The effect of universal testing and treatment for HIV on health-related quality of life ' data from the HPTN 071 (PopART) cluster randomised trial in Zambia and South Africa


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. We examined the effect of a combination prevention intervention, including UTT, on HRQoL among PLHIV.
METHODS: Data were from HPTN 071 (PopART), a three-arm cluster randomised controlled trial in 21 urban and peri-urban 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 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 an open cohort of randomly selected adults (18-44 years) in randomly selected households, using data from baseline and 36-months. HRQoL scores (range:0-1), and the prevalence of problems in five dimensions of HRQoL (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). HRQoL among PLHIV with laboratory confirmed HIV status was compared between arms. This was achieved using two-stage cluster-level analyses, controlling for baseline imbalances in language(s) used to complete the survey, wealth and HRQoL, as well as age and gender.
RESULTS: Data from 10,900 PLHIV (women, n=9,205, 84.4%; men, n=1,695, 15.6%) were examined. At 36-months, the mean HRQoL score was 0.893 (95% confidence interval:0.891-0.894) in Arm A, 0.888 (0.886-0.890) in Arm B and 0.891 (0.889-0.892) in Arm C. There was no evidence of a difference in HRQoL scores between arms (adjusted mean difference, A vs C:0.003, -0.001-0.006; B vs C:-0.004, -0.014-0.005). However, the geometric mean prevalence of problems with pain/discomfort was 2.4% in Arm A, 7.5% in Arm B and 7.8% in Arm C, with prevalence lower in Arm A than C (adjusted prevalence ratio:0.37, 0.14-0.97). There was no evidence of a difference in effect between men and women.
CONCLUSIONS: The PopART UTT intervention did not change overall HRQoL, suggesting that improving HRQoL among PLHIV might require more than access to testing and treatment. However, PLHIV had fewer problems with pain/discomfort under the full intervention; this benefit of UTT should be maximised in further roll-out.

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