Health-related quality of life, viral load suppression and survival among older persons living with hiv in Uganda

Abstract

The population of older persons living with HIV (OPLHIV, aged ≥50 years) is steadily increasing, presenting an emerging public health challenge in low- and middle-income countries. Advances in ART have improved viral suppression, survival, and health-related quality of life (HRQoL), yet evidence on these outcomes among older adults in Uganda remains limited. This study assessed HRQoL, viral suppression, and survival among OPLHIV in Uganda. A cross-sectional survey involving 439 OPLHIV was conducted using a semi-structured questionnaire to collect socio-demographic, lifestyle, clinical, and non-clinical data. HRQoL was measured across seven domains and analyzed using ordinal regression. Viral load suppression (<200 copies/mL) was examined using binary logistic regression. Additionally, a retrospective cohort analysis of 30,758 electronic medical records from TASO Centres of Excellence (1987–2023) assessed survival using Cox proportional hazards regression. The mean age of participants was 58.0 years (SD ±7.4), and 42% reported good HRQoL. Multiple socio-demographic and clinical characteristics—such as age ≥60 years, education level, marital status, WHO clinical stage II, unemployment, TB history, multiple sexual partners, and viral load >200 copies/mL—were significantly associated with HRQoL domains (p<0.05). Viral suppression was achieved by 88% of respondents. Factors associated with viral suppression included unemployment (aOR=4.1; 95% CI 1.73–9.84), good adherence (aOR=16.6; 95% CI 1.91–145.60), spousal/family support (aOR=2.6; 95% CI 0.98–7.19), receiving food supplies (aOR=6.0; 95% CI 1.17–31.58), absence of recent opportunistic infections (aOR=0.28; 95% CI 0.07–1.09), and WHO stage II (aOR=0.14; 95% CI 0.04–0.53). Survival analysis showed that being female (aHR=1.19; 95% CI 1.15–1.22), married (aHR=0.99; 95% CI 0.77–0.80), separated/divorced (aHR=0.85; 95% CI 0.80–0.90), WHO stage II (aHR=1.66; 95% CI 1.62–1.73), viral load >200 copies/mL (aHR=1.49; 95% CI 1.44–1.54), and fair adherence (aHR=0.94; 95% CI 0.74–1.19) were significantly associated with mortality risk. Older persons living with HIV in Uganda face important challenges in health-related quality of life, viral suppression, and survival. While viral suppression was high, fewer than half achieved good overall HRQoL, with outcomes strongly influenced by age, education, marital and employment status, WHO clinical stage, viral load, and adherence. Survival was significantly associated with sex, marital status, disease stage, viral non-suppression, and adherence. These findings highlight the need for comprehensive, age-responsive HIV care that combines routine clinical monitoring with psychosocial and socioeconomic support to improve quality of life, sustain viral suppression, and enhance survival among older adults living with HIV.