title: The health related quality of life of people living with HIV/AIDS in sub-Saharan Africa - a literature review and focus group study.
abstract: BACKGROUND
  While health outcomes of HIV/AIDS treatments in terms of increased longevity has been the subject of much research, there appears to be very limited research on the improved health related quality of life (HRQL) that can be applied in cost-utility analyses in Africa south of the Sahara (SSA). Most of the literature that does exist present HRQL measured by disease specific instruments, but such data is of little use as input to economic evaluations.
  
  
  METHODS
  A systematic review of the literature on HRQL weights for people living with HIV/AIDS in Africa was performed, and the findings are presented and interpreted. We also use focus group discussions in panels of clinical AIDS experts to test the preference based on a generic descriptive system EQ-5D. We contrast quality of life with and without antiretroviral treatment (ART), and with and without treatment failure.
  
  
  RESULTS
  In only four papers were the HRQL weights for HIV/AIDS in sub-Saharan Africa estimated with generic preference based methodologies that can be directly applied in economic evaluation. A total of eight studies were based on generic health profiles. While such 'health profiles' are not preference based, the scores could potentially be transformed into health state utilities. Most of the available literature (20 papers) utilized disease specific instrument, which are not applicable for economic evaluation.The focus group discussions revealed that HRQL weights are strongly correlated to disease stage. Furthermore, clinical experts consistently report that ART has a strong positive impact on the HRQL of patients, although this effect appears to rebound in cases of drug resistance.
  
  
  CONCLUSIONS
  EQ-5D appears to be an appropriate tool for measuring and valuing HRQL of HIV/AIDS in Africa. More empirical research is needed on various methodological aspects in order to obtain valid and reliable HRQL weights in economic evaluations of HIV/AIDS prevention and treatment interventions.
authors.affiliation: Research Group Global Health: Ethics, economics and culture, Centre for International Health and Department of Public Health, University of Bergen, Norway. bjarne.robberstad@cih.uib.no
authors.forename: Bjarne
authors.initials: B
authors.lastname: Robberstad
authors.forename: Jan Abel
authors.initials: JA
authors.lastname: Olsen
references.citation: AIDS. 2006 May 12;20(8):1181-9
references.pmid: 16691070
references.citation: AIDS. 2008 Jul;22 Suppl 1:S123-30
references.pmid: 18664944
references.citation: Disabil Rehabil. 2004 Mar 18;26(6):371-6
references.pmid: 15204489
references.citation: Cent Afr J Med. 2000 Aug;46(8):208-13
references.pmid: 11317592
references.citation: Qual Life Res. 2005 May;14(4):971-80
references.pmid: 16041894
references.citation: Med Decis Making. 2002 Nov-Dec;22(6):475-81
references.pmid: 12458977
references.citation: Qual Life Res. 1996 Apr;5(2):275-80
references.pmid: 8998496
references.citation: Lancet. 2006 Mar 11;367(9513):817-24
references.pmid: 16530575
references.citation: Lancet. 2002 May 11;359(9318):1635-43
references.pmid: 12020523
references.citation: AIDS Care. 2006 Aug;18(6):614-20
references.pmid: 16831790
references.citation: J Health Econ. 1997 Dec;16(6):703-30
references.pmid: 10176780
references.citation: Nurs Health Sci. 2008 Dec;10(4):266-72
references.pmid: 19128302
references.citation: Lancet. 2002 May 25;359(9320):1851-6
references.pmid: 12044394
references.citation: BMC Public Health. 2007 Sep 14;7:244
references.pmid: 17854510
references.citation: Acta Psychiatr Scand. 2002 Jul;106(1):9-19
references.pmid: 12100343
references.citation: BMJ. 1999 Apr 3;318(7188):916-9
references.pmid: 10102858
references.citation: AIDS Care. 2006 Feb;18(2):109-20
references.pmid: 16338768
references.citation: BMJ. 2002 Apr 13;324(7342):860-1
references.pmid: 11950717
references.citation: J Econ Perspect. 2006 Summer;20(3):121-42
references.pmid: 17176527
references.citation: Cost Eff Resour Alloc. 2006 Dec 06;4:20
references.pmid: 17147833
references.citation: Health Policy Plan. 2006 Nov;21(6):411-20
references.pmid: 16984894
references.citation: BMJ. 2005 Dec 17;331(7530):1431-7
references.pmid: 16282380
references.citation: BMC Infect Dis. 2006 Sep 01;6:136
references.pmid: 16948852
references.citation: Med Care. 1997 Nov;35(11):1095-108
references.pmid: 9366889
references.citation: AIDS Care. 2005 Jul;17(5):579-88
references.pmid: 16036244
references.citation: Lancet. 2006 Oct 7;368(9543):1254-9
references.pmid: 17027731