Effect of Psychosocial Support Interventions on Quality of Life Among Elderly Persons on Antiretroviral Therapy in the Greater Accra Region of Ghana: A Mixed Method Study

Abstract

Introduction The proportion of Elderly Persons Living with HIV (EPLHIV) is increasing worldwide due to wider access to antiretroviral therapy (ART). In Ghana, individuals aged 50 years and older accounted for 34% of people living with HIV (PLHIV) in 2023, up from 19% in 2020. Although ART has improved health outcomes, psychosocial issues such as depression, stigma, and social isolation continue to diminish quality of life (QoL) among EPLHIV. Targeted psychosocial support interventions (PSSI), including Mobile Health (mHealth) and Differentiated Service Delivery (DSD), may help address these challenges, yet evidence of their effectiveness remains limited. This study therefore assessed the impact of PSSI on the QoL of EPLHIV receiving antiretroviral therapy in three health facilities in Accra, Ghana. Methods The study employed a pre- and post-quasi-experimental design, utilizing a sequential exploratory mixed-method approach implemented in three phases. It was carried out in three health facilities, each serving as one arm of the study. In the first phase, a formative assessment that comprised Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) was conducted to describe the QoL among EPLHIV, identify the barriers and facilitators in accessing ARV services, and assess the feasibility of using mobile technology for delivering psychosocial support to them. Qualitative data was thematically analyzed using NVivo QSR software version 12, following the deductive approach. Findings from this then informed subsequent phases of the study. In the second phase, two PSSIs; Short Voice Messages (SVM) and a face-to-face DSD were developed. In the third phase, 437 participants were enrolled for the quantitative study, and these participants were divided into three arms. Participants in one arm received SVM on PSSI, the second arm participated in a face-to-face DSD session, and the third received the routine standard of care for PLHIV per the GHS treatment guidelines. Baseline data was collected prior to a 16 week implementation of the interventions. Quantitative data were then collected using a structured questionnaire that allowed adaptability and flexibility and analyzed using STATA version 17. Data was presented using proportions, frequencies, percentages, means, and standard deviations based on the distributions. Analysis of variance (ANOVA) and t-tests were used to examine the association between background characteristics and QoL. At the multivariable level, multiple linear regression was used to examine the effect of the intervention on QoL, and Difference in Differences (DID) used to estimate the average treatment effect of the intervention on QoL. All variables were considered statistically significant at a 95% confidence interval (p < 0.05). Results The formative assessment showed that EPLHIV face physical, social, and psychological challenges that affect QoL, compounded by barriers such as inadequate tailored care and limited psychosocial support. However, facilitators like task-sharing, counselling, social support networks, and the feasibility of mobile technology for psychosocial interventions offer promising solutions to improve ART access and QoL. Overall QoL improved from 89.1 to 94.1 post intervention, with the SVM arm showing the highest increase (88.9 to 98.8), followed by the DSD arm (88.7 to 94.6), while the control arm declined (89.7 to 87.7). Multiple regression showed that at endline, EPLHIV in the DSD facility had better QoL [DID: +5.17; 95% CI=+1.77, +8.56] compared to controls. Those in the SVM intervention were also more likely [Coeff: 11.58; 95% CI=-7.87–15.29] to have higher QoL than controls. Divorced/separated participants [Coeff: -4.860; 95% CI=-8.57, -1.15] and those on additional HIV medications [Coeff: -10.73; 95% CI=-21.33– -0.12] had lower QoL. DID analysis revealed significant QoL gains for both interventions, with average treatment effects of 12.978 for SVM and 7.952 for DSD. Moreover, 93.9% of SVM and 95.3% of DSD participants found the interventions highly beneficial and recommended continuation. Conclusions The study demonstrates that the QoL of EPLHIV is significantly influenced by their social, physical, and psychosocial environments. Psychosocial support interventions such as Voice messages and DSD interventions significantly improved the QoL of EPLHIV. These findings highlight the need for targeted strategies to address the QoL of PLHIV.