Misalignment Between Patient-Reported Quality of Life and Guideline-Based Preventive Care Indicators in People Living With HIV: A Cross-Sectional Study.

Background The widespread use of antiretroviral therapy has transformed HIV infection into a chronic, manageable condition, shifting the focus of care toward patient-centered outcomes such as health-related quality of life (HRQoL). However, the extent to which HRQoL aligns with guideline-based healthcare quality indicators remains unclear. Objective To evaluate HRQoL and its alignment with guideline-based preventive care indicators in people living with HIV in a public healthcare setting. Methods An observational, cross-sectional study was conducted at a public secondary-care hospital of the Instituto Mexicano del Seguro Social (IMSS) in Oaxaca, Mexico, including 80 adult patients with HIV receiving outpatient care. Participants were selected through consecutive sampling. Inclusion criteria comprised adults (≥18 years) with a confirmed diagnosis of HIV infection under active follow-up, while patients with incomplete clinical records were excluded. HRQoL was assessed as a continuous variable using the Spanish version of the Medical Outcomes Study Short Form-30 (MOS-SF-30). Compliance with guideline-based preventive care indicators derived from Grupo de Estudio del SIDA (GESIDA) was calculated as the proportion of fulfilled indicators per patient. Descriptive statistics were used, and the relationship between variables was evaluated using Spearman's rank correlation coefficient (rho). Results The median HRQoL score was 91 (q25-q75: 86.2-94). In contrast, overall compliance with GESIDA indicators was low, with a median of 28.5% (q25-q75: 22-33%). Antiretroviral therapy coverage was 100% (80/80 patients), whereas several preventive indicators, including hepatitis A vaccination and substance use screening, showed no compliance (0%). Preventive care indicators consistently showed lower performance compared to treatment-related indicators. No statistically significant correlation was observed between HRQoL and compliance with GESIDA indicators (rho = 0.014, p = 0.899). Conclusions People living with HIV exhibited high HRQoL despite low compliance with guideline-based preventive care indicators. The absence of correlation between these variables suggests a misalignment between objective measures of healthcare quality and patient-reported outcomes. These findings highlight the need to strengthen preventive strategies and adopt comprehensive, patient-centered approaches to optimize long-term care.