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ViewAttendees 2

Symposia

Health Psychology / Behavioral Medicine - Adult

Session: Examining the Various Stages of Domestic and Global Mental Health Interventions for HIV from Treatment Development Priorities to Treatment Response

1 - (SYM 63) Multimorbidity and Disease Control in Kwazulu-natal, South Africa: The Importance of Considering Health-related Quality of Life and Care Engagement in Behavioral Medicine Intervention Development

Saturday, November 18, 2023
10:30 AM – 12:00 PM PST
Location: Tahuya (508), Level 5



Background: Health-related quality of life (HRQoL) assesses the perceived impact of health status across life domains. Although research has explored the relationship between specific conditions, including HIV, and HRQoL in low-resource settings, less attention has been paid to the association between multimorbidity and HRQoL. This study assessed the degree to which HIV contributes to HRQoL relative to other diseases and combinations of diseases.



 





Methods: In a sample of South African adults (N = 14,008), we documented disease histories (heart attack, stroke) and the presence of both infectious (HIV, tuberculosis) and non-infectious chronic diseases (blood pressure, diabetes). Five domains of HRQoL (mobility, pain/discomfort, self-care, usual activity, anxiety/depression) and one overall rating of health were measured with the EQ-5D, which has been validated across global contexts. After examining the association between number of conditions and HRQoL, we estimated the effect of joint associations among combinations of diseases, each HRQoL domain, and overall health. Then, in one set of ridge regression models, we assessed the relative impact of HIV, diabetes, stroke, heart attack, high blood pressure, and tuberculosis on the HRQoL domains; in a second set of models, the contribution of treatment (controlled vs. uncontrolled disease) was added.



 





Results: Having more diagnosed conditions adversely affected overall health (r = -0.053) and all other HRQoL domains. However, having more infectious conditions was associated with better overall health (r = 0.045, driven by HIV), whereas having more non-infectious conditions was associated with worse overall health (r = -0.11, driven by stroke and heart attack). In the first set of models, combinations of non-infectious diseases were most detrimental for overall health, whereas positive HIV status predicted self-reported good health. In the second set, combinations of uncontrolled non-infectious conditions were predictive of poor health, whereas controlled HIV was most strongly associated with self-reported good health.



 


Conclusion

: While the presence of non-infectious diseases (controlled, uncontrolled, prior, current) was associated with poor HRQoL, the presence of controlled HIV was associated with greater HRQoL. Treatment and engagement in HIV care may explain these effects. In settings with a high burden of both non-infectious and infectious diseases, incorporating multimorbidity into healthcare strategies and improving the integration of care may improve HRQoL.