Self-Reported Sleep and Associated Variables In Adults Living with HIV in Jakarta, Indonesia

The purpose of this study was to determine the correlates of self-reported sleep and to understand the impact of sleep on quality of life among adults living with HIV in Indonesia. Prior studies mainly from high-income countries provide insights into the importance of sleep in people living with HIV (PLH). Current evidence indicates that poor sleep has negative consequences on PLH, including decreased adherence to antiretroviral therapy (ART) and diminished quality of life. Addressing factors associated with poor sleep in PLH is vital to enhance quality of life for PLH. This dissertation is presented in the form of two manuscripts. The first manuscript focuses on characteristics and correlates of insomnia while the second examines association between self-reported sleep, other symptoms, and quality of life. Together, the results of the two manuscripts highlight the characteristics and the variables that are associated with poor sleep in this population. This dissertation study represents one of the first studies of sleep in persons living with HIV (PLH) conducted in a lower middle-income, Muslim majority, Asian country. In this population of HIV-infected and mostly drug-dependent adults receiving ART, almost two-thirds (67%) of them indicated poor sleep according to the Pittsburg Sleep Quality Index (PSQI) and one-third (33.5%) had Insomnia Severity Index (ISI) scores indicating clinically significant insomnia, which by itself impacts daytime functioning, quality of life, and may contribute to suboptimal ART adherence in this population. It was noted that when PLH with and without insomnia were compared, insomnia significantly differed by level of ART adherence, drug use, opioid use, anxiety, depression, pain, fatigue, sleep environment, and religious practice. Our data support the idea that HIV infection potentially predisposes or precipitates insomnia due to the psychosocial stress associated with it. Using hierarchical regression analysis, and guided by The University of California San Francisco Symptom Management Theory, we found that compared with variables under person and environment domains, the most significant correlates of insomnia were variables under health/status dimension (anxiety, fatigue, pain) that uniquely explained around one-third of the variance in insomnia. After adjusting for other covariates, insomnia was positively associated with anxiety, fatigue, and pain, and negatively associated with ART adherence and Islamic practice. We also examined the association of a self-reported and important symptom outcome; quality of life. Our key findings were that adjusted for gender, level of education, drug/alcohol use, and ART adherence, quality of life was negatively associated with fatigue, self-reported sleep (insomnia), and methadone treatment. Our results suggest that interventions that focus on helping adults living with HIV in the Indonesian context would need to assist patients to reduce levels of fatigue and insomnia. Future research is necessary to explore how PLH on methadone treatment could be assisted to deal with treatment-associated issues that affect quality of life.