Abstract
BACKGROUND: Children and adolescents living with HIV face unique physical, psychological, and social challenges that can significantly affect their health-related quality of life (HRQoL). Understanding the dimensions and determinants of HRQoL among them is crucial to developing solutions to improve their overall well-being. This research aimed to assess the HRQoL and its determinants among children and adolescents living with HIV in Eastern Uganda. METHODS: A cross-sectional study was conducted with 228 respondents. Sociodemographic and clinical variables were assessed using an investigator-designed questionnaire, and HRQoL was assessed using the World Health Organization HIV Quality of Life - BREF tool. A multiple linear regression model was used to identify independent factors associated with HRQoL. RESULTS: The mean age of the respondents was 13.68 ± 1.95 years, 129 (56.58%) were female, and 182 (79.82%) perceived high support from friends. The mean QoL was highest within the spiritual domain (17.07 ± 3.11), while the independence domain indicated the lowest quality of life (14.57 ± 2.26). Approximately 48.5% attained the mean overall QoL score (96.22). Better financial status (being not well off or quite well off) was significantly associated with higher scores across physical, psychological, independence, environmental, spiritual, and overall QoL (p < 0.05). High perceived family support was also positively associated with higher psychological, environmental, spiritual, and overall QoL scores. In contrast, family history of mental illness and the presence of other chronic illnesses were significantly associated with lower psychological and environmental scores. Being Muslim/other religion was associated with lower physical domain scores, while being in high school or above was linked to better environmental scores. CONCLUSION: Spirituality was a key source of emotional support, reflected in the highest QoL scores, while low independence scores suggest that stigma and overprotection may hinder autonomy and social development. Although overall QoL was generally good, disparities across domains underscore the need for targeted interventions. Improved financial status and strong family support were consistently associated with better QoL outcomes, while comorbid conditions and a family history of mental illness negatively impacted well-being among children and adolescents living with HIV in Eastern Uganda.