Frailty among adult people living with HIV in Tanzania: a single-centred hospital-based cross-sectional study
Regina Protas Mmanda, Mary-Winnie Asifa Nanyaro, Joan Rugemalila, Tumaini NaguIntroduction
Frailty is recognised as a significant health challenge among adults living with HIV. The increasing ageing population in more than 21.1 million people living with HIV (PLHIV) in Eastern and Southern Africa is of public health concern; however, data on the prevalence and associated factors of frailty in this population are limited. This study aimed to determine the prevalence of pre-frailty, frailty, identify associated factors and assess its impact on quality of life (QoL) among adult PLHIV attending Muhimbili National Hospital in Tanzania.
Methods
A hospital-based, cross-sectional study was done in 2023 at the Care and Treatment Clinic (CTC). Adult PLHIV aged 35 years and above were enrolled using a linear systematic sampling. Frailty was assessed using the FRAIL scale which measured fatigue, resistance, ambulation, illnesses and loss of weight, where scores of 3–5, 1–2 and 0 indicated frailty, pre-frailty and healthy, respectively. WHOQOL-HIV BREF instrument measured QoL scores (4–20) using physical, psychological, level of independence, social relationships, environmental health and belief domains. Factors associated with frailty were determined using ordinal logistic regression. Comparison of QoL scores between frailty groups was determined using one-way Analysis of Variance (ANOVA). Statistical significance was set at p<0.05.
Results
A total of 268 PLHIV were included with a mean age of 51.8±10.0 years. Prevalence of pre-frailty and frailty was 23.5% and 27.6%, respectively. Factors associated with frailty included older age (≥50 years), being female and ever being diagnosed with a mental disorder. The QoL score was 16.2±1.6. Low scores in physical health and level of independence domains were significantly associated with increasing frailty severity status.
Conclusion
More than 50% of adult PLHIV had pre-frailty and frailty status. This is a multifactorial condition not solely a consequence of HIV infection itself. Its association with reduced QoL highlights the importance of integrating routine frailty screening into CTC care.