The Role of Personality, Social Economic and Prevention Strategy Effects in Health-Related Quality of Life Among People Living with HIV/AIDS
Authors: wang xiaowen , luo hongbing , yao enlong , tang renhai , dong wenbin , liu fuyong , liang jun , li huilan , xiao minyang , zhang zuyang , niu jin , song lijun , fu liru , li xuehua , qian shicong , guo qing , song zhizhong 
Published: May 2021

Abstract
Background HIV/AIDS has transformed into a chronic controllable but not yet curable disease as other chronic diseases. The first-three 90% was an epidemic control, the addition of so-called fourth 90% that included the improved HRQoL for PLWHIV required solutions beyond ART and viral load suppression. To explore the effects of specific factors on HRQoL could help to appreciate the quality of health care they received and to support the policy making during the whole prevention process. Our study will explore the role of personality, social economic and prevention strategy effects in health-related quality of life among people living with HIV/AIDS.MethodsA cross-sectional study was conducted among PLWHIV aged more than 16 years old in the 10 municipals in Yunnan province, China. Individual-level HRQoL data were measured by SF-12 and EQ-5D-5L. We assembled municipal-level data about social economic from the Yunnan Statistical Yearbook in 2020 carried out by Statistical Bureau of Yunnan Province. Another municipal-level data about prevention strategy was from the evaluation system for the quality of strategy implemented. We used the principal component analysis to build the social economic and strategy effect on each area respectively and used multi-level model (MLM) to explore the personality, social economic and strategy effects in health-related quality of life among PLWHIV. ResultsAccording to the principal component analysis, all the ten areas were classified into ten models by the social-economic level and four kinds by the prevention strategy practice level. About area effect, the significant difference of global HRQoL measured by EQ-5D-5L index score was found between strategy 1 and strategy 2 (Z=2.14, P<0.05). The significant difference of mental component of HRQoL measured by PCS-12 was found between strategy 1 and strategy 3 (Z=-3.23, P<0.001). About individual effect, the significant difference of global HRQoL measured by EQ-5D-5L and also demonstrated in the variables of all have known HIV status and not clear whether to know compared to no one know the infectious status(Z=-4.89, P<0.001,Z=-2.65, P<0.01). The significant difference was found in the physical component of HRQoL measured by PCS-12 between partial have known HIV status, all have known HIV status and not clear whether to know compared to no one know the infectious status(Z=-2.29, P<0.01,Z=-3.49, P<0.001, Z=-2.58, P<0.05). We also found the significant difference between the all have known HIV status and no one know the infectious status (Z=-3.160, P<0.01). The significant difference also existed in the variables of anxiety score and depression score (Z=-7.84, P<0.001, Z=-2.58, P<0.05). These significant differences were also found in the physical component and mental component of the HRQoL measured by PCS-12 and MCS-12 (Z=-7.07, P<0.001,Z=-2.98, P<0.05; Z=-16.81, P<0.001,Z=-11.25, P<0.05). Otherwise the social support score contributed positively to predict the PCS-12 and the MCS-12 (Z=3.34, P<0.001,Z=8.14, P<0.001). The interaction effect demonstrated between the individual-level variable of anxiety and the area-level variable of strategy practice whatever in global HRQoL or PCS-12 and MCS-12(Z=3.3.32, P<0.001; Z=3.28, P<0.001; Z=3.27, P<0.001). It demonstrated that the effects of individual-level predictors of others know HIV status, transmission model, recent CD4 counts, social support, anxiety and depression on HRQoL were different among different areas.DiscussionOur study identified the possible strategy determinant of individual HRQoL of PLWHIV and we also found the area effect on the HRQoL. In our study, we considered the social-economic model to explain the area effect. The area-level predictors explained a proportion of the between-area variation of the HRQoL scores, whatever the physical component and the mental component. Our study demonstrated the impact of the stigma, social support, anxiety, depression and social economic status on the HRQoL in the individual-level. This study also showed the evidence of initial casual heterogeneity on the effects of HRQoL. The impact of the individual-level factors on a respondent’s HRQoL may be modified by the area-level characteristics to some extents. Finally our study demonstrated a model combined of area-level social-economic and prevention strategy practice and individual effect on the HRQoL, which could be a valuable resource for evaluating the overall health of the areas and help improve local decision making.