Correlates of Poor Quality of Life Among Older People Living With HIV: A Cross‐Sectional Analysis of the Tanzania HIV and Aging Cohort Study

Abstract

INTRODUCTION: Older people living with HIV (PLH) have a high multimorbidity burden that may impair quality of life (QOL). This study assessed the burden of geriatric syndromes and medical comorbidities and their association with QOL among older PLH in urban Tanzania. These results are important to understand the growing complexities of care needs in this population and inform future strategies. METHODS: We conducted a cross-sectional analysis of baseline data from the Tanzania HIV and Aging Longitudinal Cohort Study (THALCS). Eligible participants (age ≥50 years, on anti-retroviral therapy [ART] for ≥3 years) were recruited between April and July 2024 from seven HIV care and treatment centres. Participants were excluded if pregnant or unable to consent. QOL was assessed using the WHOQOL-HIV-BREF, a 31-item tool in six domains. Domain scores were converted to a 0-100 scale, and the overall QOL score was calculated. Geriatric syndromes and medical comorbidities were assessed using standard tools. Multivariable linear regression examined the associations, adjusting for sociodemographic and HIV-related factors. RESULTS: Among the 400 participants (median age: 57 [IQR: 53-63] years; 50% females; ART duration: 10-19 years [60.3%]), the majority were on first-line dolutegravir-based ART (83.5%) with undetectable viral load (78.5%). The most common medical comorbidities were dyslipidaemia (80.2%), hypertension (54.5%) and overweight/obese (50.8%). Frailty (13.8%) and pre-frailty (48.3%) were observed. Median QOL score was 75.4 (IQR: 66.3-83.5), highest in physical health and spirituality domains (87.5 [IQR: 75-100] and 87.5 [IQR: 68.7-93.7]) and lowest in environmental domain 62.5 (IQR: 50-75). Males had a higher median overall QOL score than females (76.8 [IQR: 67.9-83.7] vs. 72.9 [IQR: 65.2-83.4], p = 0.036). Pre-frailty (β = -3.41, 95% CI: -5.64, -1.18, p = 0.003), mild depression (β = -7.88, 95% CI: -11.17, -4.60, p<0.001) and moderate/severe depression (β = -19.25, 95% CI: -24.67, -13.83, p<0.001) were associated with poorer QOL. Functional impairment showed a dose-response relationship with QOL. Increasing age (β = 0.18, 95% CI: 0.02, 0.34; p = 0.026) and higher income (>500,000 TZS) (β = 7.16, 95% CI: 3.10, 11.21; p = 0.001) were associated with better QOL. CONCLUSIONS: A high prevalence of geriatric syndromes and medical comorbidities was observed among older PLH in Tanzania, several of which were negatively associated with QOL. These findings underscore the need to integrate holistic care models in HIV programmes for older PLH.