Comparing Treatment Approaches on Health Outcomes and Quality of Life for People Living with HIV Infection in Kasarani Kenya

Two existing clinical models were studied for their relative effectiveness in promoting positive perceived quality of life and in managing the course of HIV. One treatment approach was Peer Social Support (PSS) used primarily in low social economic neighborhoods with limited access to highly organized medical care. The second approach, Comprehensive Clinic Care (CCC), was based more in a medical model. Patients went to an urban medical facility for regular follow-up appointments where medical examinations and patient education were provided. The objective of this study was to determine if there were differences in treatment outcomes between these two clinical models. The study employed a convenience sample of 103 subjects for the Peer Social Support group and 90 for the Comprehensive Clinic Care group. Retrospective time’s series design was used. Statistical measures used were; Univariate analysis of variance, chi square and one way repeated measures of ANOVA. The CCC groups had higher mean physical component scores for quality of life, X = 52.5 (SD 6.8), than those in the PSS groups, X=49.5 (SD 7.5), F(1,191)=8.4, p=0.006. The mean mental component quality of life score was also higher for the CCC group X=51.4, (SD 9.3) than the PSS group, X=47.7, (SD 9.1), F(1,191)=7.8, p=0.006. Weight showed a similar pattern, being higher for CCC, X=68 (SD 13.1) than PSS group X=63.5 (SD 12.5), t(182)=-2.36, p=0.02. The PSS group did have a higher CD4 count, X=468 (SD 200), than the CCC group, X=356 (SD 281), F(1,162)=8.89, p=0.003. No difference was observed in retention, PSS subjects returned for 90% of their appointments, and the CCC group for 87% of their appointments, X2 (3, N=181)=4.39, p=0.222. Both models appear to work for the clientele they serve. CCC is a good model for urban areas. PSS is a less expensive clinic model that is shown here to work in rural areas. Since nurses manage these rural clinics, more nurses need to be prepared to provide in low income resource settings.