HIV.¹¹

A significant association was noted between oral zinc, age and gender and a significant association was observed between health-related counselling and occupation. No significant association between any other demographical variables in experimental group or control group was noted.¹²

Conclusion

Eudemonia of people living with HIV/AIDS keeps fluctuating and is not normalized to the extent it should. Many mixed method studies were conducted on various dimensions of health to address the life experiences of people living with HIV/AIDS and to improve the quality of life. In this regard, oral zinc supplementation has come up as a ray of hope to boost immune system and repetitive health related counselling contributed towards better treatment compliance and optimism. Our study recommends conduct of randomized controlled trial on oral zinc supplementation to enhance the immune levels of PLHIV.

Conflict of Interest

Nil

Financial Funding

Nil