Health-related quality of life among people living with HIV in the era of universal test and treat: results from a cross-sectional study in KwaZulu-Natal, South Africa

Abstract

Background

The World Health Organisation’s (WHO) key population-based strategy for ending the human immunodeficiency virus (HIV) epidemic is universal HIV test and treat (UTT) along with pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Despite the successful scale-up of the UTT strategy in sub-Saharan Africa (SSA), the quality of life (QoL) of people living with HIV (PLHIV) remains sub-optimal. Poor QoL in PLHIV may threaten the UNAIDS 95-95-95 programme targets. Monitoring QoL of PLHIV has become a key focus of HIV research among other outcomes so as to understand health-related QoL (HRQoL) profiles and identify interventions to improve programme performance. This study aimed to describe HRQoL profiles and identify their predictors in PLHIV in KwaZulu Natal, South Africa.

Methods

We conducted a secondary data analysis of a cross-sectional survey conducted between May and June 2022 among PLHIV (n = 105) accessing HIV services at an outpatient clinic in KwaZulu-Natal, South Africa. Socio-demographic, HRQoL (EQ-5D-5L index scores), clinical data, depressive symptoms (CES-D-10), and viral load data were collected from all participants. We examined predictors of HRQoL using generalised linear models controlling for age and sex.

Results

The mean age of the participants was 45 years (SD = 13). The proportion of participants with disabilities and comorbidities were 3% and 18%, respectively. Depressive symptoms were present in 49% of the participants. Participant’s mean EQ-5D-5L index score was 0.87 (SD = 0.21) and ranged from 0.11 to 1.0. The mean general health state (EQ-VAS) was 74.7 (SD = 18.8) and ranged from 6 to 100. Factors that reduced HRQoL were disability (β = −0.607, p ≤ 0.001), comorbidities (β = − 0.23, p ≤ 0.05), presence of depressive symptoms (β = −0.10, p ≤ 0.05), and old age (β = −0.04, p ≤ 0.05). Factors that increased HRQoL were a good perceived health state (β = 0.147, p ≤ 0.001) and availability of social support (β = 0.098, p ≤ 0.05).

Conclusion

A combination of old age (60 years and above), any disability and comorbidities had a considerable effect on HRQoL among PLHIV. Our findings support the recommendation for an additional fourth UNAIDS target that should focus on ensuring that 95% of PLHIV have the highest possible HRQoL. Psycho-social support interventions are recommended to improve the HRQoL of PLHIV.

Keywords:

• HIV
• HRQoL
• KwaZulu-Natal
• South Africa

Acknowledgements

We would like to acknowledge South African Medical Research Council (SAMRC) for authorizing use of the dataset for this study.

Ethics approval

This study was approved by the South African Medical Research Council (SAMRC) Health Research Committee. Its ethical approval reference number is: EC006-4/2022.

Consent for publication

Not Applicable.

Study design

Reuben Christopher Moyo, Lovemore N. Sigwadhi, Stanley Carries, Zibuyisile Mkhwanazi, Arvin Bhana, Davide Bruno, Marie-Claire Van Hout, and Darshini Govindasamy.

Methodology

Reuben Christopher Moyo, Lovemore N. Sigwadhi, Stanley Carries, Zibuyisile Mkhwanazi, Arvin Bhana, Davide Bruno, Marie-Claire Van Hout, and Darshini Govindasamy.

Data analysis

Reuben Christopher Moyo, Lovemore N. Sigwadhi, and Darshini Govindasmay.

Discussion

Marie-Claire Van Hout, Eugene L Davids and Darshini Govindasamy, Reuben Christopher Moyo, Stanley Carries, Zibuyisile Mkhwanazi, Arvin Bhana, Davide Bruno.

Proofreading

Marie-Claire Van Hout, Eugene L Davids, Reuben Christopher Moyo, Arvin Bhana, Davide Bruno, Darshini Govindasamy

Disclosure statement

The authors declare no competing interests.

Availability of data and materials

The data for this study may be accessed on request from the corresponding author.

Additional information

Funding

This study was not funded.