Abstract
Background
The involvement of quality of life as the UNAIDS fourth 90 target to monitor the global HIV response highlighted the development of patient-reported outcome (PRO) measures to help address the holistic needs of people living with HIV/AIDS (PLWHA) beyond viral suppression. This study developed and tested preliminary measurement properties of a new patient-reported outcome (PROHIV-OLD) measure designed specifically to capture influences of HIV on patients aged 50 and older in China.
Methods
Ninety-three older people living with HIV/AIDS (PLWHA) were interviewed to solicit items and two rounds of patient cognitive interviews were conducted to modify the content and wording of the initial items. A validation study was then conducted to refine the initial instrument and evaluate measurement properties. Patients were recruited between February 2021 and November 2021, and followed six months later after the first investigation. Classical test theory (CTT) and item response theory (IRT) were used to select items using the baseline data. The follow-up data were used to evaluate the measurement properties of the final instrument.
Results
A total of 600 patients were recruited at the baseline. Of the 485 patients who completed the follow-up investigation, 483 were included in the validation sample. The final scale of PROHIV-OLD contained 25 items describing five dimensions (physical symptoms, mental status, illness perception, family relationship, and treatment). All the PROHIV-OLD dimensions had satisfactory reliability with Cronbach’s alpha coefficient, McDonald’s ω, and composite reliability of each dimension being all higher than 0.85. Most dimensions met the test-retest reliability standard except for the physical symptoms dimension (ICC = 0.64). Confirmatory factor analysis supported the structural validity of the final scale, and the model fit index satisfied the criterion. The correlations between dimensions of PROHIV-OLD and MOS-HIV met hypotheses in general. Significant differences on scores of the PROHIV-OLD were found between demographic and clinical subgroups, supporting known-groups validity.
Conclusions
The PROHIV-OLD was found to have good feasibility, reliability and validity for evaluating health outcome of Chinese older PLWHA. Other measurement properties such as responsiveness and interpretability will be further examined.
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Introduction
HIV has infected a total of 84.2 million people and claimed 36.3 million lives worldwide since the start of the epidemic [1]. Today, HIV remains to be a major global public issue. An estimated 40.1 million people were living with HIV/AIDS worldwide at the end of 2021 [2]. Given the large population of China, the influence of HIV in China should not be underestimated despite the relatively low prevalence. By the end of 2020, China had 1.05 million people living with HIV/AIDs and 351,000 cumulative reported deaths [3].
The widespread application of the highly active antiretroviral therapy (HAART) has made HIV infection a manageable chronic health condition, enabling people living with HIV/AIDS (PLWHA) to live a longer life. At the same time, HIV infection and antiretroviral treatment could accelerate the aging process of PLWHA [4]. The World Health Organization suggested the age of 50 to be a cut-off to discriminate older subjects within HIV-infected people [5]. As of the end of 2019, there were about 7.5 million PLWHA aged 50 and over worldwide, making up one fifth of PLWHA [6]. As a result of increasing access to effective HIV diagnosis and treatment, China has also witnessed an increasing number of older PLWHA in recent years [7]. In 2011, the proportion of older PLWHA aged between 50 and 64 in China reached 13.6%, up from 1.6% in 2000 [8].
However, longer life expectancy does not necessarily mean better well-being. Alongside physical discomforts, PLWHA also struggle with depression, anxiety, financial stress, and HIV-related discrimination [9]. To fully understand the health status of PLWHA and address their holistic needs beyond viral suppression, patient-reported outcome (PRO) measures should be developed and validated to complement biomarkers to depict patients’ experience with the disease and treatment [10].
Among the previous studies assessing health outcomes of PLWHA, generic instruments have been most widely used as they can facilitate comparison between different disease or treatment groups, but they were not originally designed to identify disease-specific issues and therefore may fail to capture important impacts of HIV [11]. As for specific PRO instruments established for PLWHA, quite a number of them were developed before the wide application of HARRT, decreasing their validity in evaluating treatment effectiveness [12, 13]. Besides, PRO instruments for PLWHA introduced from foreign countries should be used with caution as they might be culturally inappropriate [Preliminary work Literature review and focus group interviews with health care professionals were conducted first, based on which an initial conceptual framework involving physical, emotional, social, and treatment was generated. According to the conceptual framework, a total of 93 patients were interviewed face-to-face and videotaped. At numerous points in the interview, participants were encouraged to spontaneously add any comments or areas related to the disease that they deemed appropriate and important. Once completed, the videotapes were transcribed. Transcriptions were then compared against the original videotapes by a second set of research assistants. The transcripts of the interviews were reviewed and coded by 2 researchers, and items were generated and categorized. A draft preliminary item pool of 56 items was then presented to patients who had not participated in the initial interviews to evaluate the relevance, importance, comprehensibility, and potential redundancy of items, during which one item was discarded because of overlap with other items. The remaining 55 items comprised the preliminary PROHIV-OLD instrument tested here. Items were scored using a 7-point Likert scale with anchor points labored from “not at all” to “very much”. The recall period is determined to be one month.
Methods
Design and subjects
From February 2021 to November 2021, participants were recruited from six designated hospitals of three cities with varying socioeconomic status according to GDP per capita in Zhejiang Province, China. Participants were followed six months later after first investigation. PLWHA aged 50 and over, with ongoing antiviral therapy were eligible to participate in this study, while those who had cognitive issues, could not understand Mandarin Chinese, or at terminal stage of AIDS were excluded.
The PROHIV-OLD and a validated outcome measure, the Medical Outcomes Study HIV Health Survey (MOS-HIV) [19] were administered at baseline and at 6-month follow up. Demographic and HIV-related information were also collected. The baseline data was used as the study sample for item reduction analyses (Phase I), and the follow-up data as the validation sample to test the final instrument (Phase II).
This study was approved by the Institutional Review Board of Zhejiang University (approval number: ZGL202007-03), and written informed consent was obtained from all participants.
Phase I: item reduction
Item reduction based on the CTT
Distribution of scores of each item was analyzed. An item should be removed if floor or ceiling effects exceed 20% [20]. Items with standard deviations lower than 1, or coefficients of variation lower than 0.3 are deemed to be of low degree of variability and should be removed [21].
Exploratory factor analysis (EFA) aided in item reduction and exploration of factor structure. Exploratory structural equation modeling (ESEM) was also employed to analyze the factor structure. ESEM can be seen as a compromise between the flexibility of EFA and the rigor of SEM [22]. It has been used when factor structures were not yet well established as it allows for a more detailed model fit assessment [23, 24]. The principal axis factoring analysis with an oblique rotation was employed to extract factors. The scree plot [25], Horn’s parallel analysis (PA) [26] and Velicer’s minimum average partial (MAP) [27] were adopted to determine the number of factors to be extracted. Proposed models were compared by ESEM using the following fit indices, chi-square divided by degree of freedom (χ2/df), Tucker-Lewis index (TLI), standardized root mean square residual (SRMR), root mean square error of approximation (RMSEA), and Bayesian information criterion (BIC). Satisfactory model fit requires χ2/df < 3, TLI\( \ge \)0.9, SRMR<0.08, RMSEA<0.08, and a lower BIC [53]. However, few HIV/AIDS specific instruments have been developed using IRT to date. This study used both CTT and IRT to select items in the phase of item reduction, ho** to further improve the performance this instrument.
In item selection by EFA, determining the appropriate number of factors is an important yet controversial issue as no single procedure seems to be entirely satisfactory among the many rules of thumb and statistical indices for addressing the dimensionality issue [54, 55]. The more common indices of the Kaiser’s criterion [54] and the more accurate methods of the PA and MAP [30, 42] were employed in this study to identify the number of latent factors needed to accurately account for the common variance among the items. ESEM, which offers the advantage of providing the overall tests of model fit [56], was then conducted to compare the fitness of the proposed competing models to determine the optimal factor structure. A five-factor structure was finally determined and the factor rotation resulted in as many as 22 items being deleted, the strict requirements of EFA on the number and correlation of variables, as well as the sample size and distribution could explain the large number of items being deleted at this stage [57], previous studies also found quite a number of items being removed by EFA [58, 59].
In item reduction using IRT, 2 items failed to meet the discrimination criterion and were first deleted. Disordered thresholds were detected for 3 items, indicating that respondents may have difficulty in distinguishing between the response options and these 3 items were removed consequently. Uniform DIF was observed for 5 items and 4 items exhibited non-uniform DIF. No consensus has been reached on the disposition of items with DIF. Items with non-uniform DIF were generally required to be deleted, while appropriate weightings can be applied to items with uniform DIF [60, 61]. Some studies suggested to determine the salience of DIF by testing the magnitude of DIF beyond significance, and items that exhibits DIF with large magnitude of impact, whether uniform or non-uniform, are supposed to be deleted [37, 42, 43]. This study also examined the magnitude of DIF, the DIF observed had no substantial influence, therefore only items with non-uniform DIF were finally removed.
The reliability and validity of the final instrument have been rigorously tested. Internal consistency reliability of the PROHIV-OLD was supported by the high Cronbach’s alpha coefficients, McDonald’s ω and CR, which are deemed to be more suitable to evaluate reliability for multidimensional instruments [62], further confirmed the reliability for each dimension. All dimensions demonstrated good test-retest reliability except that the ICC of the physical symptoms dimension was slightly less than 0.7. Apart from disease and treatment related symptoms, the physical symptoms dimension also contains items less specifically related with HIV infection, such as energy, and sleep quality, which might be responsible for the lower test-retest reliability of this dimension.
Regarding the structure validity of PROHIV-OLD, the poor fitness of the one-factor model confirmed that the PROHIV-OLD is multidimensional in nature, and the final structure of the instrument was supported by CFA. Correlations between comparable PROHIV-OLD and MOS-HIV dimensions were stronger than those between less comparable dimensions. The correlations between the role functioning scale of the MOS-HIV with all five dimensions of the PROHIV-OLD were weak. The two entries in the MOS-HIV role functioning scale concern the ability to do certain kinds or amounts of work, housework, or schoolwork, which are no longer the main content of older adults’ social life, instead, their social relationship and interaction will be more confined to family [63, 64], which possibly resulted in the stronger correlation between the MOS-HIV role functioning scale with the PROHIV-OLD family relationship dimension. This also implied the uniqueness of older patients’ experience and the conceptual framework of the PROHIV-OLD.
Known-groups validity was examined across a range of demographic and clinical relevant factors. Similar with existing studies, gender [48] and income differences [49] on dimension scores have been detected. For clinical factors, all the five dimensions of PROHIV-OLD distinguished patients with different levels of CD4+T cell counts well, while no significant associations were found between any dimensions of the PROHIV-OLD and HIV-1 RNA level. The proportion of patients with abnormal plasma HIV-1 RNA level (11.47%) might be too small to detect its effect on patients’ perceived health status. Dyslipidemia was associated with poorer performance on the physical symptoms dimension, whereas patients with abnormal liver or kidney function did not report more physical symptoms. One possible reason was that the liver and kidney function can only be roughly determined based on limited medical information, future studies can consider to employ more precise medical examinations and include respondents’ self-perceived condition.
Several potential limitations of this study should be stated. First, generalizability of this study might be inadequate given that only patients in Zhejiang province were included. Besides, epidemic-related control policies under COVID-19 prevented us from interviewing hospitalized patients, who are at higher possibility of undergoing serious opportunistic infections or other adverse events, which further limited the representativeness of the study sample. Second, for older PLWHA with poor vision, investigators assisted them to fill the survey by reading the items verbatim to them, which might cause selection and social desirability bias. Third, the primary aim of instrument development and validation limited this study to only detect the presence and the salience of DIF, the underlying complex mechanisms for DIF remain to be identified in future qualitative and quantitative studies. Fourth, although the reliability and validity shown in this study seems to be satisfactory, the instrument’s ability to detect change over time remains to be examined to further support the psychometric properties of this instrument. Nevertheless, this large study in multiple sites with rigorous instrument development and validation methods provided a strong foundation for health outcome assessment and promotion for the ever-increasing population of older PLWHA.
Conclusions
The PROHIV-OLD instrument demonstrated acceptable reliability and validity, suggesting that it can be implemented in clinical research and practice to provide further valuable information on health outcome of older PLWHA in China. Other measurement properties such as responsiveness and interpretability will be further examined.
Data availability
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
References
UNAIDS, Global HIV. & AIDS statistics–Fact sheet. https://www.unaids.org/en/resources/fact-sheet. Accessed 9 April 2023.
World Health Organization. HIV and AIDS. https://www.who.int/news-room/fact-sheets/detail/hiv-aids. Accessed 10 January 2023.
Annals of information on comprehensive prevention and treatment for AIDS, STD and, Hepatitis C. Bei**g: National Center for AIDS & STD Control and Prevention, The Chinese Center for Disease Control and Prevention (CDC); 2020.
High KP, Brennan-Ing M, Clifford DB, Cohen MH, Currier J, Deeks SG, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr. 2012;60(Suppl 1Suppl 1):S1–18.
World Health Organization. Impact of AIDS on older people in Africa: Zimbabwe case study. Switzerland: World Health Organization; 2002.
UNAIDS Data 2019. The Joint United Nations Programme on HIV and AIDS. http://aidsinfo.unaids.org/. Accessed 12 January 2023.
Wei H, Li B, Lan G. Research progress on AIDS epidemic characteristics of Elderly Population in China. Appl Prev Med. 2021;27(2):189–93.
Wang L, Qin Q, Ge L, Ding Z, Cai C, Guo W, et al. Characteristics of HIV infections among over 50-year-olds population in China. Chin J Epidemiol. 2016;37(2):222–6.
Lazarus JV, Safreed-Harmon K, Barton SE, Costagliola D, Dedes N, Del Amo Valero J, et al. Beyond viral suppression of HIV - the new quality of life frontier. BMC Med. 2016;14(1):94.
Kall M, Marcellin F, Harding R, Lazarus JV, Carrieri P. Patient-reported outcomes to enhance person-centred HIV care. Lancet Hiv. 2020;7(1):E59–68.
O’Brien N, Chi YL, Krause KR. Measuring Health outcomes in HIV: Time to bring in the patient experience. Ann Glob Health. 2021;87(1):2.
Brown G, Mikołajczak G, Lyons A, Power J, Drummond F, Cogle A, et al. Development and validation of PozQoL: a scale to assess quality of life of PLHIV. BMC Public Health. 2018;18(1):527.
Holmes WC, Shea JA. Two approaches to measuring quality of life in the HIV/AIDS population: HAT-QoL and MOS-HIV. Qual Life Res. 1999;8(6):515–27.
Maimaiti R, Yuexin Z, Kejun P, Wubili M, Lalanne C, Duracinsky M, et al. Assessment of Health-related quality of life among people living with HIV in **njiang, West China. J Int Assoc Provid AIDS Care. 2017;16(6):588–94.
Liu R, Wu S, Hao Y, Gu J, Fang J, Cai N, et al. The Chinese version of the world health organization quality of life instrument-older adults module (WHOQOL-OLD): psychometric evaluation. Health Qual Life Outcomes. 2013;11:156.
Wheelwright S, Darlington AS, Fitzsimmons D, Fayers P, Arraras JI, Bonnetain F, et al. International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer. Br J Cancer. 2013;109(4):852–8.
De Ayala RJ. The theory and practice of item response theory. 1st ed. New York: Guildord; 2009.
Barlow PB, Skolits G, Heidel RE, Metheny W, Smith TL. Development of the Biostatistics and clinical epidemiology skills (BACES) assessment for medical residents. Postgrad Med J. 2015;91(1078):423–30.
Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, validity and usefulness of the Medical outcomes Study HIV Health Survey (MOS-HIV). Qual life Research: Int J Qual life Aspects Treat care Rehabilitation. 1997;6(6):481–93.
Raat H, Botterweck AM, Landgraf JM, Hoogeveen WC, Essink-Bot ML. Reliability and validity of the short form of the child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples. J Epidemiol Community Health. 2005;59(1):75–82.
Pang H, Kang X, Li Z, Zhang J, Lv R, Jiang J. An application of Item Response Theory in Item Selection of Chinese Self-management of heart failure instrument. Chin J Health Stat. 2014;31(1):57–60.
Marsh HW, Morin AJS, Parker PD, Kaur G. Exploratory Structural Equation Modeling: An Integration of the Best Features of Exploratory and Confirmatory Factor Analysis. In: Cannon TD, Widiger T, editors. Annual Review of Clinical Psychology, Vol 10. Annual Review of Clinical Psychology. 102014. p. 85-+.
Morin AJS, Maiano C. Cross-validation of the short form of the physical self-inventory (PSI-S) using exploratory structural equation modeling (ESEM). Psychol Sport Exerc. 2011;12(5):540–54.
Maiano C, Morin AJS, Lanfranchi MC, Therme P. The Eating attitudes Test-26 revisited using exploratory structural equation modeling. J Abnorm Child Psychol. 2013;41(5):775–88.
Cattell RB. Handbook of multivariate experimental psychology. 2nd ed. Chicago: Rand McNally; 1966.
Horn JL. A rationale and test for the number of factors in factor analysis. Psychometrika. 1965;30(2):179–85.
Velicer WF, Eaton CA, Fava JL. In: Goffin RD, Helmes E, editors. Construct explication through factor or component analysis: a review and evaluation of alternative procedures for determining the number of factors or components. Boston, MA: Springer; 2000.
Yu M. Scale Preparation and Development: application of the Rasch Measurement Model. **nbei, China: Psychological; 2020.
Posada D, Buckley TR. Model selection and model averaging in phylogenetics: advantages of akaike information criterion and bayesian approaches over likelihood ratio tests. Syst Biol. 2004;53(5):793–808.
Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods. 1999;4(3):272–99.
Cousi C, Igier V, Quintard B. French cross-cultural adaptation and validation of the Quality of Life-Alzheimer’s Disease scale in Nursing Homes (QOL-AD NH). Health Qual Life Outcomes. 2021;19(1).
Sekiguchi M, Wakita T, Otani K, Onishi Y, Fukuhara S, Kikuchi S, et al. Development and validation of a Symptom scale for lumbar spinal stenosis. Spine. 2012;37(3):232–9.
Lamash L, Josman N. Full-information factor analysis of the Daily Routine and Autonomy (DRA) questionnaire among adolescents with autism spectrum disorder. J Adolesc. 2020;79:221–31.
Luo YH, Yang J, Zhang YB. Development and validation of a patient-reported outcome measure for stroke patients. Health Qual Life Outcomes. 2015;13.
Samejima F. Estimation of latent ability using a response pattern of graded scores. Psychometrika. 1969;34(1):1–97.
Liu B. Measurement of patient-reported outcomes: principles, methods, and applications. Bei**g, China: People’s Medical Publishing House; 2011.
Pinto MNFC, Pinto RMC, Mendonca TMS, Souza CG, da Silva CHM. Validation and calibration of the patient-reported outcomes measurement information system: Pediatric PROMIS®Emotional distress domain item banks, Portuguese version (Brazil/Portugal). Qual Life Res. 2020;29(7):1987–97.
Hu X, Zhao Z, Zhang S-K, Luo Y, Yu H, Zhang Y. CA-PROM: validation of a general patient-reported outcomes measure for Chinese patients with cancer. Cancer Epidemiol. 2020;67.
Wang W, Zhou Y. Application status and Prospect of item response theory in Health-Related scales. Chin J Health Stat. 2018;35(4):633–6.
Baker FB. The basics of Item Response Theory. 2nd ed. ERIC Clearinghouse on Assessment and Evaluation; 2001.
Crane PK, Gibbons LE, Jolley L, van Belle G. Differential item functioning analysis with ordinal logistic regression techniques - DIFdetect and difwithpar. Med Care. 2006;44(11):S115–23.
Fayers PM, Machin D. Quality of life: the assessment, analysis and reporting of patient-reported outcomes. 3rd ed. Chichester: Wiley; 2016.
Jodoin MG, Gierl MJ. Evaluating type I error and power rates using an effect size measure with the logistic regression procedure for DIF detection. Appl Measur Educ. 2001;14(4):329–49.
Mokhtaryan-Gilani T, Ozgoli G, Kariman N, Nia HS, Doulabi MA, Nasiri M. Psychometric properties of the Persian translation of maternal postpartum quality of life questionnaire (MAPP-QOL). Health Qual Life Outcomes. 2021;19(1).
Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.
Hays RD, Hayashi T. Beyond internal consistency reliability: Rationale and user’s guide for Multitrait Analysis Program on the microcomputer. Behav Res Methods Instruments Computers. 1990;22(2):167–75.
Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.
Huang Y, Yin Y, Yang B, Tian C, Yu J, Liu C, et al. Study on the quality of life and related influencing factors among HIV/AIDS patients over 50 yearsold. Chin J Aids STD. 2021;27(5):490–3.
**e F, Zheng H, Huang L, Yuan Z, Lu Y. Social Capital Associated with Quality of Life among People Living with HIV/AIDS in Nanchang, China. Int J Environ Res Public Health. 2019;16(2).
Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature age-related comorbidities among HIV-Infected persons compared with the General Population. Clin Infect Dis. 2011;53(11):1120–6.
Liu N, Lv J, Liu JC, Zhang YB. The PU-PROM: a patient-reported outcome measure for peptic ulcer disease. Health Expect. 2017;20(6):1350–66.
Hagman BT, Kuerbis AN, Morgenstern J, Bux DA, Parsons JT, Heidinger BE. An item response theory (IRT) analysis of the short inventory of problems-alcohol and drugs (SIP-AD) among non-treatment seeking men-who-have-sex-with-men: evidence for a shortened 10-item SIP-AD. Addict Behav. 2009;34(11):948–54.
Cappelleri JC, Lundy JJ, Hays RD. Overview of classical test theory and item response theory for the quantitative Assessment of items in develo** patient-reported outcomes measures comment. Clin Ther. 2014;36(5):648–62.
Reise SP, Waller NG, Comrey AL. Factor analysis and scale revision. Psychol Assess. 2000;12(3):287–97.
Gorsuch RL. Exploratory factor analysis: its role in item analysis. J Pers Assess. 1997;68(3):532–60.
Asparouhov T, Muthen B. Exploratory structural equation modeling. Struct Equation Modeling-a Multidisciplinary J. 2009;16(3):397–438.
Kahn JH. Factor analysis in counseling psychology research, training, and practice: principles, advances, and applications. Couns Psychol. 2006;34(5):684–718.
Lv J, Xue J, Luo Y, Zhang Y. Item screening about PRO Scale of Chronic Heart failure. Chin J Health Stat. 2014;31(3):379–82.
Zhu L, Kong J, Zheng Y, Song M, Cheng X, Zhang L, et al. Development and initial validation of the chronic hepatitis B quality of life instrument (CHBQOL) among Chinese patients. Qual Life Res. 2019;28(11):3071–81.
Lutomski JE, Krabbe PFM, den Elzen WPJ, Olde-Rikkert MGM, Steyerberg EW, Muntinga ME, et al. Rasch analysis reveals comparative analyses of activities of daily living/instrumental activities of daily living summary scores from different residential settings is inappropriate. J Clin Epidemiol. 2016;74:207–17.
Pallant JF, Miller RL, Tennant A. Evaluation of the Edinburgh Post Natal Depression Scale using Rasch analysis. BMC Psychiatry. 2006;6.
Flora DB. Your coefficient alpha is probably wrong, but which Coefficient omega is right? A tutorial on using R to obtain better reliability estimates. Adv Methods Practices Psychol Sci. 2020;3(3):484–501.
Moor N, de Graaf PM, Komter A. Family, welfare state generosity and the vulnerability of older adults: a cross-national study. J Aging Stud. 2013;27(4):347–57.
Huang Y. Family relations and life satisfaction of older people: a comparative study between two different hukous in China. Ageing Soc. 2012;32:19–40.
Acknowledgements
We would like to thank the patients for their participation. We are also thankful to physicians and nurses who participated in this study for their kind help during data collection.
Funding
This study was supported by the National Natural Science Foundation of China, Grant Number 72174177.
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HMW, DLP, and TCE conceived and designed the study. YJZ contributed to research design, data collection and statistical analysis. RZ assisted in data collection and drafted the manuscript. JYY, JZ, RJG, BJW, and BHM participated in data collection. HMW, DLP, TCE, RZ, YJZ, and BJW finalized the manuscript. All authors have read and agreed to the final version of the manuscript.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Zhejiang University (approval number: ZGL202007-03). Informed consent was obtained from all individual participants included in the study.
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Zhou, R., Zheng, YJ., Wang, BJ. et al. Development and validation of the patient-reported outcome for older people living with HIV/AIDS in China (PROHIV-OLD). Health Qual Life Outcomes 22, 30 (2024). https://doi.org/10.1186/s12955-024-02243-0
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DOI: https://doi.org/10.1186/s12955-024-02243-0