title: Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: a randomised controlled trial from north-eastern Vietnam.
abstract: BACKGROUND
  Among people living with HIV (PLHIV) on antiretroviral therapy (ART), it is important to determine how quality of life (QOL) may be improved and HIV-related stigma can be lessened over time. This study assessed the effect of peer support on QOL and internal stigma during the first year after initiating ART among a cohort of PLHIV in north-eastern Vietnam.
  
  
  METHODS
  A sub-sample study of a randomised controlled trial was implemented between October 2008 and November 2010 in Quang Ninh, Vietnam. In the intervention group, participants (n = 119) received adherence support from trained peer supporters who visited participants' houses biweekly during the first two months, thereafter weekly. In the control group, participants (n = 109) were treated according to standard guidelines, including adherence counselling, monthly health check and drug refills. Basic demographics were measured at baseline. QOL and internal stigma were measured using a Vietnamese version of the WHOQOL-HIVBREF and Internal AIDS-related Stigma Scale instruments at baseline and 12 months. T-tests were used to detect the differences between mean values, multilevel linear regressions to determine factors influencing QOL.
  
  
  RESULTS
  Overall, QOL improved significantly in the intervention group compared to the control group. Among participants initiating ART at clinical stages 3 and 4, education at high school level or above and having experiences of a family member dying from HIV were also associated with higher reported QOL. Among participants at clinical stage 1 and 2, there was no significant effect of peer support, whereas having children was associated with an increased QOL. Viral hepatitis was associated with a decreased QOL in both groups. Lower perceived stigma correlated significantly but weakly with improved QOL, however, there was no significant relation to peer support.
  
  
  CONCLUSIONS
  The peer support intervention improved QOL after 12 months among ART patients presenting at clinical stages 3 and 4 at baseline, but it had no impact on QOL among ART patients enrolled at clinical stages 1 and 2. The intervention did not have an effect on Internal AIDS-related stigma. To improve QOL for PLHIV on ART, measures to support adherence should be contextualized in accordance with individual clinical and social needs.
authors.affiliation: Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. tamvanvu@yahoo.com
authors.forename: Vu
authors.initials: V
authors.lastname: Van Tam
authors.forename: Mattias
authors.initials: M
authors.lastname: Larsson
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pharris
authors.forename: Björn
authors.initials: B
authors.lastname: Diedrichs
authors.forename: Hoa Phuong
authors.initials: HP
authors.lastname: Nguyen
authors.forename: Chuc Thi Kim
authors.initials: CT
authors.lastname: Nguyen
authors.forename: Phuc Dang
authors.initials: PD
authors.lastname: Ho
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marrone
authors.forename: Anna
authors.initials: A
authors.lastname: Thorson
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D035061:Control Groups; D003376:Counseling / Q000379:methods; D005195:Family Relations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006305:Health Status Indicators; D006801:Humans; D007398:Interpersonal Relations; D016014:Linear Models; D008297:Male; D010349:Patient Compliance; D010379:Peer Group; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014744:Vietnam
chemical_list: D044966:Anti-Retroviral Agents