Determinants of Quality of Life of People Living with Human Immunodeficiency Virus in Africa: A Systematic Review

ABSTRACT: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome continues to shape the lives of millions in Africa and remains a major public health concern. Despite advances in prevention and treatment, the quality of life (QoL) of people living with HIV (PLHIV) has often been overlooked. For many PLHIV, survival is no longer the only concern; emotional well-being, social ties, economic security, and dignity are now equally vital. QoL is increasingly recognized as a key outcome of HIV care, indicating whether treatment enables PLHIV not only to survive but to live well and participate fully in society. In this context, this systematic review aimed to synthesize current evidence on determinants of QoL among PLHIV in Africa. The review was registered in PROSPERO (CRD42025640388) and followed the PRISMA guidelines. A comprehensive search of PubMed, Scopus, and Web of Science identified studies from 2020 to 2025 involving adults (18-50 years) living with HIV in African countries. Socioeconomic, medical, and psychosocial determinants were examined. Study quality was assessed using validated risk-of-bias tools, and due to heterogeneity in design, a narrative synthesis was conducted. Twenty studies met the inclusion criteria, most cross-sectional and used validated QoL instruments. Overall methodological quality was sufficient to support the review's conclusions. Twenty-eight determinants of QoL were identified and grouped into sociodemographic, psychosocial, clinical, and environmental domains. Despite marked underrepresentation of data from some African regions, the findings highlight the need for comprehensive, multidimensional interventions to improve the well-being of PLHIV in Africa.