What shapes the quality of life among older persons living with HIV? A multidimensional assessment from The Aids Support Organisation clinics in Uganda

The Quality of Life (QoL) Composite Index provides a multidimensional, person-centred measure integrating functioning, symptom burden, general health perception, psychological, social, and living environmental, offering a critical metric for assessing successful ageing with HIV. However, evidence on the determinants of this composite measure among older persons living with HIV (OPLHIV) in Uganda remains limited. To estimate the Quality-of-Life Composite Index and identify its key determinants among OPLHIV receiving care from The AIDS Support Organisation (TASO) in Uganda. A cross-sectional study was conducted among OPLHIV aged ≥ 50 years attending TASO clinics across Uganda. The primary outcome was the QoL Composite Index (range: 0–1), derived from a validated multidimensional instrument capturing functioning, symptom burden, general health perception, and living environment. Data were collected through face-to-face interviews. Multivariable associations were assessed using a Beta regression with log link. Conversely, a random forest regression as a machine learning model was run to reveal the important variables shaping the QoL as assessed through the Index. Among 439 participants, the median QoL Composite Index was 0.51 (IQR: 0.41–0.61). After model regularization, two socioeconomic factors were independently associated with a higher QoL Composite Index: attainment of tertiary/university education ( β = 0.226, 95% CI 0.105–0.346, p < 0.001) and being employed (β = 0.078, 95% CI 0.018–0.138, p = 0.011). The presence of a non-communicable disease (co-morbidity) was strongly associated with a lower QoL Composite Index. HIV-specific clinical indicators—including age, duration of HIV infection, viral load, and ART adherence—were not independently associated with the composite measure. The QoL Composite Index effectively elucidates the multidimensional phenomenon of well-being among older Ugandans living with HIV and demonstrates that this is shaped predominantly by socioeconomic conditions and multi-morbidity rather than HIV-specific clinical markers. Improving the quality of life in later life with HIV therefore requires care models that extend beyond viral suppression to address socioeconomic security and integrated geriatric health needs.