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

Objectives Measure the prevalence and severity of disability, and examine disability risk factors among adults living with HIV in London, United Kingdom (UK). Methods We conducted a quantitative cross-sectional study. The following self-reported questionnaires were administered: World Health Organization Disability Assessment Schedule 2.0 (WHODAS), HIV Disability Questionnaire (HDQ), a disability item using the Equality Act disability definition (EADD), and demographic and HIV questionnaire. We calculated the proportion (95% Confidence Interval; CI) of “severe” and “moderate” disability as measured using EADD and WHODAS scores ≥2 respectively. We measured disability severity with HDQ domain severity scores. We used demographic and HIV characteristic questionnaire responses to assess potential risk factors of “severe” (EADD) and “moderate” (WHODAS scores ≥2) disability using logistic regression analysis, and HDQ severity domain scores using linear regression analysis. Results Of 201 participants, 176 (87.6%) identified as men, with 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. The HIV characteristic of late HIV diagnosis was a risk factor for severe disability [Odds Ratio (OR) 2.71; CI 1.25, 5.87]. The 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 disability domains; physical, mental and emotional, difficulty with day-to-day activities, and challenges to social participation. Personal factors of identifying as a woman and being aged <50 years were risk factors ( P ≤0.05) for HDQ disability 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, reduce disability, and optimise health and function.