Prevalence and correlates of neurocognitive disorders and the impact on quality of life in women aging with HIV in Nairobi, Kenya.

Abstract

Introduction As antiretroviral therapy (ART) coverage expands, people living with HIV (PLHIV) are surviving into older age. In sub-Saharan Africa, women constitute the majority of PLHIV, and emerging evidence suggests that women living with HIV (WLHIV) face a disproportionate burden of neurocognitive impairment as compared to women living without HIV. Despite its clinical importance, neurocognitive impairment among older WLHIV in African settings remains under-recognized and poorly understood.Objective To estimate the prevalence and correlates of neurocognitive impairment and assess its association with health-related quality of life (HRQoL) in WLHIV aged ≥50 years in Kenya. Methods: We conducted a cross-sectional secondary analysis of 200 women aged ≥50 years enrolled at the Comprehensive Care Centre at Kenyatta National Hospital between September 2024 and March 2025. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the score was classified as normal (26-30), mild (18-26), moderate (10-17) and severe (>10). The quality of life was measured using the WHOQOL-BREF-HIV instrument and domains assessed were Physical, Psychological, Independence, Social Relationships, Environment and Spirituality/Religion. Depression and Post Traumatic Stress Disorder (PTSD) were evaluated using PHQ-9 and PCL-5, respectively. Logistic and linear regression models were used to identify correlates of cognitive impairment and its association with Health Related Quality of Life (HRQoL) domains. Results: Most participants (62%) were aged 50-59 years, and the majority had completed at least primary school. The prevalence of any form of cognitive impairment was 86%, with mild impairment (66%) being the most common. Being between age 60-69 years was significantly associated with higher odds of moderate to severe impairment compared to aged 50-59 years. Attaining secondary education or higher was strongly protective against moderate to severe impairment after adjustment. Overall HRQoL scores did not differ significantly by cognitive status, but participants with normal or mild cognitive impairment had higher psychological QoL scores compared to those with moderate or severe impairment. Conclusion: Cognitive impairment was prevalent in our study population, with mild impairment being the most common. Advancing age and lower educational attainment are key risk factors for cognitive impairment. Routine cognitive screening, integrated psychosocial support, and interventions to build cognitive reserve, especially through improved education and mental health services, are urgently needed to promote healthy aging and preserve quality of life in this population.