Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa
Abstract 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 stud...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Health and Quality of Life Outcomes |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12955-023-02179-x |
| _version_ | 1797556335662858240 |
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| author | Tamlyn A. Rautenberg Shu Kay Ng Gavin George Mahomed-Yunus S. Moosa Suzanne M. McCluskey Rebecca F. Gilbert Selvan Pillay Isaac Aturinda Kevin L. Ard Winnie R. Muyindike Nicholas Musinguzi Godfrey Masette Melendhran Pillay Pravi Moodley Jaysingh Brijkumar Rajesh T. Gandhi Brent Johnson Henry Sunpath Mwebesa B. Bwana Vincent C. Marconi Mark J. Siedner |
| author_facet | Tamlyn A. Rautenberg Shu Kay Ng Gavin George Mahomed-Yunus S. Moosa Suzanne M. McCluskey Rebecca F. Gilbert Selvan Pillay Isaac Aturinda Kevin L. Ard Winnie R. Muyindike Nicholas Musinguzi Godfrey Masette Melendhran Pillay Pravi Moodley Jaysingh Brijkumar Rajesh T. Gandhi Brent Johnson Henry Sunpath Mwebesa B. Bwana Vincent C. Marconi Mark J. Siedner |
| author_sort | Tamlyn A. Rautenberg |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-10T17:00:17Z |
| format | Article |
| id | doaj.art-d2b188a0d0b546e59e050e2059d1f1ea |
| institution | Directory Open Access Journal |
| issn | 1477-7525 |
| language | English |
| last_indexed | 2024-03-10T17:00:17Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Health and Quality of Life Outcomes |
| spelling | doaj.art-d2b188a0d0b546e59e050e2059d1f1ea2023-11-20T11:00:03ZengBMCHealth and Quality of Life Outcomes1477-75252023-08-012111810.1186/s12955-023-02179-xDeterminants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in AfricaTamlyn A. Rautenberg0Shu Kay Ng1Gavin George2Mahomed-Yunus S. Moosa 3Suzanne M. McCluskey4Rebecca F. Gilbert5Selvan Pillay6Isaac Aturinda7Kevin L. Ard8Winnie R. Muyindike 9Nicholas Musinguzi10Godfrey Masette11Melendhran Pillay12Pravi Moodley13Jaysingh Brijkumar14Rajesh T. Gandhi15Brent Johnson16Henry Sunpath17Mwebesa B. Bwana18Vincent C. Marconi19Mark J. Siedner20School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith UniversitySchool of Medicine and Dentistry, Centre for Applied Health Economics, Griffith UniversityHealth Economics and HIV Research Division, University of KwaZulu-NatalCollege of Health Sciences, University of KwaZulu-NatalDepartment of Medicine, Massachusetts General HospitalDepartment of Medicine, Massachusetts General HospitalCollege of Health Sciences, University of KwaZulu-NatalFaculty of Medicine, Mbarara University of Science and TechnologyDepartment of Medicine, Massachusetts General HospitalFaculty of Medicine, Mbarara University of Science and TechnologyFaculty of Medicine, Mbarara University of Science and TechnologyFaculty of Medicine, Mbarara University of Science and TechnologyNational Health Laboratory ServiceDepartment of Medicine, Massachusetts General HospitalCollege of Health Sciences, University of KwaZulu-NatalDepartment of Medicine, Massachusetts General HospitalDepartment of Biostatistics and Computation Biology, University of RochesterCollege of Health Sciences, University of KwaZulu-NatalFaculty of Medicine, Mbarara University of Science and TechnologyDepartment of Medicine, Emory University School of MedicineCollege of Health Sciences, University of KwaZulu-NatalAbstract 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.https://doi.org/10.1186/s12955-023-02179-xVirological failureHealth state utility valuesEQ-5DHIVHealth related quality-of-lifeTwo part regression |
| spellingShingle | Tamlyn A. Rautenberg Shu Kay Ng Gavin George Mahomed-Yunus S. Moosa Suzanne M. McCluskey Rebecca F. Gilbert Selvan Pillay Isaac Aturinda Kevin L. Ard Winnie R. Muyindike Nicholas Musinguzi Godfrey Masette Melendhran Pillay Pravi Moodley Jaysingh Brijkumar Rajesh T. Gandhi Brent Johnson Henry Sunpath Mwebesa B. Bwana Vincent C. Marconi Mark J. Siedner Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa Health and Quality of Life Outcomes Virological failure Health state utility values EQ-5D HIV Health related quality-of-life Two part regression |
| title | Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa |
| title_full | Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa |
| title_fullStr | Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa |
| title_full_unstemmed | Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa |
| title_short | Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa |
| title_sort | determinants of health related quality of life in people with human immunodeficiency virus failing first line treatment in africa |
| topic | Virological failure Health state utility values EQ-5D HIV Health related quality-of-life Two part regression |
| url | https://doi.org/10.1186/s12955-023-02179-x |
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