Health-related quality of life of adults living with HIV in England & Wales: a utility analysis of EQ-5D-5L compared to the general population

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compared to the general population Meaghan Kall Public

1 Health-related quality of life of adults living with HIV in England & Wales: a utility analysis of EQ-5D-5L compared to the general population Meaghan Kall Public Health England on behalf of the Positive Voices study group

2 Background High-quality provision of HIV specialist services in the UK with excellent HIV-related clinical outcomes UNAIDS goals almost achieved HIV is a social and lifelong condition the effects on quality of life is not clear There is a need to monitor outcomes beyond clinical endpoints (e.g. viral suppression) 2

3 Health-related QoL as an outcome Quality of life across the life course Lazarus et al BMC Medicine Positive Voices: The National Survey of People Living with HIV

4 ASTRA study (2011/12) UK survey of 3,200 HIV patients attending 8 clinical centres EuroQol (EQ-5D-3L) Poor hr-qol associated with: Longer time since diagnosis Non-white ethnicity Female No children Lower education Smoking Miners et al Lancet HIV Positive Voices: The National Survey of People Living with HIV

5 Presentation objectives 1. Present national estimates of health-related quality of life among people with HIV in England and Wales 2. Compare EQ-5D-5L utility scores to the general population and identify HIV sub-populations at greatest risk of poor HRQoL 5

6 Methods EuroQol (EQ-5D-5L) Internationally standardised instrument to measure 5 domains of health-related quality of life 5-item Likert scale: None/ Slight/ Moderate/ Severe/ Extreme Unweighted utility values were calculated and compared to recently published EQ 5D 5L values for England 1. Values range from 0 to 1, where 1 represents the best possible health. 1 Devlin, N. J., et al. (2017) Valuing health related quality of life: An EQ 5D 5L value set for England. Health Economics. 2018; 27:

7 Results: Distributions of EQ-5D-5L in PLHIV Mobility 28% have some problems Self-care Usual activities Pain & discomfort Anxiety & depression 13% have some problems 27% have some problems 46% have some problems 50% have some problems 0% 20% 40% 60% 80% 100% No problems Slight Moderate Severe/Extreme 7

8 Results: Distributions of EQ-5D-5L in PLHIV Mobility Self-care Usual activities Pain & discomfort Anxiety & depression 0% 20% 40% 60% 80% 100% No problems Slight Moderate Severe/Extreme 8

9 Mobility. Self-care. Usual activities. Pain & discomfort. Anxiety & depression. Results: Distributions of EQ-5D-5L in PLHIV vs UK gen pop PLHIV 28% UK gen pop 26% 13% 9.2% 27% 24% 46% 41% 50% 24% 0% 20% 40% 60% 80% 100% No problems Slight Moderate Severe/Extreme 9

10 General UK Population Positive Voices Men Women Trans/Non-binary On ARV Not on ARV Sex between Men Injecting Drugs Heterosexual sex Blood/blood products Mother to child EQ-5D-5L utility values in general population vs HIV populations 1,0 0,8 0,6 0,86 0,60 0,60 0,62 0,50 0,60 0,68 0,59 0,63 0,48 0,83 0,4 0,31 0,2 0,0 Gender Treatment Status Exposure group 10

11 Limitations Self-reported data... TODAY Unadjusted comparisons demographic differences likely to be important Usefulness of a generic instrument for HIV does not measure things like stigma/discrimination, side effects of medication Quality of life is complex and unique to the individual findings interpreted as a broad-brush comparison to the overall health of the general population 11

12 Conclusions Despite being a young population, with near-normal life expectancy and excellent HIV treatment outcomes, quality of life for people with HIV in England and Wales remains significantly worse than the general UK population HRQoL particularly poor for trans people with HIV and people who acquired HIV through injecting drugs or blood/blood products Good mental health and pain relief remain important factors in ensuring a good quality of life for people living with HIV Health inequalities remain, and a patient-centred approach should be adopted to identify areas for intervention (e.g. improved mental health support) to improve the quality of life of people with HIV 12

13 Good HIV care and support DOES make a difference... 13

Data on trans people and HIV in the UK

Data on trans people and HIV in the UK Peter Kirwan National Infection Service, Public Health England Email: peter.kirwan@phe.gov.uk Who are Public Health England Public Health England was established