Older Ugandans With Treated HIV Report Better QoL Than Ugandans Without HIV
- This study explored the association between treated HIV and health-related quality of life (HRQoL) among older adults (ages ≥49) in rural Uganda
- As a group, 298 people recruited from HIV clinics reported better HRQoL than 302 age- and sex-similar people without HIV
- The difference was observed in multiple domains, including overall self-reported health, the European Quality of Life 5D health utility index and its subscales of self-care, and pain/discomfort
- The increased HRQoL seen among people with HIV in terms of health utility was more evident in women than men
- In the global north, older people with HIV generally report worse HRQoL than people without HIV do; the findings might be explained by the additional interventions that often accompany the scale-up of antiretroviral therapy in sub-Saharan Africa
Studies conducted in the global north generally show that older people with HIV (PWH) report lower health-related quality of life (HRQoL) than people without HIV (PWOH). In sub-Saharan Africa, by contrast, where 70% of PWH reside, emerging data suggest the reverse is true.
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To gain insights for designing the next generation of HIV care programs in sub-Saharan Africa, researchers at Massachusetts General Hospital analyzed data from a cohort study of older adults in Uganda being treated for HIV. Lien T. Quach, PhD, research fellow in the Medical Practice Evaluation Center and the Center for Aging and Serious Illness at Mass General, Mark J. Siedner, MD, MPH, an infectious disease specialist and researcher in the Medical Practice Evaluation Center and the Center for Global Health, and colleagues report in Aging & Mental Health that in several respects, Ugandan PWH had better HRQoL than PWOH.
The Quality of Life and Aging with HIV in Rural Uganda Study, an ongoing cohort study, enrolled 298 PWH ages 49 and older who had been using antiretroviral therapy for at least three years. This analysis compared them with 302 age- and sex-similar PWOH selected using population census data.
All participants completed the following:
- The European Quality of Life Vertical Visual Analog Scale (EQ-VAS)—rating of overall health on a scale of 0 (worst) to 100
- The EQ-5D-3L survey—ratings of health status on five subscales: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression
- The EQ-5D index (health utility)—a continuous variable derived from the EQ-5D-3L subscale ratings; the range is 0 (death) to 1 (complete health)
PWH had higher unadjusted mean HRQoL compared with PWOH as measured by the:
- EQ-VAS—mean score 74 vs. 67; P<0.0001
- EQ-5D index—mean score 0.82 vs. 0.78; P<0.001
These differences persisted in multivariable models adjusted for age, education, marital status, alcohol consumption, and the number of comorbidities.
In addition, PWH were more likely than PWOH to report:
- No problems on the self-care subscale of the EQ-5D-3L (adjusted OR [aOR], 1.96; P<0.05)
- No problems on the pain/discomfort subscale of the EQ-5D-3L (aOR, 1.83; P<0.05)
There was no difference in the number of comorbidities between men and women overall, but the relationship between HIV status and HRQoL differed by gender:
- Among women, PWH had higher EQ-5D index scores and higher EQ-VAS scores than PWOH
- Among men, PWH had better overall EQ-VAS scores than PWOH but similar EQ-5D index scores
- On EQ-5D-3L subscales, HIV status was associated with better self-care among women but not men
- Men living with HIV, but not women living with HIV, reported not having problems with pain/discomfort; this may be related to stigma and norms of masculinity
- Men living with HIV, but not women living with HIV, reported having anxiety/depression; men living with HIV may be more reluctant to seek social support for their mental health problems, making this a particularly difficult public health problem to address
- Age did not modify the relationship between HIV treatment and HRQoL
Mechanisms of the Global Differences
The findings might be explained by the additional interventions that often accompany the scale-up of antiretroviral therapy in sub-Saharan Africa and other resource-limited settings. Those can include peer support, vocational training, job referrals, clean water, food security, microfinance training, and access to primary health care.
Many interventions can be expected to counteract or even ameliorate the low HRQoL observed among PWH in the global north. The social support network needed for ongoing care together with facilitating by HIV health care services intervention may also be a key contributing factor.
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