Impact on depression and health‐related quality of life among people living with HIV in Accra, Ghana
Authors: Sackey Joachim , Zhang Fang Fang , Rogers Beatrice , Aryeetey Richmond , Wanke Christine 
Published: November 2023

Background

The number of people living with HIV (PLWH) in Ghana was about 270,000 in 2015. The nutrition assessment counseling and support (NACS) program was introduced into Ghana by the Food and Nutrition Technical Assistance (FANTA) in October 2009. Its aim is to improve the nutritional status of people with HIV and Tuberculosis. Ever since NACS was introduced in Ghana, its impact on depression and health‐related quality of life (HRQol) has not been assessed.

Objective

To evaluate the impact of receiving care in an HIV clinic designated to offer NACS on depression and HRQol among PLWH in Accra, Ghana.

Methods

Six (three NACS and three comparable non‐NACS) HIV clinics were selected for this pilot study with 25 PLWH recruited from each clinic. A prospective cohort design with a follow up of 6 months was used with study measurements at baseline, three and six months after recruitment. Inclusion criteria: HIV positive adults at least six months on antiretroviral therapy. Depression symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES‐D). HRQol was measured using the EuroQol five dimensions questionnaire (EQ‐5D‐3L). Mixed models in SAS for repeated measures were used to analyze the data.

Results

Of the 152 participants recruited, there were no statistically significant differences in baseline population characteristics between participants recruited from either group. Overall the study participants were female (84%), 40 years old, earned the equivalent of $0–77/month (66.7%) and were the main breadwinners of their homes (54.6%). A little over a third (33.5%) had not disclosed their HIV positive status to their spouses or children. The overall mean BMI of the study population was 25.8±5.7kg/m2 with 26.5% of them being overweight and 20.5% of them being obese. No nutrition counseling was provided during the counseling sessions directly observed and no food support was available on site in both the NACS and non‐NACS HIV clinics surveyed at baseline.

When compared to those in non‐NACS HIV clinics, receiving care in a NACS HIV clinic was significantly associated with lower depression symptom scores over time even after adjusting for other covariates (p=0.03). There was no statistically significant association between receiving care in a NACS HIV clinic and HRQol assessed using both the EQ‐5D descriptive scale (p=0.09) and visual analogue scale (p=0.21) after adjusting for other covariates.

Conclusions

Results suggest that when compared to those receiving care in non‐NACS facilities receiving care in a HIV clinic designated to offer NACS was associated with less depression symptoms but not higher quality of life scores over time. This is in spite of the poor implementation of the program in the NACS HIV clinics. Future studies are needed on how to better implement nutrition programs such as NACS to improve its impact on health outcomes among PLWH.

Support or Funding Information

Brown/Tufts/Miriam Fogarty AIDS International Training and Research Program (2D43TW000237)