Factors associated with reduced function and quality of life among adult people with HIV with depression and substance use in the Asia-Pacific region

Abstract

Background: Depression and substance use (SU) disorders are prevalent among people with HIV (PWH) and impact health outcomes despite successful antiretroviral therapy (ART). We explored quality of life, functional ability and associated factors among PWH screened positive for depression and/or SU.

Methods: This cross-sectional study recruited adult PWH during routine follow-up at five HIV clinical sites in the Asia-Pacific region. Participants were screened for depression using Patient Health Questionnaire-9 and SU using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Quality of life (QoL) was assessed with WHOQOL-HIV BREF and functional ability with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Factors associated with mean QoL and disability scores were analysed using linear regression.

Results: Of 864 PWH enrolled, 753 screened positive for depression or SU. The median (interquartile range, IQR) age was 38 (31-47) years and 97% were on ART. Overall mean WHOQOL-HIV BREF and WHODAS scores indicated greater impairment with increasing depressive symptom severity and SU risk. In multivariate analysis, PWH reporting previous trauma/stress (difference = 2.7, 95% confidence interval [CI] 1.5-3.9, P < 0.001) and past mental health diagnosis (difference = 5.0, 95% CI 2.9-7.1, P < 0.001) were associated with greater disability and poorer QoL scores across multiple domains ( P < 0.01 for all). Higher CD4 T-cell counts was also associated with better QoL scores and functional ability.

Conclusion: PWH with depression/SU experienced poorer QoL and function despite routine engagement in HIV care. Efforts to integrate mental health services and interventions addressing disability into HIV management should be prioritized in the region.

Figure 1:. Distribution of PLWH screened positive for depression and/or substance use and mean scores for WHODAS 2.0 and overall Quality of Life (QoL).

(A) Distribution of participants screened positive for depression and/or substance use from all participants recruited in the study (n=864) and corresponding mean WHODAS 2.0 and overall QoL (Q1 of WHOQOL-HIV BREF) scores in each group; (B) Trends in mean WHODAS 2.0 (black line) and overall QoL scores (grey bars) by depression symptom severity assessed using the PHQ-9 in PLWH screened positive for depression in the cohort (n=411). The number of participants for each severity group is indicated in the x-axis.

Figure 2:. Heat plots describing (A) mean overall QoL and (B) WHODAS 2.0 scores among PLWH screened positive for substance use categorised by type and extent (low, moderate, high) of substance use reported (n=681).

Mean QoL and WHODAS 2.0 scores are displayed in each box for each type of substance (vertical scale) and the extent of its use (low to high-risk) (horizontal scale). Darker shades indicate poorer QoL and greater disability which corresponds with lower mean QoL and higher WHODAS scores, respectively.