Health-Related Quality of Life in People Living with HIV and Hypertension: Effects of a Short Message Service–Based Mobile Health Intervention (MOPHADHIV Trial)

Abstract

Mobile health (mHealth) interventions offer scalable support for adherence and self-management, yet their effects on health-related quality of life (HRQoL) among people living with HIV (PLWH) and comorbid hypertension remain unclear. We evaluated HRQoL outcomes using data from the MOPHADHIV trial, a 12-month short message service (SMS)-based randomized controlled trial conducted at four community health centres in Cape Town, South Africa. HRQoL was measured using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility index (Ugandan value set) and the EuroQol Visual Analogue Scale (VAS) at baseline and 12 months. Between-group differences were assessed using two-sample t-tests and analysis of covariance (ANCOVA) models adjusting for baseline HRQoL and covariates. A total of 582 participants (279 control; 303 intervention) with complete HRQoL data at baseline and 12 months were included in the analysis. Baseline HRQoL was high and comparable across arms. At 12 months, EQ-5D-5L utility was slightly higher in the control arm (0.97 vs 0.95; mean difference 0.03; t = 2.66, p = 0.01), corresponding to a small effect size (Cohen’s d = 0.22). In adjusted models, intervention allocation was associated with a small reduction in EQ-5D-5L utility (β = − 0.02, p = 0.01; fully adjusted β = − 0.03, p < 0.01). VAS scores improved in both groups, with no significant between-arm differences. In this cohort of PLWH with hypertension, a 12-month SMS-based intervention did not improve HRQoL and was associated with a small reduction in EQ-5D-5L utility. High baseline HRQoL and limited sensitivity of EQ-5D-5L to HIV-related psychosocial domains may partly explain these findings.