Development and validation of PozQoL: a scale to assess quality of life of PLHIV

BMC Public Health, 2018 18:527, https://doi.org/10.1186/s12889-018-5433-6

Abstract

Background

Advances in medical treatment for HIV are driving major changes in HIV policy and practice, including the encouragement of intake and adherence to HIV antiretroviral treatment (ART) by people living with HIV (PLHIV) for both personal and public health benefits. However, there is increasing recognition that achieving these goals will require a concurrent focus on the broader psychological and social wellbeing of PLHIV. Increasingly calls are being been made to incorporate a stronger focus on quality of life (QoL) of PLHIV into HIV prevention policy.

In order to achieve this goal, HIV community, support and healthcare services need a valid, short and practical way to evaluate QoL of PLHIV accessing their programs. Current QoL measures are either long, complex, restricted in their use, or expensive. To address these shortcomings, the PozQoL study aimed to develop, test and validate a short and freely available scale assessing QoL among PLHIV.

Methods

Drawing on a literature review, the prioritisation of domains and development of the initial pool of items was conducted in consultation with PLHIV community organisations in Australia. The items covered health concerns, psychological, social, and functional wellbeing. Testing involved a baseline and a follow-up survey of 465 adult Australians living with HIV. Participants were recruited through social media and various community organizations nationwide. The survey included the pilot PozQoL scale and other validated measures of health and wellbeing.

Results

Guided by an Exploratory Factor Analysis and conceptual considerations, a 13-item scale was developed. The PozQoL scale demonstrated high levels of fit in a Confirmatory Factor Analysis, very good internal consistency, test-retest reliability, and concurrent validity with other measures that approximated different aspects of QoL.

Conclusion

The PozQoL scale has been tested in a diverse sample of adult PLHIV living in Australia, demonstrating very good reliability and validity. The insights from PLHIV and other stakeholders supported the balancing of statistical rigour and conceptual accuracy. The scale is now ready to be implemented and field-tested across a range of community, support and healthcare programs for PLHIV. This will make a significant contribution to the evaluation and enhancement of programs for PLHIV.

Changing attitudes to and engagement with biomedical HIV prevention by gay and bisexual men

Centre for Social Research in Health, UNSW, 2017

The latest findings from the PrEPARE Project have now been published. The  PrEPARE Project is a longitudinal study of Australian gay and bisexual men’s attitudes to biomedical HIV prevention, particularly PrEP and treatment as prevention (TasP).

With the unprecedented scaling up of PrEP access in many states over the last few years, we have observed a surge in PrEP use, and increasing levels of support for PrEP in the community. Belief in the effectiveness of TasP has also increased, although many men remain skeptical about it. The report includes national summary data. it is hoped that the report will be useful in assessing community readiness for biomedical prevention and potential issues in implementation.

Key findings:

» Nearly a quarter of gay and bisexual men (24%) reported they had ever used PrEP. This was a large increase from the 2015 survey (3%).

» Most current PrEP users were accessing it from a research study or demonstration project (82%) and the majority (74%) reported increased sexual confidence and reduced concern about acquiring HIV as a result of PrEP.

» Nearly all participants (95%) had heard of PrEP and two-thirds of participants (66%) knew someone who had taken PrEP; substantial increases from the 2015 survey. Knowledge of PrEP also improved between 2015 and 2017.

» Willingness to use PrEP has increased among HIV-negative and untested men (to 37% in 2017) and concern about using it has fallen (to 36%).

» Support for gay and bisexual men using PrEP increased to 75% in 2017, as did willingness to have sex with someone using PrEP (47%).

» Belief that HIV treatment prevents transmission increased to 20% in 2017; the increase was primarily among HIV-negative and untested men.

» Agreement that early HIV treatment is necessary increased to 79% in 2017; this increase was concentrated among HIV-positive men