The effect of universal testing and treatment for HIV on health-related quality of life – an analysis of data from the HPTN 071 (PopART) cluster randomised trial

Davis, Katherine, Pickles, Michael, Gregson, Simon, Hargreaves, James R., Ayles, Helen, Bock, Peter, Pliakas, Triantafyllos, Thomas, Ranjeeta ORCID: 0000-0002-0947-4574, Ohrnberger, Julius, Bwalya, Justin, Bell-Mandla, Nomtha, Shanaube, Kwame, Probert, William, Hoddinott, Graeme, Bond, Virginia, Hayes, Richard, Fidler, Sarah and Hauck, Katharina (2023) The effect of universal testing and treatment for HIV on health-related quality of life – an analysis of data from the HPTN 071 (PopART) cluster randomised trial. SSM - Population Health, 23. ISSN 2352-8273

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Abstract

Background: HIV treatment has clear Health-Related Quality-of-Life (HRQoL) benefits. However, little is known about how Universal Testing and Treatment (UTT) for HIV affects HRQoL. This study aimed to examine the effect of a combination prevention intervention, including UTT, on HRQoL among People Living with HIV (PLHIV). Methods: Data were from HPTN 071 (PopART), a three-arm cluster randomised controlled trial in 21 communities in Zambia and South Africa (2013–2018). Arm A received the full UTT intervention of door-to-door HIV testing plus access to antiretroviral therapy (ART) regardless of CD4 count, Arm B received the intervention but followed national treatment guidelines (universal ART from 2016), and Arm C received standard care. The intervention effect was measured in a cohort of randomly selected adults, over 36 months. HRQoL scores, and the prevalence of problems in five HRQoL dimensions (mobility, self-care, performing daily activities, pain/discomfort, anxiety/depression) were assessed among all participants using the EuroQol-5-dimensions-5-levels questionnaire (EQ-5D-5L). We compared HRQoL among PLHIV with laboratory confirmed HIV status between arms, using adjusted two-stage cluster-level analyses. Results: At baseline, 7,856 PLHIV provided HRQoL data. At 36 months, the mean HRQoL score was 0.892 (95% confidence interval: 0.887–0.898) in Arm A, 0.886 (0.877–0.894) in Arm B and 0.888 (0.884–0.892) in Arm C. There was no evidence of a difference in HRQoL scores between arms (A vs C, adjusted mean difference: 0.003, -0.001-0.006; B vs C: -0.004, -0.014-0.005). The prevalence of problems with pain/discomfort was lower in Arm A than C (adjusted prevalence ratio: 0.37, 0.14–0.97). There was no evidence of differences for other HRQoL dimensions. Conclusions: The intervention did not change overall HRQoL, suggesting that raising HRQoL among PLHIV might require more than improved testing and treatment. However, PLHIV had fewer problems with pain/discomfort under the full intervention; this benefit of UTT should be maximised during roll-out.

Item Type:	Article
Official URL:	https://www.sciencedirect.com/journal/ssm-populati...
Additional Information:	© 2023 The Author(s)
Divisions:	Health Policy
Subjects:	H Social Sciences R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	01 Aug 2023 09:15
Last Modified:	25 Apr 2024 18:36
URI:	http://eprints.lse.ac.uk/id/eprint/119887

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