Thien Quy Pham, Qiong Wu, Cindy Pan, Lam Ha, Thanh C Bui, Md Safaet Hossain Sujan, Stephen L Schensul, Roman Shrestha, Ngoan Tran Le, Toan Ha
Quality of Life Research, February 2026. Abstract
Although antiretroviral therapy (ART) has been highly effective in controlling HIV, many people with HIV (PWH) continue to experience poor quality of life (QoL), especially in resource-limited settings. This secondary analysis of a randomized clinical trial examined the impact of sequenced multilevel interventions on QoL among 940 men living with HIV who use alcohol in Mumbai, India. Participants were assigned to one of three intervention sequences—individual counseling (IC), group intervention (GI), and collective advocacy (CA) across three sites, a pilot site receiving all three interventions simultaneously, or a control site receiving standard care. QoL was measured using the EQ-5D-3 L instrument at baseline, 9, 18, and 24 months. Linear mixed models were used to assess the effect of intervention sequences on QoL over time, adjusting for sociodemographic and clinical covariates. The GI–CA–IC sequence significantly improved QoL compared to the control group (β = 0.04, 95% CI 0.02 to 0.06, p < 0.001). Conversely, the IC–GI–CA sequence showed a significant decline in QoL(β = − 0.02, 95% CI − 0.04 to − 0.01, p = 0.009). Pairwise comparisons confirmed the advantage of the GI–CA–IC sequence. Initiating with group sessions, followed by collective advocacy, and concluding with individual counseling may lead to greater improvements in QoL than other sequences. These results have significant implications for tailoring multilevel HIV interventions to optimize outcomes in local contexts. However, further research is needed to confirm these findings and explore the mechanisms underlying sequence effects.