Community Based Non Communicable Disease Services as a Predictor of Improved Quality of Life of People Living with HIV in Uganda: A Randomized Controlled Trial

Abstract

A comprehensive and culturally applicable community based Non Communicable Diseases (NCD) services package was implemented with an aim to test the effectiveness of the community based NCD services on the quality of life (QoL) of people with HIV. The Randomized Controlled Trial (RCT) was conducted to compare the effectiveness of the community based NCD services as intervention. The control group received the usual HIV services in the community. Participants were randomly allocated to receive weekly and monthly intervention sessions using the standard care in the community ARV drug distribution points. Paired and independent t-tests were performed to compare changes in the QoL scores at the baseline and the endline. Between November and December 2018, 1076 individuals were screened, of whom 438 were randomly assigned to either the intervention or control group in the ratio of 1:1. The post intervention results revealed that the community based NCD services were effective and improved the QoL in all the three domains; the physical, environmental and social relationship domains. The QoL was higher at endline across all domains in the treatment group compared to the control group, the mean differences were statistically significant (p = 0.000 < 0.05). Thus, the community based NCD services were efficacious in improving QoL of HIV infected people. Findings could be utilized at regular community service settings for its Journal of Environmental Science and Public Health 304 J Environ Sci Public Health 2020; 4 (4): 304-317 DOI: 10.26502/jesph.96120102 sustainability and long-term effect. The intervention created improved understanding of HIV and NCD integration health promotion strategies and community support systems activities by the VHT, ART expert clients and the community volunteers. Keywords: Community; Non Communicable Diseases; Services; Quality of Life; HIV; People Living with HIV; Uganda 1. Introduction There was an indication in 2012 that NonCommunicable Diseases (NCDs) were responsible for 38 million (68%) of the world’s 56 million deaths [1]. Almost three quarters of all NCD (28 million) and the majority of premature deaths (82%) occur in low and middle income countries mainly in Asia and SubSaharan African (SSA) countries [1] . Yet, the published evidence showed that, the current community service delivery models of ART according to Grismund [2] “do not include the integrated community management and prevention of Diabetes Mellitus(DM) and hypertension as comorbidities in SSA” (pg. 4). The lack of the NCD services affects the prevention programmes for the comorbidities among the HIV patients receiving AntiRetroviral Therapy (ART) in the communities. Globally, deaths from NCDs are projected to reach 52 million by 2030 [3]. The deaths related to hypertension and diabetes among HIV patients on Antiretroviral Therapy (ART) increased due to scale up of the treatment and aging with HIV [4]. Most deaths occurred among HIV people with Hypertension (HT) and Diabetes Mellitus (DM) conditions that needs daily medication and or to make life style changes to ensure they can live as well as possible with their condition [1]. Therefore, the individual and family support systems are important in reducing the burden of HIV and NCDs.