Moving beyond viral suppression: quality of life in HIV prevention and care
File(s)
Author(s)
Davis, Katherine
Type
Thesis or dissertation
Abstract
As life expectancy of people living with HIV (PLHIV) has increased, improving their health-related quality of life (HRQoL) has become more important. This thesis aimed to contribute to understanding of the factors that influence HRQoL among PLHIV, and to support identification of strategies to intervene, in high-burden settings in sub-Saharan Africa. The thesis examined three interrelated areas that may affect HRQoL: symptoms of depression, universal testing and treatment (UTT), and HIV-related stigma. Initially, the prevalence of symptoms of depression in Manicaland, Zimbabwe, was assessed using cross-sectional sero-survey data. The results revealed a substantially higher burden of symptoms of depression among PLHIV than HIV-negative people, highlighting the need for targeted mental health interventions. Second, longitudinal evaluation of further data from Manicaland showed that, among young women, symptoms of depression were associated with starting sex, which suggests that intensified mental health interventions could be beneficial for this demographic. Following the longitudinal evaluation, a cost-effectiveness analysis of the Friendship Bench intervention for symptoms of depression among PLHIV in Manicaland was performed, using mathematical modelling. Delivering three years of Friendship Bench was highly likely to be cost-effective at a threshold above $975 per disability-adjusted life year averted, therefore Friendship Bench should be considered for implementation. Next, the effect of UTT on HRQoL was investigated using data from Zambia and South Africa. No evidence was found of an association between UTT and overall HRQoL among PLHIV after three years, indicating that alternative approaches are required to raise HRQoL. Finally, the relationship between HIV-related stigma and HRQoL was explored, using the same data. This revealed that internalised stigma and stigma experienced in the community were associated with worse HRQoL, emphasising the value of stigma reduction programmes. Together, these analyses highlight critical areas for intervention to improve HRQoL among PLHIV.
Version
Open Access
Date Issued
2023-12-31
Date Awarded
2024-10-01
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Hauck, Katharina
Gregson, Simon
Pickles, Michael
Sponsor
Wellcome Trust (London, England)
Grant Number
220098/Z/20/Z
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)