Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa : a cross-sectional baseline survey of the HPTN 071 (PopART) trial
Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Background: The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that
of HIV-negative people. However, little is known about how these populations compare in terms of health-related
quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and
South Africa.
Methods: As part of the HPTN 071 (PopART) study, data from adults aged 18–44 years were gathered between
Nov 28, 2013, and March 31, 2015, in large cross-sectional surveys of random samples of the general population in
21 communities in Zambia and South Africa. HRQoL data were collected with a standardised generic measure of
health across five domains. We used β-distributed multivariable models to analyse differences in HRQoL scores
between HIV-negative and HIV-positive individuals who were unaware of their status; aware, but not in HIV care; in
HIV care, but who had not initiated ART; on ART for less than 5 years; and on ART for 5 years or more. We included
controls for sociodemographic variables, herpes simplex virus type-2 status, and recreational drug use.
Findings: We obtained data for 19 750 respondents in Zambia and 18 941 respondents in South Africa. Laboratoryconfirmed
HIV status was available for 19 330 respondents in Zambia and 18 004 respondents in South Africa;
4128 (21%) of these 19 330 respondents in Zambia and 4012 (22%) of 18 004 respondents in South Africa had
laboratory-confirmed HIV. We obtained complete HRQoL information for 19 637 respondents in Zambia and
18 429 respondents in South Africa. HRQoL scores did not differ significantly between individuals who had initiated
ART more than 5 years previously and HIV-negative individuals, neither in Zambia (change in mean score –0·002,
95% CI –0·01 to 0·001; p=0·219) nor in South Africa (0·000, –0·002 to 0·003; p=0·939). However, scores did differ
between HIV-positive individuals who had initiated ART less than 5 years previously and HIV-negative individuals in
Zambia (–0·006, 95% CI –0·008 to –0·003; p<0·0001). A large proportion of people with clinically confirmed HIV
were unaware of being HIV-positive (1768 [43%] of 4128 people in Zambia and 2026 [50%] of 4012 people in South
Africa) and reported good HRQoL, with no significant differences from that of HIV-negative people (change in mean
HRQoL score –0·001, 95% CI –0·003 to 0·001, p=0·216; and 0·001, –0·001 to 0·001, p=0·997, respectively). In
South Africa, HRQoL scores were lower in HIV-positive individuals who were aware of their status but not enrolled
in HIV care (change in mean HRQoL –0·004, 95% CI –0·01 to –0·001; p=0·010) and those in HIV care but not on
ART (–0·008, –0·01 to –0·004; p=0·001) than in HIV-negative people, but the magnitudes of difference were small.
Interpretation: ART is successful in helping to reduce inequalities in HRQoL between HIV-positive and HIV-negative
individuals in this general population sample. These findings highlight the importance of improving awareness of
HIV status and expanding ART to prevent losses in HRQoL that occur with untreated HIV progression. The gains in
HRQoL after individuals initiate ART could be substantial when scaled up to the population level.
Description
CITATION: Thomas, R., et al. 2017. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa : a cross-sectional baseline survey of the HPTN 071 (PopART) trial. Lancet Global Health, 5(11): e1133-e1141, doi:10.1016/S2214-109X(17)30367-4.
The original publication is available at http://www.thelancet.com/journals/langlo
The original publication is available at http://www.thelancet.com/journals/langlo
Keywords
Highly active antiretroviral therapy, HIV-positive persons -- South Africa, HIV-positive persons -- Zambia, Well-being
Citation
Thomas, R., et al. 2017. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa : a cross-sectional baseline survey of the HPTN 071 (PopART) trial. Lancet Global Health, 5(11): e1133-e1141, doi:10.1016/S2214-109X(17)30367-4