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

Katherine Davis; Michael Pickles; Simon Gregson; James R Hargreaves; Helen Ayles; Peter Bock; Triantafyllos Pliakas; Ranjeeta Thomas; Julius Ohrnberger; Justin Bwalya; Nomtha Bell-Mandla; Kwame Shanaube; William Probert; Graeme Hoddinott; Virginia Bond; Richard Hayes; Sarah Fidler; Katharina Hauck; HPTN 071 (PopART) Study Team

doi:10.1016/j.ssmph.2023.101473

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 Popul Health. 2023 Jul 22:23:101473. doi: 10.1016/j.ssmph.2023.101473. eCollection 2023 Sep.

Authors

Katherine Davis^{1

2}, Michael Pickles^{1

2}, Simon Gregson^{1

2}, James R Hargreaves³, Helen Ayles^{4

5}, Peter Bock⁶, Triantafyllos Pliakas³, Ranjeeta Thomas⁷, Julius Ohrnberger^{1

2}, Justin Bwalya⁵, Nomtha Bell-Mandla⁶, Kwame Shanaube⁵, William Probert⁸, Graeme Hoddinott⁶, Virginia Bond^{5

9}, Richard Hayes¹⁰, Sarah Fidler¹¹, Katharina Hauck^{1

2}; HPTN 071 (PopART) Study Team

Affiliations

¹ MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK.
² Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK.
³ Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
⁴ Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
⁵ Zambart, School of Medicine, University of Zambia, Lusaka, Zambia.
⁶ Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa.
⁷ Department of Health Policy, London School of Economics, London, WC2A 2AE, UK.
⁸ Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK.
⁹ Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
¹⁰ Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
¹¹ Department of Infectious Disease, Faculty of Medicine, Imperial College London, W2 1PG, UK.

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.

Keywords: Cluster randomised controlled trial; HIV; Health-related quality of life; South Africa; Universal testing and treatment; Zambia.

Abstract

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