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      Factors influencing the quality of life in persons living with human immunodeficiency virus infection in Almaty, Kazakhstan

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          Abstract

          The study purpose was to determine the factors associated with health-related quality of life (HRQoL) among people living with HIV (PLHIV) in Kazakhstan. A convenience sample of 531 adult PLHIV registered at the Almaty City AIDS Center was used for this cross-sectional study. HRQoL data were collected with the World Health Organization’s Quality of Life HIV brief questionnaire, depression – with Patient Health Questionnaire-9, and clinical data were retrieved from medical records. Multivariate logistic and Tobit censored regressions were used to examine the relationship of socio-demographic, behavioral, and clinical factors with HRQoL and the six specific HRQoL domains: 35.8% of participants did not report good HRQoL. The following variables were identified as independent predictors of poor HRQoL: probable depression (adjusted odds ratio [AOR] 13.42, 95% confidence interval [CI]: 4.56–39.52); history of injecting drug use (AOR 2.10, 95% CI: 1.40–3.14); CD4+ T-cell count <200 cells/mm 3 (AOR 2.17, 95% CI: 1.30–3.62); previously married status (AOR 2.23, 95% CI: 1.16–4.28); and co-infection with tuberculosis, syphilis, toxoplasmosis, Chlamydia, herpes simplex, or cytomegalovirus (AOR 1.59, 95% CI: 1.06–2.39). HRQoL of PLHIV in Almaty was independently influenced by several factors. An interdisciplinary approach is needed in planning healthcare and social services addressing improvement of HRQoL among PLHIV.

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          Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration.

          This article reviews the evidence on the adverse health consequences of low socioeconomic status, homelessness, and incarceration among drug users. Social and economic factors shape risk behavior and the health of drug users. They affect health indirectly by shaping individual drug-use behavior; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication. Minority groups experience a disproportionately high level of the social factors that adversely affect health, factors that contribute to disparities in health among drug users. Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use.
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            What determines health-related quality of life among people living with HIV: an updated review of the literature

            Background As infection with the Human Immunodeficiency Virus (HIV) has evolved to a chronic disease, perceived health-related quality of life (HRQoL) is becoming a prominent and important patient-reported outcome measure in HIV care. Literature discusses different factors influencing HRQoL in this population, however, currently no consensus exists about the main determinants. In this review a clear, up-to-date overview of the determinants influencing HRQOL among people living with HIV is provided. Methods All studies published before July 2013 that identified determinants of HRQoL among people living with HIV in high-income countries, were considered in this narrative review. PubMed, Web of Science and The Cochrane Library were consulted using the keywords ‘determinants’, ‘quality of life’, ‘HIV’ and ‘AIDS’. To be included, studies should have reported overall health and/or physical/mental health scores on a validated instrument and performed multivariable regression analyses to identify determinants that independently influence perceived HRQoL. Results In total, 49 studies were included for further analysis and they used a variety of HRQoL instruments: Medical Outcomes Study Short Form-36 or variants, Medical Outcomes Study-HIV, HIV Cost and Services Utilization Study measure, Multidimensional Quality of Life Questionnaire, HIV targeted quality of life instrument, Functional Assessment of Human Immunodeficiency Virus Infection, HIV Overview of Problems Evaluation System, EuroQol, Fanning Quality of Life scale, Health Index and PROQOL-HIV. In this review, the discussed determinants were thematically divided into socio-demographic, clinical, psychological and behavioural factors. Employment, immunological status, presence of symptoms, depression, social support and adherence to antiretroviral therapy were most frequently and consistently reported to be associated with HRQoL among people living with HIV. Conclusions HRQoL among people living with HIV is influenced by several determinants. These determinants independently, but simultaneously impact perceived HRQoL. Most HRQoL instruments do not capture all key determinants. We recommend that the choice for an instrument should depend on the purpose of the HRQoL assessment. Electronic supplementary material The online version of this article (doi:10.1186/2049-3258-72-40) contains supplementary material, which is available to authorized users.
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              Employment status is associated with both physical and mental health quality of life in people living with HIV.

              To evaluate the relationship between employment status and health-related quality of life (HRQOL) in HIV/AIDS. A total of 361 participants provided baseline data in the context of an ongoing cohort study examining the natural history of neurobehavioral functioning and its effects on HRQOL. We administered tests and collected laboratory data to determine demographic status, HIV disease markers, psychosocial symptom burden, neurocognitive function and HRQOL (MOS-HIV). We performed regression analyses to evaluate the contribution of employment status to the physical and mental health components of quality of life (QOL). Multivariate analyses showed that employment status was strongly related to better physical and mental health QOL after controlling for potential confounders. We found, however, that employment status had a greater impact on physical health than mental health QOL [physical health (β = 6.8, 95% CI 4.6 to 9.1) and mental health QOL (β = 3.3, 95% CI 0.93 to 5.7)]. The effect of employment for physical health QOL was stronger than that observed for ethnicity, social support, or having an AIDS diagnosis and was comparable to that observed with having many HIV-related symptoms. This cross-sectional study suggests that there may be physical and mental health benefits associated with obtaining or keeping employment, or more likely that both selection and causation mechanisms comprise an interactional and reinforcing process.
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                Author and article information

                Journal
                Int J STD AIDS
                Int J STD AIDS
                STD
                spstd
                International Journal of STD & AIDS
                SAGE Publications (Sage UK: London, England )
                0956-4624
                1758-1052
                15 November 2019
                November 2019
                : 30
                : 13
                : 1318-1328
                Affiliations
                [1 ]Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
                [2 ]Division of HIV-Infection and Infection Control, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
                [3 ]Department of Epidemiology and Biostatistics, University at Albany, SUNY, Albany, NY, USA
                [4 ]Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
                Author notes
                [*]

                These authors have contributed equally to the work.

                [*]Bakhytkul T Zhakipbayeva, 94 Tole bi Street, Almaty 050012, Kazakhstan. Email: bzhakip@ 123456mail.ru
                Author information
                https://orcid.org/0000-0002-7933-4841
                https://orcid.org/0000-0002-6511-6560
                Article
                10.1177_0956462419876484
                10.1177/0956462419876484
                7433689
                31726932
                70b9258f-fb0e-4280-a895-1d639f27882f
                © The Author(s) 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 10 February 2019
                : 13 August 2019
                Funding
                Funded by: New York State International Training and Research Program;
                Categories
                Original Research Articles

                plhiv, health related quality of life, kazakhstan hiv,asia,epidemiology,aids

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