Medical Outcomes Study HIV Health Survey Research Articles

Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study.

This study aimed to explore health-related quality of life (HRQoL) and its associated factors among people living with HIV/AIDS (PLWH) in Sichuan, China. A total of 401 PLWH were recruited from the city of Panzhihua between August 2018 and January 2019. Demographic characteristics and disease-related data were collected by self-administered questionnaires and medical system records. Health-related quality of life (HRQoL) was measured by the medical outcome study HIV health survey (MOS-HIV), which measured ten subdimensions and two summarized dimensions, the physical health summary score (PHS) and the mental health summary score (MHS). Logistic regression models were used to explore the variables independently associated with quality of life. The PHS and MHS measured by MOS-HIV were 53.66 ± 6.80 and 51.31 ± 7.66, respectively. Younger age, higher educational level, no methadone use, higher CD4 lymphocyte counts, less symptom counts and heathy BMI significantly were associated with higher HRQOL in the univariate χ2-test analysis. Education level was found to have a significant influence on patients' quality of life, both in physical health (P = 0.022) and mental health (P = 0.002) dimensions. Younger age (P = 0.032), higher CD4 lymphocyte counts (P = 0.007), less symptom counts (P < 0.001) and health BMI level (P < 0.001) were positively related to the PHS of quality of life in the multivariable logistic regression model. The HRQoL of PLWH in Sinchuan Province was relatively low. Age, educational level, methadone use, CD4 lymphocyte counts, symptom counts and BMI were positively related to quality of life. This study indicates that health caregivers should pay more attention to comorbidity issues and mental health in PLWH, especially for those with lower education levels, unhealthy body mass index, more symptomatic presentation and older age.

A randomized comparison of health-related quality of life outcomes of dolutegravir versus efavirenz-based antiretroviral treatment initiated in the third trimester of pregnancy

IntroductionEvidence on health-related quality of life (HRQoL) outcomes is limited for new antiretroviral therapies (ART). Dolutegravir-based treatment is being rolled out as the preferred first-line treatment for HIV in many low- and middle-income countries. We compared HRQoL between treatment-naïve pregnant women randomized to dolutegravir- or efavirenz-based ART in a clinical trial in Uganda and South Africa.MethodsWe gathered HRQoL data from 203 pregnant women of mean age 28 years, randomized to either dolutegravir- or efavirenz-based ART. We used the medical outcomes study-HIV health survey at baseline, 24 and 48 weeks between years 2018 and 2019. Physical health summary (PHS) and mental health summary (MHS) scores were the primary study outcomes, while the 11 MOS-HIV subscales were secondary outcomes. We applied mixed model analysis to estimate differences within and between-treatment groups. Multivariate regression analysis was included to identify associations between primary outcomes and selected variables.ResultsAt 24 weeks postpartum, HRQoL scores increased from baseline in both treatment arms: PHS (10.40, 95% CI 9.24, 11.55) and MHS (9.23, 95% CI 7.35, 11.10) for dolutegravir-based ART; PHS (10.24, 95% CI 9.10, 11.38) and MHS (7.54, 95% CI 5.66, 9.42) for efavirenz-based ART. Increased scores for all secondary outcomes were significant at p < 0.0001. At 48 weeks, improvements remained significant for primary outcomes within group comparison. Estimated difference in PHS were higher in the dolutegravir-based arm, while increases in MHS were more for women in the efavirenz-based armat 24 and 48 weeks. No significant differences were noted for corresponding PHS scores at these time points compared between groups. Differences between arms were observed in two secondary outcomes: role function (1.11, 95% CI 0.08, 2.13), p = 0.034 and physical function outcomes (2.97, 95% CI 1.20, 4.73), p = 0.001. In the multivariate analysis, internet access was associated with higher PHS scores while owning a bank account, using the internet and longer treatment duration were associated with an increase in MHS scores.ConclusionWe found no important differences in HRQoL outcomes among HIV-positive women started on dolutegravir relative to efavirenz in late pregnancy. Increases in HRQoL in the first year after delivery provide additional support for the initiation of ART in HIV-positive women presenting late in pregnancy.Trial Registration Clinical Trial Number: NCT03249181

Predictors of Stigma and Health-Related Quality of Life Among People Living with HIV in Northern Thailand

HIV-related stigma and discrimination have been a significant barrier to accessing health care, hence contributing to poor health outcomes. This study aimed to investigate factors associated with HIV-related stigma and discrimination and health-related quality of life (HRQoL) among people living with HIV in rural Thailand setting. A cross-sectional convenience sample of 161 HIV-positive Thai patients was recruited from a single rural district hospital using a self-administered questionnaire entailing sociodemographic information, the 12-item stigma scale, the Medical Outcomes Study HIV Health Survey (MOS-HIV), and the EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Linear regression and the multi-variable analyses were used to investigate factors associated with stigma and HRQoL, whereas the correlations between stigma and quality of life variables were tested by Pearson correlations. Being married and duration of antiretroviral therapy were negatively correlated with HIV stigma, while increased age was inversely associated with HRQoL. Being employed and having sufficient money for living contributed positively to predict HRQoL. HIV stigma was negatively associated with mental health summary (MHS) and visual analog scale (VAS) score, whereas duration diagnosed with HIV and the use of two nucleoside reverse transcriptase inhibitors in combination with protease inhibitor regimen were negative factors associated with VAS and health utility, respectively. The findings confirm complex and inseparable associations of factors relating to HIV-related stigma and HRQoL. The development of effective interventions tailored at individual level is warranted to address this gap.

Effects of pharmaceutical care interventions on humanistic outcomes in hypertensive people living with HIV: results of a randomized controlled trial

To evaluate the effects of pharmaceutical care (PC) interventions on humanistic outcomes in HIV-positive patients with hypertension. This prospective, open-label, parallel randomized controlled trial was conducted in the HIV clinic of the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria, from August 2018 to October 2019. Eligible patients were randomized sequentially and equally into two study arms: the control arm (CA), where participants received the traditional care and the intervention arm (IA), where participants received PC by the research pharmacist. The patient's HIV knowledge questionnaire, the Hypertension Knowledge-Level Scale, the Medical Outcome Study-HIV Health Survey and the Patient Satisfaction with Pharmaceutical Service questionnaire were used to assess participants' HIV-related knowledge, hypertension-related knowledge, health-related quality of life (HRQoL) and satisfaction with PC, respectively. These were self-completed at baseline, 6 months and 12 months. Data were analysed using SPSS (IBM version 25.0). Out of the 206 participants randomized, 182 completed the 12-month follow-up. After 12 months, there was a significant improvement in HIV-related knowledge (∆ = 11.28%, t(180) = 4.41, P < 0.001) and hypertension-related knowledge (∆ = 5.94%, t(180) = 3.25, P = 0.001) in the IA over and above those observed in the CA. Similarly, PC interventions led to significant improvements in HRQoL (∆ = 6.5%, t(180) = 5.50, P < 0.001) and satisfaction with PC in the IA (∆ = 18.12%, t(180) = 11.85, P < 0.001) at the end of the study. PC significantly improved humanistic outcomes in HIV-positive patients with hypertension after a 12-month intervention.

Comparison of Turkish version of the medical outcomes study-HIV health survey with short form health survey-36 in people living with human immunodeficiency virus.

Several questionnaires have been developed to evaluate the quality of life (QoL) for people living with human immunodeficiency virus (HIV). The aim of this study was to compare Turkish version of the Medical Outcomes Study-HIV Health Survey (MOS-HIV) with Short Form Health Survey (SF-36) in people with HIV. A hundred and 14 patients with HIV were consecutively included. The MOS-HIV and SF-36 questionnaires were applied to all patients at the same day. MOS HIV included 35 items and assessed general health perceptions (GH), physical functioning (PF), social functioning (SF), mental health (MH), bodily pain (P), cognitive functioning, health distress, overall QoL, health transition, role functioning (RF), energy/vitality (EV), physical (Physical health summary score) and mental (MHSS) health summary scores. SF-36 included 36 items and measured eight domains of health concepts including SF, PF, P, RF, GH, role emotional, vitality (V) and MH. Correlation analysis and Bland- Altman plots were used to compare the MOS-HIV and SF-36 questionnaires. GH, PF, P, RF, EV, SF, and MH domains of the MOS-HIV were significantly correlated with those of SF 36. The agreement between the tests were 91.2% for PF, 92.1% for RF and pain, 94.7% for GH, 95.6% for EV, 92.1% for SF and 93.9% for MH. Turkish version of the MOS HIV showed moderate correlations and agreement with SF 36 suggesting its use as an alternative to SF 36 in assessing QoL in these patients.

Abstract EP08: Cardiometabolic Diseases, Quality Of Life And Sleep In Adults With Hiv In The Deep South

Introduction: Cardiometabolic diseases (CMDs) are prevalent among middle-aged and older people living with HIV (OPLWH), particularly in the Deep South. However, the role CMDs play on quality-of-life outcomes among OPLWH remain understudied. Purpose: The purpose of this observational study was to examine the association between CMDs and physical health-related quality of life (P-HRQOL) and quality of sleep among PLWH in the Deep South. Methods: This cross-sectional study included N=261 HIV-infected participants aged 40+ recruited from a University HIV/AIDS clinic located in the Southeastern United States. CMDs were self-reported and consisted of hypertension, heart failure, stroke, diabetes mellitus, Angina due to heart disease, and high cholesterol. P-HRQOL and sleep quality scores were obtained using the Medical Outcome Study HIV Health Survey (MOS-HIV) and Pittsburgh sleep quality index (PSQI). We performed regression analyses (adjusting for demographic confounders and depression) for each outcome to assess the association between CMDs and P-HRQOL and sleep quality among OPLWH. Results: The average age of participants was 51.10 ± 6.78, with 82.8% being non-white and 35.6% being males. The overall prevalence of having ≥ 1CMD was 64.4% (High cholesterol: 52.8%; Diabetes Mellitus: 22.8%; Stroke: 5.68%; Angina/chest pain: 4.5%; Heart Failure: 6.8%; Hypertension 84%). P-HRQOL scores were significantly lower in PLWH with ≥1 CMD compared to the non-CMD group (45.53 ± 11.54 Vs. 49.67 ± 10.77, p&lt;0.01). PSQI sleep disturbance scores were significantly higher among participants with ≥1CMD compared to the non-CMD group (9.28 ± 4.42 vs. 7.26 ± 4.17, p&lt;0.01). In the covariate adjusted regression analysis, each additional CMD resulted in a 1.83 decrease in P-HRQOL while PSQI sleep disturbance increased by 0.74. Conclusion: In a sample of PLWH in the Deep South, the presence of CMDs increased the risk for poor P-HRQOL and greater sleep disturbances. Interventions that focus on targeting P-HRQOL and sleep quality in OPLWH with CMDs are necessary to improve long-term outcomes.

Patient-reported outcomes in HIV clinical trials evaluating antiretroviral treatment: a systematic review

ABSTRACT We aimed to assess patterns of patient-reported outcomes (PRO) instruments’ utilization in HIV clinical trials in relation to antiretroviral therapy (ART). PubMed/MEDLINE, Scopus, and EMBASE were searched using the terms “Patient-Reported Outcomes” and “HIV/AIDS” or “Antiretroviral Treatment” or “ART” or “Antiretroviral Therapy” from 1 January 1990 until 1 December 2019. In total, 173 studies were identified and 26 were directly related to ART. Study population included treatment-naïve patients (n = 4), treatment-experienced (n = 20), or both (n = 2). Instruments were implemented to assess general experience with ART (n = 3), single-tablet regimens (STR) (n = 2), monotherapy (n = 4), regimen switch (n = 9), or regimen comparison (n = 8). The most commonly used instruments were Medical Outcomes Study-HIV Health Survey (MOS–HIV, n = 8), HIV Symptom Index (HIV-SI, n = 7) and unstructured self-reports (n = 5) followed by others. MOS–HIV was used mainly in comparative (n = 4) and monotherapy (n = 3) trials, HIV-SI in switch (n = 4) and STR (n = 2) trials, and self-reports in comparative trials (n = 3). Even though, the implementation of PRO tools is increasing with time, reporting of PRO in HIV clinical trials remains limited.

A-077 Relationship Between Mental Health and Physical Health and Neurocognitive Function among Latinx People Living With HIV

Abstract Objective The relationship between self-reported mental health (MH), physical health (PH), and neurocognition (NC) is vastly understudied among Latinx people living with HIV (PLWH). Evidence of increased somatization in this group suggests that self-reported MH and PH may contextualize cognitive outcomes among Latinx PLWH. Thus, this study examines the relationship between self-reported MH/PH and NC in a sample of Latinx PLWH. Method This study included 76 Latinx PLWH (33% female; M age = 46.0, SD = 7.08) who completed the Medical Outcomes Study HIV Health Survey (MOS-HIV) and a comprehensive neurocognitive battery. MH and PH were defined by the MOS-HIV, where higher MH and PH summary scores indicate better perceived health. Demographically-corrected T-scores were used to compute average global NC and domain scores. Results Within Latinx PLWH, partial correlations controlling for age and education found PH was associated with better processing speed (r = .28, p = .03), and MH was related to better global NC, fluency, learning, and processing speed (ps &amp;lt; .05). A series of multiple regressions (Step 1: age, education, Step 2: MH, PH summary scores) were used to predict NC domain scores. MH (R2 = .11–.15) significantly predicted better attention/working memory (β = .26, p = .03) and global NC at the trend level (β = .19, p = .07). PH did not predict any NC domains. Conclusions Findings indicate that MH and PH correlated with global and domain-specific NC within Latinx PLWH. Better self-reported MH may improve attention/working memory and global NC in Latinx PLWH. Somatization is important when considering MH/PH and cognition within Latinx PLWH; physicians should consider the impact of patients’ self-reported MH/PH on NC in Latinx PLWH.

The Medical Outcome Study-HIV Health Survey: A systematic review and reliability generalization meta-analysis.

The Medical Outcome Study-HIV Health Survey (MOS-HIV) is one of the most used questionnaires for the evaluation of the health-related quality of life (HRQoL) in people living with HIV (PLWHIV) in both medical settings and research studies. This study aimed to estimate the average reliability of the MOS-HIV scores and to evaluate the characteristics of the studies that could explain the variability between reliability estimates. Furthermore, the study aimed to estimate the induction rate of the reliability of the MOS-HIV. A systematic review of the previous literature, including studies that reported α and/or test-retest coefficients with the data at hand for the total score of the MOS-HIV and the subscales, was conducted. Fifty studies (52 samples; N = 14,132) were included in the reliability generalization meta-analysis. The average α coefficient for the total score of MOS-HIV was .91 and above .80 for all of the subscales, except for role functioning, which had an average coefficient of .76. Different study dimensions were related to the heterogeneity of reliability between studies. Reliability induction was found to be 76.1%. The results obtained in the present study indicate that the MOS-HIV is a reliable instrument for HRQoL evaluation in PLWHIV, for clinical and research purposes. In the clinical practice of health services, nurses could employ this gold standard for reliable evaluations of HRQoL in PLWHIV.

Perceived social support, depression and their impact on quality of life of people living with HIV in India

ABSTRACT Universal access to Antiretroviral Treatment (ART) has transformed HIV/AIDS into a chronic disease and issues like social support and Quality of life (QOL) have emerged as important components of care. Perceived social support influences QOL in People Living with HIV (PLHIV), though this has not been studied well in India. PLHIV were assessed for Social Support using the Multidimensional Scale of Perceived Social Support (MSPSS) and QOL was assessed with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. The factors impacting social support and its effect of on QOL were analysed. Amongst the 109 study subjects, 62 (56.9%) were men, 47 (43.1%) were women, mean age was 35 ± 7.5 years, 85.3% had WHO stage 1 disease and 80 (73.4%) were receiving ART. Only 43.1% subjects perceived high overall social support. Social support (from family/friends/others) was associated positively with physical functioning (p = 0.001), social and cognitive functioning (p = 0.000) and significantly inversely associated with depression (p = 0.002). Higher perceived social support was seen to correlate with higher CD4 count (Peak, Nadir and Current; p < 0.05) and better adherence (p = 0.003). It is concluded that social support, including support from beyond family, have a significant impact on clinical endpoints and QOL in PLHIV.

PIN90 COMPARATIVE QUALITY OF LIFE OUTCOMES OF DOLUTEGRAVIR-BASED OR EFAVIRENZ-BASED ANTIRETOVIRAL TREATMENT IN PREGNANCY FOR LATE PRESENTORS BETWEEN THE 3RD TRIAL-MESTER AND 48 WEEKS POSTPARTUM

Evidence on safety and health related quality of life outcomes is needed for rollout of new antiretroviral therapies. Dolutegravir-based treatment is being rolled out as the preferred first-line treatment for HIV in many low- and middle-income countries. We compared HRQoL between treatment-naïve pregnant women randomized to dolutegravir-based or efavirenz-base regimen in Uganda and South Africa. As part of the DoIPHIN-2 RCT, HRQoL data was gathered from 203 pregnant women mean age 28years, randomized to dolutegravir (101) and efavirenz (102). The medical outcomes study-HIV health survey was used at baseline, 24weeks and 48weeks between years 2017 and 2019. Physical health summary and mental health summary scores were primary-endpoints, while the 11 MOS-HIV subscales were secondary-endpoints. Pairwise t-tests were followed by ANCOVA analysis for within-group and between-group comparisons. Standardized multivariate regressions were included to associate selected-variables and MOS-HIV sub-scales with PHS and MHS scores. After 24weeks postpartum, significant improvements were seen in dolutegravir-treatment; PHS-scores (11.9±1.4, P<0.001); MHS-scores (10.7±1.7, P<0.001) and efavirenz-treatment; PHS-scores (9±1.1, P<0.001); MHS-scores (6.7, P<0.001) groups. Changes were not significantly different (PHS: P=0.106, MHS: P=0.087) between treatment-group comparison. Dolutegravir-treated women presented significantly higher improvements in physical function scores (8.18±3.2, P=0.012) than efavirenz treatment-group. Treatment-effects were not significant on PHS-scores (F(1,178)=0.00, P=0.967) and MHS-scores (F(1,177)=0.60, P=0.441) adjusting for viral-loads and CD4-count. After 48weeks postpartum, increase in PHS-scores and MHS-scores remained significant in both treatment-groups but were not significantly different between-groups (PHS: 1.1±1.0, P=0.269, MHS: -0.8±1.6, P=0.606). Dolutegravir-treated women presented higher scores in 8/11 MOS-HIV subscales relative to efavirenz group. Treatment effects remained insignificant on PHS-scores F(1,193)=1.32, P=0.252 and MHS-scores F(1,191)=0.04, P=0.841 adjusting for viral-loads and CD4-count. Increases in HRQoL-scores were generally higher in dolutegravir-treated women at 24weeks and 48weeks postpartum but not significantly different from those in efavirenz. Relationship between viral-load, CD4-count with PHS-scores and MHS-scores were similar in both treatments-groups.

The Roles of Health Literacy and Physician-Patient Relationship in Self-Reported Health Outcomes Within a Diverse Sample of Persons Living with HIV

Abstract Objective Barriers like poor health literacy and patient-provider communication add to health disparities in diverse populations. Perceived autonomy has been shown to improve patients’ health satisfaction and knowledge of their illness. However, no studies have examined these issues in HIV patients. This study examined the roles of health literacy and physician-patient relationship in health outcomes (e.g., mental health and emotional/physical functioning) in persons living with HIV (PLWH). Participants and Method This cross-sectional study included 91 PLWH (74% Latinx and 26% non-Latinx White; 68% Male) who completed the Test of Functional Health Literacy in Adults (TOFHLA), Physician–Patient Relationship Scale (PPRS), and Medical Outcomes Study-HIV Health Survey (MOS). The study variables included: TOFHLA total score, PPRS Part Decision- Making (PDM) and Trust subscales, and MOS Mental Health and Health Transition subscales. Results A linear regression showed that our model (ethnicity, TOFHLA, PPRS PDM and Trust) predicted MOS HT (R2 = .14, p &amp;lt; 0.05), such that Latinx ethnicity (β = .30) and better TOFHLA scores (β = -.22) predicted better MOS HT scores (ps &amp;lt; .05). Another regression showed that our model predicted MOS MH (R2 = 0.07, p = &amp;lt;.01), such that greater PPRS PDM scores predicted better MOS MH scores (β = .27, p = &amp;lt;.01). Conclusions Ethnicity and better health literacy were related to improved emotional/physical functioning over a 4-week period and greater shared decision-making was related to better overall mental health. These findings highlight the importance of identifying sociocultural factors and interpersonal processes of care to inform culturally-tailored interventions that can result in enhanced and effective treatment for PLWH patients and in improved physical and mental health outcomes.

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3\u2009L) utility index

BackgroundMapping of health-related quality-of-life measures to health utility values can facilitate cost-utility evaluation. Regression-based methods tend to lead to shrinkage of variance. This study aims to map the Medical Outcomes Study HIV Health Survey (MOS-HIV) to EuroQoL 5 Dimensions (EQ-5D-3 L) utility index, and to characterize the performance of three mapping methods, including ordinary least squares (OLS), equi-percentile method (EPM), and a recently proposed method called Mean Rank Method (MRM).MethodsThis is a secondary analysis of data from a randomized HIV treatment trial. Baseline data from 421 participants were used to develop mapping functions. Follow-up data from 236 participants was used to validate the mapping functions.ResultsIn the training dataset, MRM and OLS, but not EPM, reproduced the observed mean utility (0.731). MRM, OLS and EPM under-estimated the standard deviation by 0.3, 26.6 and 1.7%, respectively. MRM had the lowest mean absolute error (0.143) and highest intraclass correlation coefficient (0.723) with the observed utility values, whereas OLS had the lowest mean squared error (0.038) and highest R-squared (0.542). Regressing the MRM- and OLS-mapped utility values upon body mass index and log-viral load gave covariate associations comparable to those estimated from the observed utility data (all P > 0.10). EPM did not achieve this property. Findings from the validation data were similar.ConclusionsFunctions are available for mapping the MOS-HIV to the EQ-5D-3 L utility values. MRM and OLS were comparable in terms of agreement with the observed utility values at the individual level. MRM had better performance at the group level in terms of describing the utility distribution.Trial registrationNCT00988039. Registered 30 September 2009.

Comparison of Zidovudine and Tenofovir Based Regimens With Regard to Health-Related Quality of Life and Prevalence of Symptoms in HIV Patients in a Kenyan Referral Hospital

Aim: Zidovudine and tenofovir form the backbone of antiretroviral therapy in Kenya. However, their side-effects may affect the quality of life (QoL) of patients. The aim was to compare the health-related quality of life (HRQoL) of adult patients on tenofovir versus zidovudine based regimens in a referral hospital in Kenya to provide future guidance.Methods: A comparative cross sectional study among 501 adult out-patients on either tenofovir or zidovudine was undertaken in Kenyatta National Hospital between 2015 and 2016. The Medical Outcome Study HIV Health Survey (MOS-HIV) was administered along with other key aspects of treatment. Linear regression analysis was performed to identify determinants of HRQoL.Results: Patients on zidovudine had a higher Physical Health Summary Score (PHSS) and Mental Health Summary Score (MHSS) compared to those on tenofovir. The presence of any symptom of the disease and a stated inability to cope were negatively associated with PHSS, whilst having a regular source of income improved PHSS. Being on tenofovir, symptom of illness [β = -1.24; 95% CI (-2.253, -0.226)], absence of pain [β=0.413; 95% CI (0.152, 0.674)] and patient stated inability to cope with HIV [β = -1.029; 95% CI (-1.441, -0.617)] affected the MHSS. Patients on tenofovir and second line regimens had more signs and symptoms of illness.Conclusion: Participants on zidovudine based regimens showed a better performance across all aspects of HRQoL. These are considerations for the future.

Reliability and validity of the Chinese version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) in people living with HIV/AIDS (PLWHA) in China.

ObjectiveThe aim of the study was to assess the psychometric properties of the Medical Outcomes Study HIV Health Survey (MOS-HIV) in people living with HIV/AIDS (PLWHA) in mainland China.MethodsA cross-sectional survey was conducted in 646 PLWHA between May 2015 and March 2016 in Dalian, Ningbo, and Zhengzhou City, China. The MOS-HIV includes 35 items and measures 10 scales. These ten scales can be effectively calculated under two summary scale scores, the physical health score (PHS) and the mental health score (MHS), with the physical functioning, pain and role functioning scales contributing to the PHS, the mental health, health distress, quality of life and cognitive function scales contributing to the MHS, and the energy/fatigue, general health and social functioning contributing to both factors. Reliability was measured in terms of internal consistency and test-retest reliability. The internal consistency of the questionnaire was analyzed using Cronbach’s α coefficient, and test-retest reliability was assessed using Pearson’s correlation coefficient. Validity was analyzed via construct validity, convergent and discriminant validity, and known group validity. Confirmatory factor analyses (CFA) were used to test construct validity. A multiple-group CFA analysis was conducted to investigate whether the MOS-HIV measured the same constructs across gender groups.ResultsThe MOS-HIV questionnaire was reliable and valid. Reliability of the PHS and MHS scales was 0.87 and 0.89, respectively. While the Cronbach’s α coefficients for each of the dimensions were > 0.70. According to the results of the confirmatory factor analysis (CFA), the hypothesized model was acceptable. The instrument showed factorial invariance across gender groups. All correlation coefficients were greater than 0.40, with a range of 0.60–0.94. The correlation coefficients observed between items and other dimensions were lower than the coefficients for the correlations between items and hypothesized dimensions for all scales, suggesting good convergent and discriminant validity. Patients with CD4 counts >500 cells/mm3 demonstrated better QOL than those with lower CD4 counts on six scales and the PHS (p<0.05) and symptomatic respondents had significantly lower scores than asymptomatic respondents on all the scales except health transition scales (p<0.05) suggesting good known group validity.ConclusionsThe results of this study provide evidence that the MOS-HIV may be an acceptable, valid and reliable instrument for evaluating QOL of PLWHA in mainland China.

Reliability and validity of Persian version of Medical Outcome Study-HIV health survey in Iranian people living with HIV

ObjectiveTo evaluate the psychometric properties of the Persian version of the medical outcome study human immunodeficiency virus (MOS-HIV) health survey among people living with HIV or acquired immune deficiency syndrome (HIV/AIDS) in Iran is our main goal in this study. MethodsThe MOS-HIV questionnaire was translated into Persian using backward translation and the Persian version was filled by 100 HIV infected patients. Reliability of the questionnaire was estimated using Cronbach's alpha coefficient for the total questionnaire and for each dimension. Convergent, discriminant and construct validity were performed. Comparisons were performed between the subscales of the questionnaire in Iran and some other countries with t-test. ResultsThe overall Cronbach's alpha in this study was 0.90 and the range of this coefficient was from 0.71 to 0.86 across the subscales with two exceptions, general health perception and role functioning, which were at 0.65 and 0.61. Convergent and discriminant validity were excellent in all domains. The two factor confirmatory factor analysis showed a good fit based on standardized estimates of factor loading, incremental and absolute fit indices. ConclusionThe Persian version of the MOS-HIV had good reliability and validity in measuring health related quality of life in people living with HIV in Iran. Furthermore, quality of life for HIV infected patients was very low in comparing with the people in some other countries.

Mapping MOS-HIV to HUI3 and EQ-5D-3L in Patients With HIV.

Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV) is frequently used in HIV clinical trials; however, scores generated from the MOS-HIV are not suited for cost-effectiveness analyses as they do not assign utility values to health states. Our objective was to estimate and externally validate several mapping algorithms to predict Health Utilities Index Mark 3 (HUI3) and EQ-5D-3L utility values from the MOS-HIV. Methods: We developed and validated mapping algorithms using data from two HIV clinical trials. Data from the first trial (n = 367) formed the estimation data set for the HUI3 (4,610 observations) and EQ-5D-3L (4,662 observations) mapping algorithms; data from the second trial (n = 168) formed the HUI3 (1,135 observations) and EQ-5D-3L (1,152 observations) external validation data set. We compared ordinary least squares (OLS) models of increasing complexity with the more flexible two-part, beta regression, and finite mixture models. We assessed model performance using mean absolute error (MAE) and mean squared error (MSE). Results: The OLS model that used MOS-HIV dimension scores along with squared terms gave the best HUI3 predictions (mean observed 0.84; mean predicted 0.80; MAE 0.0961); the finite mixture model gave the best EQ-5D-3L predictions (mean observed 0.90; mean predicted 0.88; MAE 0.0567). All models produced higher prediction errors at the lower end of the HUI3 and EQ-5D-3L score ranges (<0.40). Conclusions: The proposed mapping algorithms can be used to predict HUI3 and EQ-5D-3L utility values from the MOS-HIV, although greater error may pose a problem in samples where a substantial proportion of patients are in poor health. These algorithms may be useful for estimating utility values from the MOS-HIV for cost-effectiveness studies when HUI3 or EQ-5D-3L data are not available.

Short Communication: The Impact of Switching from Atripla to Darunavir/Ritonavir Monotherapy on Neurocognition, Quality of Life, and Sleep: Results from a Randomized Controlled Study.

We investigated whether a treatment switch from Atripla® (tenofovir, emtricitabine, and efavirenz) to DRV/r monotherapy may improve neuropsychological performance, health-related quality of life, and sleep function. Virologically suppressed subjects and asymptomatic on Atripla for ≥6 months were randomized 1:1 to continue Atripla or switch to boosted darunavir (DRV/r) 800/100 mg once daily for 48 weeks. Neurocognitive tests, the International HIV Dementia Scale (IHDS), Medical Outcomes Study HIV Health Survey (MOS-HIV), EQ-5D-3L, and the Hospital Anxiety and Depression Scale (HADS) were completed at baseline and at week 48. Sleep function was evaluated at week 48. Twenty-six patients on DRV/r and 31 on Atripla completed the 48-week study. No significant difference in the change in scores from week 0 to week 48 between the two arms was observed in neurocognitive outcomes, IHDS, health outcomes (EQ-5D-3L and QOL), and HADS score. By contrast, the HADS score and sleep quality were both significantly better in the DRV/r arm. In conclusion, switching to DRV/r monotherapy did not affect neurocognitive function or quality of life but improved anxiety, and sleep quality was significantly better than in continued Atripla.

Social Capital and Quality of Life Among People Living With HIV/AIDS in Southeast China.

A cross-sectional study was conducted with 261 people living with HIV (PLWH) in Southeast China. A social capital questionnaire was used to measure social capital dimensions (trust, social connection, and social participation). A Chinese version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) was used to assess Quality of Life (QoL); Physical Health Summary Scores (PHS) and Mental Health Summary Scores (MHS) were calculated. Multiple regression assessed whether social capital and its dimensions were associated with PHS and MHS. After controlling for sociodemographics and HIV-related factors, lower PHS scores were found among participants with low overall social capital (P < .01) and low trust (P < .001). Lower MHS scores were found among participants with low overall social capital (P < .001), low trust (P < .001) and low social connection (P < .01). Our findings identify potential intervention targets to improve QoL among PLWH in Southeast China, including the promotion of social capital.

Related Factors Associated with Quality of life Assessed Using a Chinese Version of the MOS-HIV Health Survey in People with HIV/AIDS in China

Objectives: To evaluate the Chinese version of the 35-item Medical Outcomes Study HIV Health Survey (MOSHIV) in people living with HIV/AIDS (PLWHA) in mainland China and to study its relationship with socio-demographic characteristics and disease-related factors. Methods: 222 PLWHA recruited from outpatient clinics in Hunan province completed measures of quality of life and related factors. Results: Internal consistency of the overall score on the Chinese version of the MOS-HIV was high (α=0.95); internal consistency of the eight subscales was also high (α=0.79-0.91). Factor analysis of the MOS-HIV revealed a one-factor solution, accounting for 54.97% of the total variance. At linear regression analysis, all domains of quality of life (QOL) and Total Health Summary Score (THS) were correlated with KPS scores (r2 range 0.06-0.32), but only physical function and social function scores showed a significant correlation with CD4 cell count; the MOS-HIV however, did not distinguish between HIV disease stage. Using logistic regression analysis, KPS scores, as well as the variables of marriage, employment status, occupation before diagnosis, somebody to talk to, transmission modality of injection drug use and sex partner HIV positive showed statistically associated with a lower quality of life. Conclusions: This study presents the first evidence for the reliability and validity of the Chinese version of MOSHIV among PLWHA in mainland China. Lower scores of the MOS-HIV indicate that the QOL of the PLWHA in our study sample have been poor. This was irrespective of the stage of their disease and CD4 cell counts. This questionnaire has the potential to inform interventions aimed at enhancing and maintaining QOL of PLWHA.