The current study is the first in Bukavu to compare the HRQoL of PLHIV who visit ART clinics versus PLHIV who visit THs' offices. The number of HIV cases has increased in 2022,[3] so it is relevant to understand what influences QoL to be able to tailor better health and social care services and improve the QoL of PLHIV. Because current HIV/AIDS treatment strategies allow patients to live longer, QoL has emerged as a key indicator of health outcomes, and improving the QoL is a key objective.[7]
The present study showed that PLHIV attending ART clinics had a higher overall QoL than PLHIV visiting THs’ offices. The same was true for all domains of QoL, with PLHIV attending ART clinics having a better QoL compared with PLHIV visiting THs. This high QoL of PLHIV attending ART clinics compared with PLHIV visiting THs' offices could be explained by the fact that the majority (83.9%) of PLHIV attending clinics were well adherent to ART. Numerous studies have demonstrated a strong correlation between ART adherence and PLHIV QoL. Patients with low/moderate ART adherence were 60% less likely than patients with high adherence to have a high overall QoL score, according to a study done in Ethiopia (2020).[7] Similar findings were also reported by other studies conducted in Tunisia[17] and Ethiopia,[18] which suggest that adherence to antiretroviral treatment is associated with a higher QoL for PLHIV. Following a regimen lowers viral load and enhances patients' clinical status, both of which have an impact on QoL.[19–21]
In the present study, multiple linear regression analysis revealed that only the place of residence of PLHIV visiting THs was a significant predictor of their HRQoL. These results were different from those obtained in Brazilian and Italian studies.[9, 22] Higher education can help people deal with HIV more effectively, increase patient awareness of illness, and ultimately improve HRQoL.[23, 24] Age causes a decline in HRQoL, while these findings are different from those from Brazil and the United States.[9, 25]
The issue of therapeutic non-adherence is far more serious, especially for individuals who are HIV/AIDS positive. In addition to having an impact on the non-adherent person, the repercussions of poor patient adherence can also have a broad societal impact. Adherence is necessary for viral suppression, decreased infection, minimized opportunistic infections, and decreased resistance to antiretroviral medications.[26–28] The results of the present study showed a therapeutic non-adherence rate of 16.1% among PLHIV attending ART clinics. This low rate of non-adherence could be explained by the therapeutic education and awareness that PLHIV received in ART clinics about the advantages of adherence and the disadvantages of non-adherence. The rate of non-adherence found in this study was lower than the one found in studies carried out in Gabon, Ethiopia and Cameroon,[29–31] and higher than the one reported by in Madagascar (2023).[32] The current findings also differed from those observed in certain towns in the DRC.[33, 34] This variability in non-adherence rates could be explained by differences in the populations studied on the one hand, and by the method used to assess compliance, on the other.
Regarding the relationship between adherence to ART by PLHIV and their QoL, the present study showed that good adherence to ART increased the HRQoL score. This may be explained by the fact that adherence to treatment is the most important factor in determining the success of ART and long-term viral suppression.[35] In other words, adherence prevents the virus from multiplying, which reduces the risk of mutation and resistance to HIV, thus strengthening the immune system. The previous literature review and studies conducted in South Africa,[36] Brazil,[37] and Ethiopia[7, 38, 39] revealed that ART adherence improves the HRQoL. In addition, a study from Colombia found that non-adherence to combined ART was associated with lower QoL.[40]
In bivariate analysis, the current results showed that being separated and having a low level of education were determinants of non-adherence and therefore of poor therapeutic outcomes. Only low level of education remained significantly associated with non-adherence to ART in multivariate analysis using the logistic regression model. Having a low level of education as a predictor of non-adherence was not consistent with the results obtained by other authors in most of the studies that explored the issue.[30, 31, 34, 41] In itself, level of education does not encourage people to take their treatment as planned. However, when it follows a shared decision-making process, in which patient and doctor agree together on the best course of treatment, the level of education helps patients to adhere to their treatment.[42]