# Quality of life and retention in care among people living with HIV initiated on ART in the era of “Universal Test and Treat” policy at a large HIV Clinic in South Western Uganda

## TL;DR

This study found that people with HIV who start ART at higher CD4 counts in Uganda have worse mental health quality of life but similar physical health and retention in care compared to those starting at lower CD4 counts.

## Contribution

The study reveals a novel mental health-related QoL disparity in early ART initiation under the UTT policy.

## Key findings

- Higher baseline CD4 count was associated with lower mental health-related QoL.
- Physical health-related QoL and retention in care were similar across CD4 groups.
- PLWH with higher CD4 at ART initiation may need mental health support.

## Abstract

Anti-retroviral therapy (ART) improves the quality of life (QoL) among people living with human immunodeficiency virus (PLWH). Most studies documenting the gains in QoL have been conducted among persons starting treatment at advanced HIV disease. In the era of Universal Test and Treat (UTT) policy, most PLWH start ART early with high CD4 counts. Therefore, we investigated the association between baseline CD4 count with QoL and retention among PLWH during UTT in southwestern Uganda.

Between June 11, 2019, and June 10, 2020, we reviewed medical records for PLWH initiated on ART between April 2017 and September 2018 and interviewed them to collect QoL data. The primary exposure was CD4 count at ART initiation categorized as <500 cells/µl (low) versus ≥500 cells/µl (high). Physical and mental health-related QoL were the primary outcomes. Retention was the secondary outcome. Binary logistic regression was used to assess the association between the exposure and the primary outcome, while the Cox Proportional Hazard regression model was used for the secondary outcome.

Of 300 participants, 59.7% initiated ART at a low baseline CD4 count. ART initiation at a higher baseline CD4 count, compared to a lower baseline CD4 count, was associated with a lower mental health-related QoL (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.32–0.97) but similar physical health-related QoL (aOR 0.54, 95% CI 0.10–2.78) and retention (adjusted hazard ratio [aHR] 0.30, 95% CI 0.08–1.14).

In this cohort of PLWH on ART, those who initiated the treatment at a higher baseline CD4 were less likely to have good mental health-related QoL functioning compared to those initiating at lower CD4 counts. However, the two groups were comparable in physical health-related QoL and retention in care. PLWH initiating ART at a higher baseline CD4 may require mental health-related support as part of treatment.