Achieve better HIV outcomes using quality of life measures

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Why use quality of life measures

Quality of life measures (such as PozQoL) can help service providers to more accurately and holistically understand the experiences and needs of people living with HIV.

Focussing beyond clinical markers provides deeper context and can reveal important insights about a patient or client. For example, it may reveal barriers that are preventing them from meeting desired clinical outcomes.

Service providers can use these insights to make better decisions and improve care plans that will help them meet both clinical- and non-clinical goals.

HIV outcomes

Modern HIV treatment (ART) helps people living with HIV to achieve better health outcomes. The benefits of ART are the strongest if people can achieve an undetectable viral load (UVL).

This is the goal of UNAIDS’ ‘Fast Track Targets to end the AIDS epidemic by 2030’:

  • 95% of all people living with HIV know their HIV status
  • 95% of all people with known HIV infection will receive sustained ART
  • 95% of all people receiving ART will have viral suppression

However, we must make sure that health care for people living with HIV does not focus just on viral load. Viral suppression is important, of course, but it is not the only measure of health.

Despite the progress in HIV treatments and access to treatment, people living with HIV continue to report high rates of:

  • Sadness
  • Fear
  • Despair
  • Pain
  • Depression
  • Disappointment
  • Financial stress
  • Isolation
  • Social stigma
  • Self-stigma
  • Stigma from healthcare workers

These experiences are complex and often interrelated in vicious cycles. For example, stigma can increase depression, making it harder for people to stick to their treatment plans. This can lead to increased viral load, which impacts on physical health. Poor physical health can, in turn, lead back to increased stigma and amplified feelings of depression.

‘Beyond Viral Suppression’ — A global movement to shift focus towards quality of life

It is clear that achieving clinical HIV outcomes is not enough on its own to ensure good overall health for people living with HIV. It is also clear that improving quality of life for people living with HIV can actually help them achieve better HIV outcomes.

In the last half of the 2010s, a global movement started advocating to look beyond viral suppression towards a ‘new quality of life frontier‘.

Firstly, the global number of people living with HIV with access to testing and treatment is increasing. As a result, the number of people living with HIV who are on treatment is also increasing. This means we can expect that more people living with HIV will live longer lives. We must make sure that, as well as being longer, their lives are also healthier, happier, and more fulfilling.

Secondly, we must make sure that the emphasis on viral load does not create a new way to stigmatise and discriminate against people living with HIV. This is especially important because not all people living with HIV can achieve viral suppression.