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S. Cobbing1, V. Chetty1, S. Maddocks1, L. Chetty1
1University of KwaZulu-Natal, Physiotherapy, Durban, South Africa
Background: South Africa has the highest number of people living with HIV worldwide (PLHIV), with 8 million PLHIV out of an estimated global total of 37.9 million. Antiretroviral therapy (ART) has ensured that PLHIV are living longer lives. However, there is a growing body of evidence that shows that PLHIV are prone to a broad range of physical and cognitive disabilities. It is crucial that PLHIV are able to attain a good health-related quality of life and optimal functioning, to support the success of the widely roll out of ART in countries like South Africa. Rehabilitation and exercise has been shown to improve the quality of life and function of PLHIV but there are numerous barriers facing patients who need to access rehabilitation.
Purpose: The aim of this project is to investigate the delivery of rehabilitative care to children, adults and elderly people living with HIV in KwaZulu-Natal Province, South Africa.
Methods: This is umbrella project, consisting of a four sub-studies, namely; the design of three distinct models of care that address the needs of children, adults and people aging with HIV, as well as an investigation of the effects of a home-based rehabilitation (HBR) intervention on the function and quality of life of PLHIV living with disability. A mix-methods research design was employed, including scoping review methodologies, engagement with key stakeholders (via interviews and focus groups) and experts (via Delphi techniques) and randomised controlled trial method (for the intervention). The project is situated in a resource-poor, semi-rural community in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa.
Results: Some fundamental principles that underpinned the models of care for children and adults were a need to improve access to care, provide patient-centered care, to engage in multi-disciplinary collaboration, to provide equitable healthcare, to structure coordinated pathways of care and linkages and to provide education and training for health care workers, caregivers, educators and community care workers. The findings of the RCT demonstrated that HBR is a safe strategy for treating the functional limitations experienced by PLHIV and may further improve their quality of life. The development of the model of care for adults aging with HIV is on-going, but early findings will be presented.
Conclusion(s): Attendees will gain a better understanding of how challenging it remains to be living with HIV in this community, which can be seen as the epicentre of the global HIV epidemic. HIV being seen as “just another chronic disease” remains a distant dream in this context. However, this project provides robust evidence on how these models of care and rehabilitation options for PLHIV, can enhance the functioning and quality of life of PLHIV across the entire lifespan.
Implications:
- Evidence-based rehabilitation programmes can both add years of life and life to the years of PLHIV.
- This umbrella project offers concrete advice on the delivery and effects of rehabilitation options for PLHIV across the entire life-span.
- It is particularly pertinent to resource-poor communities, in which the vast majority of PLHIV live.
Funding, acknowledgements: Fogarty International Center of the National Institutes of Health under Award Number D43TW010131.
Keywords: People living with HIV, Community-based rehabilitation, Disability
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? Yes
Institution: University of KwaZulu-Natal (UKZN)
Committee: UKZN Biomedical Research Ethics Committee
Ethics number: BFC052/15
All authors, affiliations and abstracts have been published as submitted.
