Uncovering gaps in HIV care in belgium through patient reported outcome measures and neurocognitive screening

BACKGROUND: Patient-reported outcome measures (PROMs) are critical for evaluating health-related quality of life (HRQoL) among people living with HIV (PLHIV). This study explores HRQoL using PROMs and assesses the prevalence and implications of HIV-associated neurocognitive disorders (HAND) within the HIV Reference Centre (HRC) of Ghent University Hospital, a tertiary outpatient clinic providing routine multidisciplinary HIV care. METHODS: Between November 2021 and June 2023, 836 of 1,473 PLHIV followed completed a PROMs questionnaire assessing physical and mental health, sleep, social support, sexual health, stigma, and substance use. Screening for HAND was conducted using the European AIDS Clinical Society (EACS) guidelines, Montreal Cognitive Assessment (MoCA), and International HIV Dementia Scale (IHDS). RESULTS: Seventy-seven percent of the participants were male and mean age was 52 years (SD = 11.68). Satisfaction rates were high for physical (77%) and mental health (71%). Notably, 47% reported significant sleep disturbances, and 18.5% regularly used substances. Forty-four percent reported one or more neurocognitive complaints on the EACS screening questions, of whom 14% had impairment across all three cognitive domains. Of those reporting complaints, 36% underwent formal cognitive screening; within this screened subgroup, impaired scores were identified in 45% on the MoCA and 63% on the IHDS. Regression analyses indicated that negative feelings, sleep difficulties, low social support, and neurocognitive functioning significantly predicted overall HRQoL. CONCLUSIONS: Sleep, substance use, and neurocognitive functioning emerge as points of interest among Belgian PLHIV. Systematic identification of cognitive difficulties-when integrated with appropriate referral pathways, cardiovascular risk management, and psychosocial support rather than as isolated screening-may contribute to preserving HRQoL. The potential benefits of screening must be weighed against the risk of increasing anxiety among PLHIV.