Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa
Background Antiretroviral treatment improves health related quality of life (HRQoL) of people with human immunodeficiency virus (PWH). However, one third initiating first-line treatment experience virological failure and the determinants of HRQoL in this key population are unknown. Our study aims to identify determinants of among PWH failing antiretroviral treatment in sub-Saharan Africa. Methods We analysed data from a cohort of PWH having virological failure (> 1,000 copies/mL) on first-line ART in South Africa and Uganda. We measured HRQoL using the EuroQOL EQ-5D-3L and used a two-part regression model to obtain by-country analyses for South Africa and Uganda. The first part identifies risk factors that were associated with the likelihood of participants reporting perfect health (utility = 1) versus non-perfect health (utility < 1). The second part identifies risk factors that were associated with the EQ-5 L-3L utility scores for participants reporting non-perfect health. We performed sensitivity analyses to compare the results between the two-part model using tobit models and ordinary least squares regression. Results In both countries, males were more likely to report perfect health and participants with at least one comorbidity were less likely to report perfect health. In South Africa, participants with side effects and in Uganda those with opportunistic infections were also less likely to report perfect health. In Uganda, participants with 100% ART adherence were more likely to report perfect health. In South Africa, high HIV viral load, experiencing ART side effects, and the presence of opportunistic infections were each associated with lower HRQoL, whereas participants with 100% ART adherence reported higher HRQoL. In Uganda participants with lower CD4 count had lower HRQoL. Conclusion Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure. Trial registration ClinicalTrials.gov: NCT02787499..
Highlights What we already know: As antiretroviral treatment (ART) access has expanded for people with HIV (PWH) and the condition has transitioned from a routinely fatal to chronic disease in sub-Saharan Africa, longer term health-related quality of life (HRQoL) has become the primary focus of care. ART generally improves HRQoL, but up to one third of PWH initiating first-line ART will experience virological failure. The gap: The determinants of HRQoL for PWH suffering virologic failure in sub-Saharan Africa are unknown. What our study adds: Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:21 |
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| Enthalten in: |
Health and quality of life outcomes - 21(2023), 1 vom: 21. Aug. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rautenberg, Tamlyn A. [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| Themen: |
EQ-5D |
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| Anmerkungen: |
© The Author(s) 2023 |
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| doi: |
10.1186/s12955-023-02179-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a Background Antiretroviral treatment improves health related quality of life (HRQoL) of people with human immunodeficiency virus (PWH). However, one third initiating first-line treatment experience virological failure and the determinants of HRQoL in this key population are unknown. Our study aims to identify determinants of among PWH failing antiretroviral treatment in sub-Saharan Africa. Methods We analysed data from a cohort of PWH having virological failure (> 1,000 copies/mL) on first-line ART in South Africa and Uganda. We measured HRQoL using the EuroQOL EQ-5D-3L and used a two-part regression model to obtain by-country analyses for South Africa and Uganda. The first part identifies risk factors that were associated with the likelihood of participants reporting perfect health (utility = 1) versus non-perfect health (utility < 1). The second part identifies risk factors that were associated with the EQ-5 L-3L utility scores for participants reporting non-perfect health. We performed sensitivity analyses to compare the results between the two-part model using tobit models and ordinary least squares regression. Results In both countries, males were more likely to report perfect health and participants with at least one comorbidity were less likely to report perfect health. In South Africa, participants with side effects and in Uganda those with opportunistic infections were also less likely to report perfect health. In Uganda, participants with 100% ART adherence were more likely to report perfect health. In South Africa, high HIV viral load, experiencing ART side effects, and the presence of opportunistic infections were each associated with lower HRQoL, whereas participants with 100% ART adherence reported higher HRQoL. In Uganda participants with lower CD4 count had lower HRQoL. Conclusion Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure. Trial registration ClinicalTrials.gov: NCT02787499. | ||
| 520 | |a Highlights What we already know: As antiretroviral treatment (ART) access has expanded for people with HIV (PWH) and the condition has transitioned from a routinely fatal to chronic disease in sub-Saharan Africa, longer term health-related quality of life (HRQoL) has become the primary focus of care. ART generally improves HRQoL, but up to one third of PWH initiating first-line ART will experience virological failure. The gap: The determinants of HRQoL for PWH suffering virologic failure in sub-Saharan Africa are unknown. What our study adds: Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure. | ||
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