Skip to main content

Advertisement

SpringerLink
Log in

Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

This article has been updated

Abstract

Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF’s overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF’s overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.

Resumen

La mejora en las opciones de tratamiento ha aumentado la supervivencia de las personas que viven con el VIH (PVVIH). Por lo tanto, evaluamos los factores asociados con una mejor calidad de vida relacionada con la salud (CVRS) entre las PVVIH en Brasil. Se trata de un estudio transversal realizado con 349 PVVIH. Los datos se recopilaron mediante un cuestionario basado en entrevistas y la CVRS se evaluó mediante la versión brasileña del instrumento WHOQOL VIH BREF. Usamos un análisis de conglomerados no jerárquico (K-medias) para compilar las puntuaciones generales y de dominios del WHOQOL HIV BREF en una medida única más multidimensional para la CVRS que consta de tres conglomerados: deficiente, regular y bueno; y las asociaciones con grupos de mejor CVRS se evaluaron mediante modelos de regresión logística multinomial. Las puntuaciones de la CVRS global media y mediana fueron 15,13 (DE = 3,39) y 16. La confiabilidad y validez del WHOQOL VIH BREF versión brasileña fue confirmada entre personas que viven con el VIH en un municipio no metropolitano de mediana población de Brasil, lo que reafirma la validez transcultural de este instrumento. Los factores sexo masculino; orientaciones heterosexuales y asexuales; mayores ingresos individuales; carga viral indetectable; ausencia de comorbilidad y presencia de comorbilidad infecciosa o crónica, teniendo como referencia la enfermedad mental; y nunca haber consumido sustancias ilegales se asociaron de forma independiente con una buena CVRS. Por lo tanto, la compilación de las puntuaciones generales y de dominio del WHOQOL HIV BREF en una medida multidimensional única para la CVRS, que este estudio propuso por primera vez, puede facilitar interpretaciones y modelos de predictores más robustos. Estos diferenciales podrían simplificar la HRQoL como un indicador de salud y bienestar para ser utilizado de forma rutinaria como un resultado clave en el manejo clínico de los pacientes y en el monitoreo global de las respuestas del sistema de salud al VIH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Data relating to additional analyses will be shared upon reasonable request to the corresponding author.

Code Availability

Not Applicable.

Change history

  • 25 December 2023

    ESM has been updated.

References

  1. Costa JO, Pearson SA, Acurcio FA, et al. Health-related quality of life among HIV-infected patients initiating treatment in Brazil in the single-tablet regimen era. AIDS Care. 2019;31:572–81.

    Article  PubMed  Google Scholar 

  2. Zimpel RR, Fleck MP. Quality of life in HIV-positive brazilians: application and validation of the WHOQOL-HIV, Brazilian version. AIDS Care. 2007;19:923–30.

    Article  CAS  PubMed  Google Scholar 

  3. The WHOQOL HIV group. Initial steps to developing the world health organization’s quality of life instrument (WHOQOL) module for international assessment in HIV/ AIDS. AIDS Care. 2003;15:347–57.

    Article  Google Scholar 

  4. Mannheimer SB, Matts J, Telzak E, et al. Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care. 2005;17:10–22.

    Article  CAS  PubMed  Google Scholar 

  5. Campos LN, César CC, Guimarães MDC. Quality of life among HIV-infected patients in Brazil after initiation of treatment. Clinics. 2009;64:867–75.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Luz PM, Girouard MP, Grinsztejn B, et al. Survival benefits of antiretroviral therapy in Brazil: a model-based analysis. J Int AIDS Soc. 2016;19:20623.

    Article  PubMed  PubMed Central  Google Scholar 

  7. UNAIDS. The path that ends AIDS: UNAIDS Global AIDS Update. 2023. Geneva: Joint United Nations. Programme on HIV/AIDS; 2023. Available at: https://www.unaids.org/sites/default/files/media_asset/2023-unaids-global-aids-update_en.pdf. Accessed September 14, 2023.

  8. Ministério da Saúde. Secretaria de Vigilância em Saúde. Boletim Epidemiológico de HIV/AIDS 2022. Brasília: Ministério da Saúde. Available at: https://www.gov.br/aids/pt-br/centrais-de-conteudo/boletins-epidemiologicos/2022/hiv-aids/boletim_hiv_aids_-2022_internet_31-01-23.pdf/view. Accessed September 14, 2023.

  9. Minas Gerais. Secretaria de Estado de Saúde de Minas Gerais. Subsecretaria de Vigilância à Saúde. Superintendência de Vigilância Epidemiológica. Diretoria de Vigilância de Condições Crônicas. Coordenação Estadual de IST/Aids e Hepatites Virais. Boletim Epidemiológico Mineiro Análise Epidemiológica de HIV/Aids Panorama do ano de 2021. Belo Horizonte: SES-MG. 2021 Available at: http://vigilancia.saude.mg.gov.br/index.php/download/boletimepidemiologico-de-hiv-aids-panorama-do-ano-de-2021/?wpdmdl=15990. Accessed September 14, 2023.

  10. Noori T, Pharris A, Hong HVU. Health-related quality of life in people living with HIV, publication for the Committee on Environment, Public Health and Food Safety (ENVI), Policy Department for Economic, Scientific and Quality of Life Policies, European Parliament, Luxembourg, 2022. https://www.europarl.europa.eu/RegData/etudes/IDAN/2022/734011/IPOL_IDA(2022)734011_EN.pdf. Accessed May 30, 2023.

  11. Mesías-Gazmuri J, Folch C, Palacio-Vieira J, et al. Syndemic conditions and quality of life in the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands: a cross sectional study. Health Qual Life Outcomes. 2023;21:42.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fleck MPA, Lima AFBS, Louzada S, et al. Association of depressive symptoms and social functioning in primary care service, Brazil. Rev Saude Publica. 2002;36:431–8.

    Article  PubMed  Google Scholar 

  13. Lazarus JV, Cascio M, Anderson J, et al. A person-centred approach to enhance the long-term health and wellbeing of people living with HIV in Europe. J Int AIDS Soc. 2023;26(Suppl 1):e26117.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bucciardini R, Pugliese K, Weimer L, et al. Relationship between health-related quality of life measures and high HIV viral load in HIV-infected triple-class-experienced patients. HIV Clin Trials. 2014;15:176–83.

    Article  PubMed  Google Scholar 

  15. Silveira MF, Ferreira AC, Brito MFSF, et al. Propriedades psicométricas do WHOQOL-HIV BREF para avaliação da qualidade de vida. Psico-USF. 2019;24:475–87.

    Article  Google Scholar 

  16. Cooper V, Clatworthy J, Harding R, et al. Measuring quality of life among people living with HIV: a systematic review of reviews. Health Qual Life Outcomes. 2017;15:220.

    Article  PubMed  PubMed Central  Google Scholar 

  17. The White House, National, HIV/AIDS Strategy for the United States 2022–2025, Washington DC. 2021. https://www.whitehouse.gov/wp-content/uploads/2021/11/National-HIV-AIDS-Strategy.pdf. Accessed May 30, 2023.

  18. Lazarus JV, Safreed-Harmon K, Kamarulzaman A, et al. Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV. Nat Commun. 2021;12:4450.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bento JL. Qualidade de vida relacionada à saúde de pessoas que vivem com HIV/AIDS e fatores associados. Juiz de Fora. Dissertação [Mestrado em Saúde Coletiva] - Universidade Federal de Juiz de Fora; 2020. Available at: https://repositorio.ufjf.br/jspui/bitstream/ufjf/13053/1/joseanedelimabent.pdf. Accessed October 5, 2022.

  20. WHO. World Health Organization, WHOQOL-HIV BREF. 2012 revision. World Health Organization, 2002. Available at: https://apps.who.int/iris/handle/10665/77775. Accessed October 5, 2022.

  21. THE WHOQOL-HIV GROUP. WHOQOL-HIV instrument users manual, Genebra, WHO/MSD/MER/Rev. WHO; 2002. 2012.03. Available at: https://apps.who.int/iris/rest/bitstreams/109786/retrieve. Accessed September 14, 2023.

  22. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de DST, Aids e Hepatites Virais. Adesão ao tratamento antirretroviral no Brasil: coletânea de estudos do Projeto Atar: Projeto Atar. Brasília: Ministério da Saúde 2010; 408 p. Available at: https://www.nescon.medicina.ufmg.br/biblioteca/imagem/3035.pdf Accessed October 5, 2022.

  23. Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Arbetsrapport 1991; 14:1–69. Available at: https://core.ac.uk/download/pdf/6472456.pdf. Accessed October 5, 2022.

  24. Barger D, Hessamfar M, Neau D, et al. Assessing the psychometric properties of the French WHOQOL-HIV BREF within the ANRS CO3 Aquitaine Cohort’s QuAliV ancillary study. Health Qual Life Outcomes. 2020;18:220.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Trebuňa P, Halčinová J. Mathematical tools of cluster analysis. Appl Math. 2013;4:814–6.

    Article  Google Scholar 

  26. Victora CG, Huttly SR, Fuchs SC, et al. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26:224–7.

    Article  CAS  PubMed  Google Scholar 

  27. Cruz LN, Polanczyk CA, Camey SA, et al. Quality of life in Brazil: normative values for the WHOOQOL-BREF in a southern general population sample. Qual Life Res. 2011;20:1123–9.

    Article  PubMed  Google Scholar 

  28. Campos AC, Ferreira e Ferreira E, Vargas AM, et al. Aging, gender and quality of life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults. Health Qual Life Outcomes. 2014;12:166.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Scofield D, Moseholm E. HIV-related stigma and health-related quality of life in women living with HIV in developed countries: a systematic review. AIDS Care. 2022;34:7–15.

    Article  PubMed  Google Scholar 

  30. Gaspar J, Reis RK, Pereira FMV, et al. Qualidade De vida de mulheres vivendo com o HIV/AIDS de um município do interior paulista. Rev Esc Enferm USP. 2011;45:230–6.

    Article  PubMed  Google Scholar 

  31. Gebremichael DY, Hadush KT, Kebede EM, et al. Gender difference in health related quality of life and associated factors among people living with HIV/AIDS attending anti-retroviral therapy at public health facilities, western Ethiopia: comparative cross sectional study. BMC Public Health. 2018;18:537.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Traeen B, Martinussen M, Vittersø J, et al. Sexual orientation and quality of life among university students from Cuba, Norway, India, and South Africa. J Homosex. 2009;56:655–69.

    Article  PubMed  Google Scholar 

  33. Marshal MP, Dietz LJ, Friedman MS. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health. 2011;49:115–23.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Austin SB, Gordon AR, Ziyadeh NJ, et al. Stigma and health-related quality of life in sexual minorities. Am J Prev Med. 2017;53:559–66.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Oliveira FBM, Queiroz AAFLN, Sousa AFL, et al. Sexual orientation and quality of life of people living with HIV/Aids. Rev Bras Enferm. 2017;70:1004–10.

    Article  PubMed  Google Scholar 

  36. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yule MA, Brotto LA, Gorzalka BB. Mental health and interpersonal functioning in self-identified asexual men and women. Psychol Sex. 2013;4:136–51.

    Google Scholar 

  38. Monteiro F, Canavarro MC, Pereira M. Factors associated with quality of life in middle-aged and older patients living with HIV. AIDS Care. 2016;28(sup1):92–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zhang Q, Yang H, Fan J, et al. Older people living with human immunodeficiency virus/acquired immune deficiency syndrome in Chinese rural areas: perceived stigma and associated factors. Trans R Soc Trop Med Hyg. 2019;113:477–82.

    Article  CAS  PubMed  Google Scholar 

  40. Alford K, Banerjee S, Daley S, et al. Health-related quality of life in people living with HIV with cognitive symptoms: assessing relevant domains and associations. J Int Assoc Provid AIDS Care. 2023;22:23259582231164241.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Brañas F, Torralba M, Antela A, et al. Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV. BMC Geriatr. 2023;23:4.

    Article  PubMed  PubMed Central  Google Scholar 

  42. O’Grady T, Inman N, Younger A et al. The Characteristics and HIV-related outcomes of people living with co-occurring HIV and mental health conditions in the United States: a systematic review of literature from 2016 to 2021. AIDS Behav 2023; https://doi.org/10.1007/s10461-023-04150-9. Epub ahead of print. PMID: 37563293.

  43. Ferreira BE, Oliveira IM, Paniago AMM. Qualidade De vida de portadores de HIV/AIDS e sua relação com linfócitos CD4+, carga viral e tempo de diagnóstico. Rev Bras Epidemiol. 2012;15:75–84.

    Article  PubMed  Google Scholar 

  44. Tegegne AS. Quality of life and associated factors of HIV patients under treatment with first line regimens in public hospitals in Amhara region, north-west Ethiopia. Patient Prefer Adherence. 2023;17:1347–59.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Elzi L, Conen A, Patzen A, et al. Ability to work and employment rates in human immunodeficiency virus (HIV)-1-Infected individuals receiving combination antiretroviral therapy: the Swiss HIV cohort study. Open Forum Infect Dis. 2016;3:1–8.

    Article  Google Scholar 

  46. Institute for Health Metrics and Evaluation (IHME). GBD compare data visualization. Seattle, WA: Institute for Health Metrics and Evaluation (IHME). ; 2017. Available at: https://www.healthdata.org/data-tools-practices/interactive-data-visuals. Accessed October 5, 2022.

  47. Duko B, Ayalew M, Ayano G. The prevalence of Alcohol Use Disorders among people living with HIV/AIDS: a systematic review and meta-analysis. Subst Abuse Treat Prev Policy. 2019;14:52.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Remien RH, Stirratt MJ, Nguyen N et al. Mental health and HIV/AIDS: the need for an integrated response 2019; 33:1411–20.

    Google Scholar 

  49. Campos LN, Bonolo PF, Guimarães MDC. Anxiety and depression assessment prior to initiating antiretroviral treatment in Brazil. AIDS Care. 2006;8:529–36.

    Article  Google Scholar 

  50. Campos LN, Guimarães MDC, Remien RH. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS Behav. 2010;14:289–99.

    Article  PubMed  Google Scholar 

  51. Ofotokun I, Titanji K, Vunnava A, et al. Antiretroviral therapy induces a rapid increase in bone resorption that is positively associated with the magnitude of immune reconstitution in HIV Infection. AIDS. 2016;30:405–14.

    Article  CAS  PubMed  Google Scholar 

  52. Ahmed A, Saqlain M, Bashir N, et al. Health-related quality of life and its predictors among adults living with HIV/AIDS and receiving antiretroviral therapy in Pakistan. Qual Life Res. 2021;30:1653–64.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Blalock AC, McDaniel JS, Farber EW. Effect of employment on quality of life and psychological functioning in patients with HIV/AIDS. Psychosomatics. 2002;43:400–4.

    Article  PubMed  Google Scholar 

  54. Rueda S, Raboud J, Mustard C, et al. Employment status is associated with both physical and mental health quality of life in people living with HIV. AIDS Care. 2011;23:435–43.

    Article  PubMed  Google Scholar 

  55. Cunha GH, Fiuza MLT, Gir E, et al. Quality of life of men with AIDS and the model of social determinants of health. Rev Latino-Am Enfermagem. 2015;23:183–91.

    Article  Google Scholar 

  56. Chen D, Wang M, Duan L, et al. Quality of life among older Chinese people living with HIV/AIDS: a cross-sectional study in Hunan. Trans R Soc Trop Med Hyg. 2022;116:213–21.

    Article  PubMed  Google Scholar 

  57. Wagener MN, van den Dries L, Exel JV, et al. Determinants of employment in people living with HIV in the Netherlands. J Occup Rehabil. 2018;28:45–56.

    Article  PubMed  Google Scholar 

  58. Maulsby CH, Ratnayake A, Hesson D, et al. A scoping review of employment and HIV. AIDS Behav. 2020;24:2942–55.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Pellowski JA, Kalichman SC, Matthews KA, et al. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. 2013;68:197–209.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kalichman SC, Hernandez D, Kegler C, et al. Dimensions of poverty and health outcomes among people living with HIV Infection: limited resources and competing needs. J Community Health. 2015;40:702–8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This manuscript is part of the Master’s research of JLB in the Postgraduate Program in Collective Health at the Federal University of Juiz de Fora.

Funding

This work was supported by the National Research Council of Brazil (grant numbers 410595/2006-3 and 301101/2016-7).

Author information

Authors and Affiliations

  1. Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil

    Marcio Roberto Silva, Joseane de Lima Bento, Marina de Aguiar Oliveira, Romário Costa Fochat & Isabel Cristina Gonçalves Leite

  2. Embrapa Dairy Cattle, Brazilian Agricultural Research Company, Av. Eugênio do Nascimento, 610 - Aeroporto, Juiz de Fora, Minas Gerais, 36038-330, Brazil

    Marcio Roberto Silva

  3. Doctor João Penido Regional Hospital, Hospital Foundation of the State of Minas Gerais, Juiz de Fora, Minas Gerais, 36048-000, Brazil

    Marina de Aguiar Oliveira

  4. Faculty of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-900, Brazil

    Romário Costa Fochat

  5. Department of Statistics, Federal University of Lavras, Lavras, 37200-900, Minas Gerais, Brazil

    Geraldo Magela da Cruz Pereira

Authors
  1. Marcio Roberto Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseane de Lima Bento
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marina de Aguiar Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Romário Costa Fochat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Isabel Cristina Gonçalves Leite
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Geraldo Magela da Cruz Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MRS, JLB and GMCP made substantial contributions to the conception or design of the work, data collection and analysis and interpretation. JLB, MAO, ICGL and RCF drafted the manuscript or revised it critically for important intellectual content. All authors have approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Marcio Roberto Silva.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

Ethics approval was provided by the Federal University of Juiz de Fora (opinion number 3.017.452). We certify that the study was performed in accordance with the ethical standards established in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to Participate

Eligible participants who demonstrated adequate understanding of the trial were enrolled after providing written informed consent.

Consent for Publication

Data reports are all aggregated, and no individual data or images are presented. The study information sheet indicates that aggregate data may be published in academic publications, presentations, or published in other reports.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 82 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Silva, M.R., de Lima Bento, J., de Aguiar Oliveira, M. et al. Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil. AIDS Behav 28, 285–299 (2024). https://doi.org/10.1007/s10461-023-04220-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-023-04220-y

Keywords

Palabras Clave

Search

Navigation