Www.aids2014.org Designing a home-based rehabilitation programme for people living with HIV and disability in KwaZulu-Natal, South Africa Saul Cobbing.

www.aids2014.org

Designing a home-based rehabilitation programme for people living with HIV and

disability in KwaZulu-Natal, South Africa

Saul Cobbing

Department of Physiotherapy

University of KwaZulu-Natal, South Africa

www.aids2014.org

About the study environment• South Africa: 6.4 million PLHIV (2012) as compared to 5.2 million

(2008) – HSRC (2012)• KwaZulu-Natal (KZN): over 1.5 million PLHIV (16.9% - HSRC, 2012)• eThekwini municipality: top 10 highest prevalence in South Africa• UKZN: only university in province offering physiotherapy• Last 4 years: collaboration between UKZN, HEARD and public

hospital in a peri-urban district of KZN

www.aids2014.org

Background to study• Cyclical relationship between disability and HIV (Hanass-Hancock and

Nixon, 2009)• The International Classification of Function, Disability and Health (WHO,

2001)• Disabling effects of HIV (Myezwa, 2009)• Physiological effects of aerobic exercise and resistance exercise

(Cochrane reviews – O’Brien, 2009; 2010)• Limited evidence-based intervention studies, if any, specifically for PLHIV

and disability• Due to difficulties with access, need for alternative model of rehabilitation

(Cobbing, 2014)

HIV DISABILITY

www.aids2014.org

Aim

To determine the effect of a specifically tailored disability-inclusive home-based rehabilitation (HBR) intervention on PLHIVs’ perceived disability, quality of life and functional ability.

www.aids2014.org

Methods

Study design: Experimental – RCT

Study area: Located at St Mary’s Hospital, Marianhill

Study population: Drawn from HEARD prevalence study on HIV-related disability (>1000 participants)

Study sample: Random, stratified sampling, sample size will be determined from HEARD prevalence study

Inclusion criteria: Adult PLHIV on HAART for > 6 months, with a defined disability.

Exclusion criteria: Pregnant women, acute OI, CD4<200

www.aids2014.org

Data collection• First visit: informed consent• Random allocation into control and intervention groups• Second visit: Administration of outcome measures

(RAs)- WHOQOL-HIV BREF- WHODAS-12- Rivermead Mobility Index- Six Minute Walk Test• CBR intervention (weekly visits over 6 month period

conducted by 2 trained RAs – separate from assessment RAs)

• Third visit: Post-intervention outcome measures

www.aids2014.org

Significance• First study of it’s type in Southern Africa• Relevance to resource-poor high-HIV

prevalence local communities• Opportunity to re-design rehabilitation

models in the SA public health sector• Opportunity to influence advocacy for

increased rehabilitation resources

www.aids2014.org

My questions to you!!