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Table 5 Qualities and psychometric properties of the selected HIV-specific measures extracted from the reviews

From: Measuring quality of life among people living with HIV: a systematic review of reviews

Scale Domains addressed Completion time/No. items Response format Accessibility Validity Reliability Responsiveness Floor/ Ceiling effects Conclusions/recommendations of the reviews
ACTG SF-21 [34] Physical functioning, energy/fatigue, social functioning, role functioning, cognition, pain, health perception and emotional well-being. 4–5 mins [34]
21 items
3–6 response options per item plus a visual analogue scale Available in 2 languages [17]. No validity data available [17]. No internal consistency reported [17]. not stated Likely to have similar floor and ceiling effects to other MOS measures [17]. not stated
HIV-QL31 [35] Sex life, pain, psychological aspects, relationships, limitations caused by HIV, symptoms, impact of treatment and care 31 items Yes/No Available in English and French [18]. Discriminates between groups with different severity levels (construct validity) [20]. High internal consistency [17, 20]. not stated not stated QL-31 is a relatively sound and useful instrument where attention has been paid to the breadth of the concept as a result of listening to the concerns of patients. However it is culture-specific in the ways it has been designed [20].
MQOL-HIV [37] Mental health, physical health, physical functioning, social functioning, social support, cognitive functioning, financial status, partner intimacy, sexual functioning, perceived access to medical care 10 mins [4]
40 items
Likert scale (never – always) In a study comparing the MQOL-HIV with the MOS-HIV there were more missing data/incomplete responses on the MQOL-HIV [12] Discriminates between patients based on symptom severity, inpatient care and stage of illness [4].
MQOL-HIV scores distinguished between AIDS, symptomatic
HIV, and asymptomatic cases, on 7 domains and overall QOL in one study however inadequate discrimination between disease stages was found in a Spanish study [20].
Good internal consistency (Cronbach’s alpha >0.70) for 8 of the 10 domains [4]. Poor internal consistency for physical and mental health, physical and sexual functioning [20].
Good test-retest reliability for all domains except cognitive functioning [4].
Poor test-retest reliability [20].
Somewhat responsive to change in the number of symptoms, viral load and CD4 count over a 3-month period [4].
Responsive to perceived changes in quality of life over 6 months in one study however only five dimensions were sensitive to clinical changes during ART [20].
Less sensitive than the MOS-HIV for detecting changes after starting or switching ART. MOS-HIV detected change on a greater number of subscales [12].
Floor and/or ceiling effects were reported in some dimensions [17].
Fewer problems with floor ceiling effects when compared to the MOS-20 [20].
The MQoL-HIV was not one of the reviewed measures recommended by Clayson et al. [4]
A relatively sound and useful measure where attention has been paid to patient input and the breadth of the concept however the instrument is culture-specific [20].
PROQOL-HIV [38, 41] 8 scored domains: Physical health and symptoms, treatment impact, emotional distress, health concerns, body change, intimate relationships, social relationships, stigma and 4 additional items addressing religious beliefs, finance, having children and satisfaction with care. 7 mins [51]
43 items
Rated on a 5-point scale ranging from 0 = ‘never’ to 4 = “always” not stated not stated not stated not stated not stated No information reported in the reviews
MOS-HIV [36] Two summary scores—the physical health score and mental health score and 10 domains: physical functioning, pain, social functioning, role functioning, emotional well-being, energy/fatigue, cognitive functioning, health distress, health transition, general health and overall quality of life 10 mins [4, 12]
35 items
2–6 response options per item Translated into at least 14 languages, largely designed for industrialised world [20].
English version takes approx. 5–10 min [4, 12, 20] but twice as long has been reported for the use of some translations, e.g. Spanish, where more words are needed to express the concepts [20].
Scoring/ interpretation is complex [12, 20].
Less missing data than MQOL-HIV [12].
Mixed reports regarding construct validity with some suggesting poor construct validity [17] and others suggesting good construct validity [20].
Large body of evidence supporting convergent and discriminant validity [4, 12], although some studies have not found the expected relationship with CD4 count (construct validity) [12, 20].
Moderate /good internal consistency generally reported [4, 12, 19, 20] although Carabin reported good internal consistency for some but not all domains [17].
Inadequate test-retest reliability [17, 19].
Responsiveness has been established in a wide variety of contexts including adverse events, increased symptoms, opportunistic infections and AIDS-defining events, initiation of ART [4, 10, 12, 18].
Negligible effects in treatment experienced adults changing therapy [10].
Studies have found the MOS-HIV is more responsive than EQ-5D, HUI3 and MQOL-HIV [12].
Floor and ceiling effects have been reported [19, 20]. Well established reliability/validity and widely used but concerns that as one of the earliest HIV-specific measures to be developed it may not have continued relevance for PLWH. They question whether there is a true advantage to using the MOS-HIV over the SF-36. Would be unwise to administer alongside another MOS measure such as the SF-36 because of shared items [4].
May have limited value in cross-cultural research because although the scale has been translated into many languages, it may not have sematic and conceptual equivalence outside the USA [20]. More information is needed about performance of the scale in women, low income and other socially disadvantaged groups [20].
Can be administered individually or together with the EQ-5D to measure changes in HRQOL [10]. There is a lack of items addressing sexual function and body image [18].
Validation data draws on a range of patient groups from asymptomatic to those with advanced HIV [4].
WHOQOL-HIV BREF [39] Physical, psychological, level of independence, social, environmental, and spiritual QoL 31 items 5 point likert scale not stated not stated not stated not stated not stated not stated
Symptom Quality of Life Adherence (HIV-SQUAD) [40] HRQOL items include physical and psychological domains. The measure also includes symptoms and a visual analogue scale for adherence 24 items 5 point likert scales, dichotomous items and a visual analogue scale not stated The measure discriminated between patients at different CD4 counts and with/without hepatitis co-infection (construct validity) [12]. Cronbach’s alpha was acceptable for the physical component but <0.7 for the psychological component (internal consistency) [12] Responsive to change in HIV viral load [12]. not stated not stated