Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil

• Published in: AIDS and behavior 2024-01, Vol.28 (1), p.285-299
• Main Authors: Silva, Marcio Roberto, de Lima Bento, Joseane, de Aguiar Oliveira, Marina, Fochat, Romário Costa, Leite, Isabel Cristina Gonçalves, da Cruz Pereira, Geraldo Magela
• Format: Article
• Language: English
• Subjects: Cluster analysis; Comorbidity; Cross-sectional studies; Cultural differences; Health Psychology; Health services; Heterosexuality; HIV; Human immunodeficiency virus; Infectious Diseases; Low income groups; Measures; Medicine; Medicine & Public Health; Mental disorders; Original Paper; Public Health; Quality of life; Regression analysis; Regression models; Sexually transmitted diseases; STD; Treatment methods; Well being
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-023-04220-y

Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF’s overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF’s overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.