Prevalence, severity, and risk factors of disability among adults living with HIV accessing routine outpatient HIV care in London, United Kingdom (UK): A cross-sectional self-report study

Background The study objectives were to measure disability prevalence and
severity, and examine disability risk factors, among adults living with
HIV in London, United Kingdom (UK). Methods Self-reported questionnaires
were administered: World Health Organization Disability Assessment
Schedule 2.0 (WHODAS), HIV Disability Questionnaire (HDQ), Equality Act
disability definition (EADD), and demographic questionnaire. We calculated
proportion (95% Confidence Interval; CI) of “severe” and “moderate”
disability measured using EADD and WHODAS scores ≥2 respectively. We
measured disability severity with HDQ domain severity scores. We used
demographic questionnaire responses to assess risk factors of “severe” and
“moderate” disability using logistic regression analysis, and HDQ severity
domain scores using linear regression analysis. Results Of 201
participants, 176 (87.6%) identified as men, median age 47 years, and 194
(96.5%) virologically suppressed. Severe disability prevalence was 39.5%
(n=79/201), 95% CI [32.5%, 46.4%]. Moderate disability prevalence was
70.5% (n=141/200), 95% CI [64.2%, 76.8%]. Uncertainty was the most severe
HDQ disability domain. Late HIV diagnosis was a risk factor for severe
disability [Odds Ratio (OR) 2.71; CI 1.25, 5.87]. Social determinants of
health, economic inactivity [OR 2.79; CI 1.08, 7.21] and receiving
benefits [OR 2.87; CI 1.05, 7.83], were risk factors for “severe”
disability. Economic inactivity [OR 3.14; CI 1.00, 9.98] was a risk factor
for “moderate” disability. Economic inactivity, receiving benefits, and
having no fixed abode were risk factors (P≤0.05) across HDQ domains;
physical, mental and emotional, difficulty with day-to-day activities, and
challenges to social participation. Personal factors, identifying as a
woman and being aged <50 years, were risk factors (P≤0.05) for HDQ
domains; mental and emotional, uncertainty, and challenges with social
participation. Conclusions People living with well-controlled HIV in
London UK experienced multi-dimensional and episodic disability. Results
help to better understand the prevalence, severity, and risk factors of
disability experienced by adults living with HIV, identify areas to target
interventions, and optimise health and functioning.