<![CDATA[Introduction: Despite significant advances in antiretroviral therapy (ART), multiple factors continue to be associated with the Quality of Life (QoL) among people living with HIV (PLHIV). Although nutritional status may play an important biological role in the observed relationships, limited evidence exists regarding its statistical mediating role between behavioural, environmental, personal, and metacognitive factors and QoL among PLHIV receiving long-term treatment. Methods: This study employed an analytical cross-sectional design using Structural Equation Modelling–Partial Least Squares (SEM-PLS). Participants were selected using purposive sampling based on predefined inclusion criteria. Sample size adequacy was determined using the 10-fold rule and G*Power analysis with a medium effect size (f² = 0.15), significance level of 0.05, and statistical power of 0.80. A total of 127 PLHIV receiving ART participated in the study. Results: Among 126 PLHIV analysed (purposive, service-based sample), the measurement model showed strong convergent validity (AVE > 0.80) and reliability (Cronbach’s alpha > 0.89). Personal, behavioural, environmental, and metacognitive factors were each significantly associated with nutritional status, with personal factors showing the strongest effect (β = 0.468; p < 0.001). Nutritional status, in turn, was significantly associated with Quality of Life (β = 0.746; p < 0.001), while none of the four determinants showed a significant direct association with QoL once nutritional status entered the model. Bootstrapped indirect effects were significant for all four determinants (β = 0.249 to 0.349; 95% CI excluding zero), a pattern consistent with a statistical mediation model rather than evidence of a causal mechanism. The structural model accounted for 66.2% of the variance in QoL (R² = 0.662). Conclusion: In this cross-sectional sample of PLHIV aged 30 years and above, nutritional status showed a statistical pattern consistent with mediating the associations between personal, behavioural, environmental, and metacognitive factors and Quality of Life, explaining 66.2% of its variance (R² = 0.662). These findings should be read as hypothesis-generating rather than proof of a causal pathway, given the cross-sectional design.]]>
Copyrights © 2026
