METHODS FOR MEASURING OUTCOMES TO EVALUATE INTERVENTIONS TO IMPROVE HEALTH-RELATED QUALITY-OF-LIFE IN HIV-INFECTION

This paper describes strategies for measuring outcomes to evaluate int erventions to improve health-related quality of life (HRQL) in HIV inf ection and presents data comparing different methods of measuring HRQL from an ongoing randomized, controlled trial. Conceptual and methodol ogical contributions from the literature on the assessment of health s tatus and quality of life are reviewed, followed by a summary of empir ical work on measurement of HRQL in HIV infection and description of t he outcome measurement strategy adopted in this study. Preliminary dat a from the baseline phase of a randomized, controlled trial of an inte rvention to improve quality of life in 81 persons with HIV infection a re analyzed to address issues related to the measurement of outcomes. Three types of measures were used including: i) outcome measures of qu ality of life (SF-36, QL-Index, HIVIS, patient utilities), psychologic al well-being (POMS, CES-D, Impact of Event Scale), clinical status (s ymptoms, T4 cell counts, perceived health status), and costs associate d with hospital care; ii) measures of social support (ISEL, satisfacti on with support, difficulty seeking support); and iii) measures of per sonality characteristics hypothesized to be related to outcome (self-e steem, mastery). Correlational analyses were used to examine issues re lated to generic vs. disease-specific measures and the reliability and construct validity of different outcome measures. Findings are discus sed in terms of the reliability and convergent validity of different o utcome measures; construct validity of HRQL measures compared to psych ological vs. clinical outcomes; and construct validity of HRQL measure s compared to social support and personality measures.