Multidimensional frailty, sex differences, and quality of life among older Ugandans affected by HIV

Older people affected by HIV in sub-Saharan Africa are at increased risk of frailty and poor quality of life (QoL). However, the contributions of specific frailty domains to QoL and whether these associations differ by sex remain poorly understood.

We analysed cross-sectional data from 444 older people aged ≥50 years (mean age 64.6 years, 62% female) from the WHO SAGE-WOPS HIV sub-study in Uganda. Frailty was assessed using 15 items from the Frailty Instrument for Sub-Saharan Africa (FiSSA), and QoL with a 7-item composite index. We used multiple linear regression to examine the associations between overall and domain-specific frailty and QoL, including sex interaction terms.

Higher overall frailty was associated with lower QoL (β = -0.63, p < 0.001). Among the frailty domains, the physical (β = -0.43, p < 0.001) and socioemotional (β = -0.18, p < 0.001) domains exceeded the minimally important difference (MID) threshold, indicating clinically meaningful associations with lower QoL, whereas the visual and psychological domains were below this threshold. A significant sex interaction was observed for the psychological domain (β = -0.25, p = 0.004), indicating a stronger negative association among women. No significant sex interactions were observed for the physical, socioemotional, or visual domains.

Frailty, particularly physical, socioemotional, and psychological domains, was associated with lower QoL among older Ugandans affected by HIV. Psychological frailty was more strongly associated with poorer QoL in women. Gender-sensitive, psychosocial interventions may help address these disparities and support healthy and equitable ageing in HIV-affected populations.