MAP-Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
J Int AIDS Soc. 2022 Feb;25(2):e25884. doi: 10.1002/jia2.25884.
Health-related quality of life (HRQoL) is an important HIV outcome beyond viral suppression. However, there are limited data characterizing HRQoL of key populations, including female sex workers (FSW) living with HIV.
We used baseline data (22 June 2018-23 March 2020) of FSW who were diagnosed with HIV and enrolled into a randomized trial in Durban, South Africa. HRQoL information was collected by a generic preference-accompanied tool with five domains (EQ-5D), and summarized into a single score (range 0-1), which represents health utility. We employed multivariable beta regression models to identify determinants of HRQoL and to estimate subgroup-specific HRQoL score. Using external estimates of life expectancy and population size, we estimated the number of quality adjusted life years reduced among FSW living with HIV in South Africa associated with violence and drug use.
Of 1,363 individuals (mean age: 32.4 years; mean HRQoL score: 0.857) in our analysis, 62.6% used drugs, 61.3% experienced physical or sexual violence and 64.6% self-reported taking antiretroviral treatment (ART). The following were associated with a reduction in the average marginal HRQoL score: older age (per decade: 0.018 [95% confidence interval (CI): 0.008, 0.027]), drug use (0.022 [0.007, 0.036]), experience of violence (0.024 [0.010, 0.038]) and moderate (vs. no) level of internalized stigma (0.023 [0.004, 0.041]). Current ART use was associated with a 0.015-point (-0.001, 0.031) increase in the HRQoL score. The estimated mean (95% CI) HRQoL scores ranged from 0.838 (0.816, 0.860) for FSW who used drugs, experienced violence and were not on ART; to 0.899 (0.883, 0.916) for FSW who did not use drugs nor experience violence and were on ART. Our results can be translated into a reduction in 37,184 and 39,722 quality adjusted life years related to drug use and experience of violence, respectively, in South Africa.
These results demonstrate the association of ART with higher HRQoL among FSW and the need to further address structural risks, including drug use, violence and stigma. Population-specific estimates of HRQoL score can be further used to calculate quality-adjusted life years in economic evaluations of individual and structural interventions addressing the needs of FSW living with HIV.
NCT03500172 (April 17, 2018).
健康相关生活质量（HRQoL）是病毒抑制以外 HIV 的重要结果。然而，针对关键人群（包括感染 HIV 的性工作者）的 HRQoL 进行描述的数据有限。
我们使用了在南非德班进行的一项随机试验中诊断出 HIV 并入组的性工作者（FSW）的基线数据（2018 年 6 月 22 日至 2020 年 3 月 23 日）。HRQoL 信息通过带有五个域（EQ-5D）的通用偏好伴随工具收集，并汇总为一个单一分数（范围 0-1），代表健康效用。我们采用多变量β回归模型来确定 HRQoL 的决定因素，并估计亚组特异性 HRQoL 分数。使用预期寿命和人口规模的外部估计值，我们估计了与暴力和药物使用相关的南非 HIV 感染者中减少的生活质量调整生命年数量。
在我们的分析中，有 1363 名参与者（平均年龄：32.4 岁；平均 HRQoL 评分：0.857），其中 62.6%使用药物，61.3%经历过身体或性暴力，64.6%自我报告服用抗逆转录病毒治疗（ART）。以下因素与平均边际 HRQoL 评分降低相关：年龄较大（每十年：0.018 [95%置信区间（CI）：0.008，0.027]）、药物使用（0.022 [0.007，0.036]）、暴力经历（0.024 [0.010，0.038]）和内化耻辱感的中度（与无）水平（0.023 [0.004，0.041]）。目前的 ART 使用与 HRQoL 评分增加 0.015 分（0.001，0.031）相关。估计的平均（95%CI）HRQoL 评分范围从使用药物、经历过暴力且未接受 ART 的 FSW 的 0.838（0.816，0.860）到不使用药物且未经历过暴力且接受 ART 的 FSW 的 0.899（0.883，0.916）。我们的结果可以转化为与药物使用和经历暴力相关的 37184 和 39722 个质量调整生命年的减少，分别在南非。
这些结果表明，ART 与 FSW 的 HRQoL 较高相关，需要进一步解决包括药物使用、暴力和耻辱感在内的结构性风险。特定人群的 HRQoL 评分估计可以进一步用于计算满足 HIV 感染者需求的个体和结构性干预措施的质量调整生命年。
NCT03500172（2018 年 4 月 17 日）。
