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.
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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.
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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.
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This work was supported by the National Research Council of Brazil (grant numbers 410595/2006-3 and 301101/2016-7).
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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.
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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
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DOI: https://doi.org/10.1007/s10461-023-04220-y
Keywords
- HIV
- Acquired immunodeficiency syndrome
- Health-related quality of life
- Multinomial logistic regression models
- Non-hierarchical cluster analysis