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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

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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

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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

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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.

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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

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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

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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

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My questions to you!!