Predictors of ‘No Problem’ as the Health‑related Quality of Life Status of People Living with HIV on Differentiated Service Delivery in a Nigerian State using the EQ-5D-5L

Abstract

Background: Differentiated service delivery (DSD) aims to improve the overall quality of care that is provided to people living with HIV (PLHIV). One critical measure of self-reported satisfaction with the level of care is quality of life. This study aimed to determine the socio-demographic predictors of the quality of life (QoL) of PLHIV on DSD in a Southeastern Nigerian State. Methods: A cross-sectional study was conducted among PLHIV on DSD across Abia State, Nigeria, from February-April 2022. A sample size of 361 was estimated from the three DSD models in the state: community pharmacy-based, PLHIV-led community antiretroviral group, and health worker/facility-based models. A generic QoL tool (EQ-5D-5L) was used to obtain responses from all consenting PLHIV. Descriptive statistics were used to summarize the variables. Variations in the QoL index value and the predictors of the QoL were determined using one-way ANOVA and binary logistics regression (no problem versus others), respectively. P<0.05 was considered statistically significant. Results: A total number of 312 questionnaires were completed (response rate = 86.4%). Female gender was indicated by 162(51.9%) respondents, while 114(36.5%) stated that they were married. The highest level of education by most respondents (n=134, 42.9%) was secondary school. About a-third (115, 36.9%) reported that they have had HIV for 6-10 years. For their QoL, 284(76.3%) PLHIV had no problems (self-care), 66(21.2%) had slight problems (usual activities) and 11(3.5%) had severe problems (anxiety/depression). The index value for all the respondents was 0.837±0.006. PLHIV that were aged <20 years had a value of 0.782±0.221(F=3.923, p=0.004), while those without formal education had 0.711±0.232 (F=7.981, p≤0.001). Characteristics that were predictive of no problems status were 16-20 years of diagnosis (β=3.634, p=0.025) [mobility]; self-employment (β=11.204, p=0.013) and 16-20 years of diagnosis (β=15.561, p=0.001) [self-care]; tertiary education (β=0.246, p=0.036) [usual activities]; female gender (β=2.040, p=0.014), and 16-20 years of diagnosis (β=4.777, p=0.005) [pain/discomfort]; and 31-40 years (β=0.147, p=0.005), and not being married (β=0.363, p=0.013)[anxiety/depression]. Conclusions:The PLHIV accessing DSD at Abia State had a good quality of life. Their gender, level of education, employment status, and age were factors that were predictive of good QoL among them.