Use of quality-of-life instruments for people living with HIV: A global systematic review and meta-analysis

Introduction: Due to the effectiveness of combined antiretroviral therapy and its growing availability worldwide, most people living with HIV (PLHIV) have a near-normal life expectancy. However, PLHIV continue to face various health and social challenges that severely impact their health-related quality-of-life (HRQoL). The UNAIDS Global AIDS Strategy discusses the need to optimize quality-of-life, but no guidance was given regarding which instruments were appropriate measures of HRQoL. This study aimed to review and assess the use of HRQoL instruments for PLHIV.

Methods: We conducted a global systematic review and meta-analysis, searching five databases for studies published between January 2010 and February 2021 that assessed HRQoL among PLHIV aged 16 years and over. Multivariable regression analyses were performed to identify factors associated with the choice of HRQoL instruments. We examined the domains covered by each instrument. Random-effects meta-analysis was conducted to explore the average completion rates of HRQoL instruments.

Results and discussion: From 714 publications, we identified 65 different HRQoL instruments. The most commonly used instruments were the World Health Organization Quality-of-Life- HIV Bref (WHOQOL-HIV BREF)-19%, Medical Outcome Survey-HIV (MOS-HIV)-17%, Short Form-36 (SF-36)-12%, European Quality-of-Life Instrument-5 Dimension (EQ-5D)-10%, World Health Organization Quality-of-Life Bref (WHOQOL BREF)-8%, Short Form-12 (SF-12)-7% and HIV/AIDS Targeted Quality-of-Life (HAT-QOL)-6%. There were greater odds of using HIV-specific instruments for middle- and low-income countries (than high-income countries), studies in the Americas and Europe (than Africa) and target population of PLHIV only (than both PLHIV and people without HIV). Domains unique to the HIV-specific instruments were worries about death, stigma and HIV disclosure. There were no significant differences in completion rates between different HRQoL instruments. The overall pooled completion rate was 95.9% (95% CI: 94.7-97.0, I² = 99.2%, p < 0.01); some heterogeneity was explained by country-income level and study type.

Conclusions: A wide range of instruments have been used to assess HRQoL in PLHIV, and the choice of instrument might be based on their different characteristics and reason for application. Although completion rates were high, future studies should explore the feasibility of implementing these instruments and the appropriateness of domains covered by each instrument.