Improving the Long-term Well-being of HIV-positive Individuals

A global multidisciplinary group of HIV experts has developed a consensus statement outlining the key issues that health systems must address in order to shift away from the long-standing emphasis on viral suppression and instead provide integrated, person-centered care to people living with HIV throughout their lives.

Since the introduction of antiretroviral therapy (ART) for HIV in 1996, AIDS-related morbidity and mortality have decreased significantly. People living with HIV are now expected to live nearly as long as those who do not have the virus. Despite these advances, people living with HIV frequently report low levels of happiness and health-related quality of life.

To guide stakeholders in improving health system responses to achieve the best possible long-term health outcomes for people living with HIV, a global multidisciplinary group of HIV experts led by CUNY SPH Senior Scholar Jeffrey Lazarus and including Distinguished Professor Denis Nash and Associate Professor Diana Romero developed a consensus statement identifying the key issues health systems must address in order to move beyond the longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for people living with HIV throughout their lives.

People living with HIV are now expected to live nearly as long as people without HIV. Despite these advances, those living with HIV often report poor well-being and health-related quality of life.

The research team assembled a diverse panel of experts with expertise in the long-term health needs of people living with HIV after a rigorous, multi-stage Delphi process. The panel reviewed the literature on multimorbidity, stigma, and discrimination to identify priority issues for inclusion in the Delphi process to develop a consensus statement.

“A significant strength of this consensus statement is that it was developed through this rigorous process, which included quantitative and qualitative data from experts from over 20 countries,” Dr. Romero says.

According to the panel, multimorbidity, health-related quality of life, and stigma and discrimination remain major issues for people living with HIV, including those who have achieved viral suppression and, in particular, those from marginalized populations.

Advancing the long-term well-being of people living with HIV

“These factors can lead to depression, social isolation, and barriers to health and support services,” explains Dr. Lazarus, an associate professor at the Barcelona Institute for Global Health. “Many of these issues are not being addressed in HIV monitoring, strategies, or guidelines at the moment.”

Health-care systems have improved their ability to identify, diagnose, treat, and, increasingly, suppress viral replication in HIV patients (PLHIV). Despite these advances, many PLHIV reports a higher burden of multimorbidity and a lower health-related quality of life when compared to people without HIV.

‘There is ample evidence that addressing issues such as mental health, stigma reduction, quality of life, and, in many settings, housing, and food security will also improve HIV outcomes such as adherence to antiretroviral medications and viral suppression,’ says Dr. Nash. “The field of HIV implementation science can play a critical role in evaluating the impact of strategies integrated into HIV service delivery to address these issues.”

According to the authors, the World Health Organization (WHO) and UNAIDS should develop new HIV monitoring processes and guidelines, and Member States should commit to reporting on the indicators and implementing policies to improve health system performance and ensure the long-term well-being of the millions of people living with HIV around the world.

A multidisciplinary panel of 44 global HIV experts articulates how health systems can improve the long-term well-being of people living with HIV by addressing multimorbidity, health-related quality of life, stigma, and discrimination in a patient-centered and holistic manner. At the time of publication, the 31 consensus points presented in the “Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV” had been endorsed by more than 65 organizations worldwide.