The HIV epidemic has continued to be a key global public health issue affecting society and has claimed about 40.4 [32.9–51.3] million lives (1). At the end of 2022, the world health organization (WHO) estimated that there were about 39 million (33.1–45.7 million) people living with HIV globally, with more than two-thirds living in the WHO African Region. (1). In 2019, the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the National Agency for the Control of AIDS estimated that in Nigeria, there are about 1.8 million people that live with HIV, with a prevalence of 1.4% (2) while Onovo et al estimated the national HIV prevalence to be 2.1% with approximately 2 million people living with HIV in 2022 (3). Also, in 2022, 630 000 [480 000–880 000] people died from HIV-related causes and 1.3 million [1 million–1.7 million] people acquired HIV (4).
The "95-95-95" goal was set by the Joint United Nations Programme on HIV and AIDS to attain epidemic control. The aim is to ensure that by 2025, 95% of people living with HIV know their status, 95% of HIV positive people will be on Antiretroviral therapy (ART), and 95% of those on ART will have suppressed Viral load (5). To expand coverage and fight this epidemic, the concept of differentiated service delivery (DSD) was introduced.
Differentiated service delivery is a client-centered strategy that streamlines and modifies HIV services throughout the clinical cascade to take into consideration the preferences and needs of diverse groups of people living with HIV (PLHIV) while minimizing the health system's burden (6, 7). In order to meet the various demands and expectations of persons living with HIV, differentiated service delivery entails decreasing or increasing the intensity of the service, the frequency of the service, the service provider, and the location of the service (8).
The quality of life (QoL) of People living with HIV has become a significant public health issue and as such, QoL is increasingly becoming a significant component when evaluating the total well-being of people living with HIV (9). The QoL of people living with HIV has also become one of the indicators used to assess patient adherence to highly active antiretroviral therapy (HAART) (10). Additionally, as ART has been made available as a long-term regimen of therapy for PLHIV, the QoL has increased significantly as a measure for assessing the effects of ART. Therefore, research on the quality of life (QoL) of PLHIV will provide additional perspectives on the problems they experience and identify ways to enhance their well-being (9). Health-related quality of life (HRQoL) is increasingly recognized as a primary outcome in many clinical trials and has increased in relevance as a health outcome indicator (11). In contrast to other health measures, HRQoL is patient-reported and represents an effort to take into account how health affects practical areas of everyday life. As a result, determining HRQoL is essential to identifying and meeting the requirements of different populations, especially those populations with chronic illnesses like HIV (12).
EQ-5D-5L is the most commonly used generic preference-based multi-attribute utility instruments (MAUIs) health-related quality of life (HRQoL) measure (13). This instrument is based on self-assessment that consists of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension contains one item that informs on the degree of problems (14). It is efficient because it is generic, concise, and supported by the value sets required for an economic appraisal (15, 16). The EQ-5D has been utilized in various health conditions, has good test reliability, and also is validated for use for many disease conditions (17).
Numerous social problems that affect many PLHIV, including stigma, discrimination, anxiety, cultural standards, poverty, and overstretched health system present real barriers that prevent people from accessing the care they need and this can have an impact on their quality of life (QOL) not solely from the perspective of physical health but also from the perspective of social and mental health (10, 18, 19).
Additionally, some of the factors that influence the quality of life of PLHIV include gender, education level, career, knowledge, attitude, and behavior. For several developing countries, access to ARV therapy and adherence remain significant concerns (20).
While PLHIV in high-income countries (HIC) reports significantly lower health-related quality of life than the general population, research on HRQoL of PLHIV in low- and middle-income countries (LMIC) is limited (21). Based on these concerns, there is the need to conduct a study to evaluate the quality of life of people living with HIV on differentiated service delivery and to determine the sociodemographic predictors of ‘no problems’ in PLHIV in a South-eastern Nigerian State. Thus, the aim of this study was to determine the socio-demographic predictors of good quality of life (QoL) of PLHIV on DSD in a Southeastern Nigerian State