Home-based rehabilitation for people living with HIV in a resource-poor setting in KwaZulu-Natal, South Africa.

Abstract

This PhD thesis centres on a home-based rehabilitation intervention (HBR) for people living with HIV (PLHIV) in a resource-poor setting in KwaZulu-Natal, South Africa. South Africa has the highest number of people infected with HIV worldwide, with 6.4 million PLHIV out of an estimated global total of 36.7 million. Antiretroviral therapy (ART) has ensured that PLHIV are living longer lives. However, there is a wide range 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 wide roll out of ART in countries like South Africa. Rehabilitation and exercise have been shown to improve the quality of life and function of PLHIV but there are numerous barriers facing patients who need to access rehabilitation. This PhD study aimed to determine the effect of an alternative approach of service delivery, namely a disability-inclusive HBR intervention, on PLHIVs’ perceived disability, quality of life, functional mobility and functional capacity. The study was situated in a resource-poor, semi-rural community in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa. The design of the study intervention was informed by the synthesis of the evidence from a scoping review on HBR interventions for PLHIV, which revealed a paucity of evidence, and the practical experience of the lead author as a rehabilitation practitioner working with PLHIV. Embedded in a wider investigation related to an alternative model of care, this novel intervention, undertaken through a randomised control trial methodology, found that HBR is a safe strategy for treating the functional limitations experienced by PLHIV and may further improve their quality of life. While participants in the intervention group showed greater improvements across all outcome measures, between-group differences were nonsignificant. The community healthcare workers, who were trained via a task shifting approach to implement this HBR programme, reported feeling empowered by the knowledge and skills they attained through this study and gave valuable advice for improving future interventions. A synthesis of the overall PhD study results demonstrated that this intervention satisfied a number of the fundamental principles of a model of care for the rehabilitation of PLHIV, developed in the same study location. By building on the successes of this PhD study and addressing the limitations of its design and process, researchers can design and implement new rehabilitation interventions that involve multidisciplinary collaboration and the screening and treatment of people with a wide range of chronic conditions. This research should be combined with advocacy efforts to ensure that theoretical findings are translated into policies and practices that benefit all PLHIV, particularly those in resource-poor communities.