Associations between HIV Stigma and Health-Related Quality of Life Among People Living with HIV in Zambia and South Africa: A Cross-Sectional Analysis of Data from the HPTN 071 (POPART) Study
Author(s)
Hall E1, Davis K1, Ohrnberger J1, Pickles M1, Gregson S1, Thomas R2, Hargreaves JR3, Pliakas T3, Bwalya J4, Dunbar R5, Mainga T4, Shanaube K4, Hoddinott G5, Bond V4, Bock P5, Ayles H3, Stangl A6, Donnell D7, Hayes R3, Fidler S1, Hauck K1
1Imperial College, London, UK, 2London School of Economics, London, UK, 3London School of Hygiene and Tropical Medicine, London, UK, 4University of Zambia, Lusaka, Zambia, 5University of Stellenbosch, Cape Town, South Africa, 6Hera Solutions, Baltimore, MD, USA, 7Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Presentation Documents
OBJECTIVES:
Little is known about the relationship between HIV stigma and health-related quality of life (HRQoL) among people living with HIV (PLHIV). We aimed to explore associations between four HIV stigma outcomes and HRQoL among PLHIV and examined which HRQoL domains were most affected.METHODS:
We analysed data from HPTN 071 (PopART), a cluster randomised controlled trial in 21 urban communities in Zambia and South Africa. An open cohort of randomly selected adults (18-44 years) was surveyed at baseline and 36-months. We used data from PLHIV in the cohort at 36-months (09/2017-07/2018) who self-reported being HIV-positive and had laboratory-confirmed status. HRQoL was measured using the EuroQol-5-dimensions-5-levels (EQ-5D-5L) questionnaire. PLHIV responded to 11 questions capturing four composite stigma outcomes: internalized stigma (three questions), stigma experienced in the community (five questions), stigma experienced in healthcare settings (three questions) and any stigma experienced (11 questions). Binary variables captured whether PLHIV reported each outcome. Associations between HRQoL and stigma were examined using logistic regressions, adjusted for socio-economic confounders.RESULTS:
Data were from 3,991 PLHIV (88% women; 12% men). PLHIV who experienced stigma in the community (n=693), and those who reported internalised stigma (n=552), had higher odds of reporting problems in at least one HRQoL domain than those who had not (adjusted odds ratio:1.46, 95% confidence interval:1.12-1.89 and 1.84, 1.42-2.39, respectively). Experiencing stigma in a healthcare setting (n=158) was not associated with HRQoL (0.94, 0.57-1.50). Individuals who had experienced any stigma (n=1,034) had higher odds of reporting problems with mobility (1.97, 1.23-3.14), self-care (1.92, 1.06-3.44), performing daily activities (1.98, 1.29-3.00), pain/discomfort (1.85, 1.43-2.39), and anxiety/depression (2.73, 1.94-3.83), than those who had not.CONCLUSIONS:
Internalised stigma and stigma experienced in the community were associated with lower HRQoL. Addressing stigma and similar structural drivers is vital to improving HRQoL among PLHIV.Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
PCR134
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
Infectious Disease (non-vaccine)