Exploring the correlates of health-related quality of life in older persons on HIV antiretroviral therapy attending the Aids Support Organisation in Uganda

Abstract

Despite advancements in Anti-retroviral Therapy (ART), older persons living with HIV (OPLWHIV) continue to face significant challenges, including poor health outcomes and lower quality of life. This study aimed to explore the correlates of health-related quality of life (HRQoL) for older persons on HIV ART attending the Aids Support Organization (TASO) in Uganda. Methods: We conducted a cross-sectional survey among OPLHIV enrolled in care at 11 stand-alone TASO centres between February to August 2024. Data was analyzed using STATA 15, employing an Ordinal Logistic Regression model to identify HRQoL correlates for individuals over 50 years old living with HIV. Results: Ordinal Logistic Regression results revealed that various demographic, social, and clinical indicators significantly correlated with different HRQoL domains. General health perception was associated with multiple sexual partners (p=0.038), advanced HIV disease (p=0.011), and a viral load >200 copies/ml (p=0.003). Physical functioning correlated with tertiary education (p=0.049), being separated (p=0.004), 11-15 years on ART (p=0.027), and WHO clinical stage II (p=0.050). Factors for role functioning included age 60+ (p=0.002), secondary education (p=0.021), unemployment (p=0.001), WHO clinical stage II (p=0.002), and TB history (p=0.037). Social functioning linked to secondary education (p=0.004), being widowed (p<0.001), viral load >200 copies/ml (p=0.008), and WHO clinical stage II (p=0.011). Pain was associated with age 60+ (p=0.014), tertiary education (p=0.004), and unemployment (p=0.005). Energy correlated with secondary education (p=0.062), being separated (p=0.021), viral load >200 copies/ml (p=0.003), and WHO clinical stage II (p=0.028). Health distress was tied to secondary education (p<0.001), tertiary education (p<0.001), unemployment (p=0.033), and WHO stage II (p<0.001). Finally, mental health was associated with secondary education (p=0.017), being widowed (p=0.043), multiple sexual partners (p=0.015), and WHO stage II (p=0.001). Overall HRQoL specifically correlated with age 60+ (p<0.001), secondary education (p<0.001), and WHO stage II (p=0.008). Conclusion: Significant correlates across multiple HRQoL domains consistently included age (60+ years), educational attainment (secondary and tertiary), unemployment, separated or widowed marital status, specific HIV markers (advanced HIV disease, viral load >200 copies/ml, ART duration), and WHO clinical stage II. Having multiple sexual partners and a history of TB also factored into certain domains. Given these findings, TASO Uganda, with its extensive regional presence, is exceptionally well-positioned to implement multifaceted interventions. These should prioritize comprehensive support for older adults, promote health education and social support, enhance comprehensive HIV care, and provide integrated geriatric HIV health services to improve the HRQoL of OPLWHIV in Uganda.