A novel method for assessing poor quality of life among people with HIV.

Abstract

Background: The U.S.'s National HIV/AIDS Strategy (NHAS) prioritizes improving QoL among people with HIV (PWH) but co-occurrence of different aspects of QoL is not well described. We developed and applied a novel, multi-item assessment of poor quality of life (QoL) among PWH, and examined associations with selected outcomes.

Setting: 2018-2021 CDC Medical Monitoring Project data on 15,855 U.S. PWH.

Methods: The poor QoL index, measured by the number of indicators of poor QoL experienced included: poor/fair self-rated health, unmet needs for mental health services, and subsistence needs (hunger/food insecurity, unstable housing/homelessness, unemployment). Score distributions were analyzed alongside data on individual QoL indicators. Associations with selected adverse outcomes were assessed, including not being retained in care, missing ≥1 HIV medical appointments, missing ≥1 ART dose, not having sustained viral suppression, and having ≥1 emergency room visit or ≥1 hospitalization.

Results: Overall, 55.1% of PWH had ≥1 indicator of poor QoL; 8.4% had ≥3 indicators. Over a quarter (26.5%) of people who inject drugs experienced ≥3 indicators of poor QoL. A large percentage of people aged 18-24 years and transgender women had subsistence needs; 36.4% of cisgender Black women had poor/fair self-rated health. After adjusting for age, race/ethnicity, and gender, higher poor QoL index scores-and each indicator of poor QoL-were associated with worse outcomes.

Conclusions: We demonstrated the utility in using the poor QoL index to identify those at higher risk of experiencing health challenges. Expanding national recommendations to include this QoL assessment could help in meeting NHAS goals for improving PWH's well-being.