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      The need for a Rehabilitation Model to address the disparities of public healthcare for people living with HIV in South Africa

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      Author(s): 1 , , 2
      Publication date (Electronic):
      Journal: African Journal of Disability
      Publisher: AOSIS OpenJournals

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          Abstract

          Rehabilitation in the context of HIV management in Africa is still a neglected field which holds great promise for the improvement of the quality of life as well as integration of people living with HIV back into their communities and homes. However, rehabilitation has not been incorporated into HIV care despite the fact that a large number of people living with HIV experience disability. The dearth of literature and lack of models of care to roll out rehabilitation for people living with HIV in Africa are astounding. Well-resourced countries have emerging approaches on the management of disability in the context of HIV. However, epidemic countries are still lacking such an approach neglecting the devastating effects of disability on individual livelihoods and antiretroviral treatment adherence. Thus, rehabilitation needs to be integrated into the response to HIV. This article advocates for the development and implementation of a model of care to guide rehabilitation of people living with HIV in South Africa.

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          The health-related quality of life of people living with HIV/AIDS.

          X Tinise, Jennifer Jelsma, Robert J Hughes … (2004)
          The prevalence of people living with HIV/AIDS (PLWA) in South Africa is estimated to be approximately 14.2% of the total population. In the absence of anti-retroviral therapy, PLWA are likely to experience a steady decline in function, as their immune systems become increasingly compromised. However, there is limited information available to determine the potential role of rehabilitation interventions in the management of PLWA in a resource-poor community. Subjects were recruited from the population of beneficiaries of HIV/AIDS clinics run by Medecins Sans Frontières, which provides anti-retroviral therapy to PLWA within a resource poor community. The subjects, who were either in WHO Stage 3 or 4 of the disease and/or had a CD4 count of less than 200, were interviewed after enrolment on the anti-retroviral programme and before treatment was initiated. They were therefore not yet receiving anti-retroviral therapy. The control group consisted of a community sample randomly selected from the same area and who were in the same age range. As all participants were Xhosa speaking, the Xhosa version of the EQ-5D measure of HRQoL was utilized. The Mann-Whitney U-test was used to determine whether there was a difference in the rank ordering of responses to the five different domains of the EQ-5D and the Visual Analogue Scale of Health Status scores. There were 123 and 108 subjects in the experimental and control groups, respectively. In the domain of mobility 30.9% of the subjects reported some or severe problems, compared to 14.8% of the control group (p < 0.001). The corresponding figures for the other domains were: self-care 14.8% and 4.6% (p = 0.016), usual activity 31.7% and 10.2% (p < 0.001), pain/discomfort 69.1% and 33.3% (p < 0.001) and anxiety/depression 33.4% and 24.2% (p = 0.123) for the experimental and control groups respectively. PLWA reported a VAS score of 60.4 (SD 22.1), which was significantly lower than that of the community sample (80.13, SD 20.4, p < 0.001). Self-reporting indicates that Health Related Quality of Life is severely comprised in PLWA in Stages 3 and 4 and limitations in the four domains of mobility, usual activities, pain/discomfort and anxiety/depression constitute major problems for PLWA. There is an obvious need to provide a continuum of care, encompassing not only medical but also physical and mental rehabilitation services as well. In an area of high HIV prevalence, the provision of appropriate, multi-disciplinary health care services to PLWA presents a major challenge to the health services.
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            Rehabilitation in HIV/AIDS: development of an expanded conceptual framework.

            Kelly O’Brien, Stephanie Nixon, Catherine Worthington … (2005)
            In industrialized countries where HIV infection is becoming a chronic, episodic condition, rehabilitation services have the potential to play an expanded role for people living with HIV/AIDS (PLHAs). However, little is known about rehabilitation in the context of HIV. This paper documents the development of an enhanced, multidisciplinary conceptual framework of rehabilitation in the context of HIV, using the perceptions of PLHAs and rehabilitation professionals. Rehabilitation, broadly defined, is a dynamic process that includes all prevention and/or treatment activities and/or services that address body impairments, activity limitations and participation restrictions for an individual. The framework was developed through broad consultation and interviews with thirteen key informants. Themes that emerged from analysis of interviews related to concepts of rehabilitation in the context of HIV, rehabilitation professionals' roles in the context of HIV, and barriers to access and delivery of rehabilitation services. While there was some variation, key informants generally viewed rehabilitation as a goal-oriented and client-centered process with the potential to impact a range of life domains. Themes were presented to members of a national advisory committee (including PLHAs and health care providers), who produced the foundation of the HIV rehabilitation framework. The framework uses the perspective of the person living with HIV/AIDS, and includes individual life domains that may be affected by HIV, drawing and expanding upon the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health.
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              The increasing chronicity of HIV in sub-Saharan Africa: Re-thinking "HIV as a long-wave event" in the era of widespread access to ART

              Stephanie Nixon, Jill Hanass-Hancock, Alan Whiteside … (2011)
              HIV was first described as a "long-wave event" in 1990, well before the advent of antiretroviral therapy (ART). The pandemic was then seen as involving three curves: an HIV curve, an AIDS curve and a curve representing societal impact. Since the mid-2000's, free public delivery of life-saving ART has begun shifting HIV from a terminal disease to a chronic illness for those who can access and tolerate the medications. This increasing chronicity prompts revisiting HIV as a long-wave event. First, with widespread availability of ART, the HIV curve will be higher and last longer. Moreover, if patterns in sub-Saharan Africa mirror experiences in the North, people on ART will live far longer lives but with new experiences of disability. Disability, broadly defined, can result from HIV, its related conditions, and from side effects of medications. Individual experiences of disability will vary. At a population level, however, we anticipate that experiences of disability will become a common part of living with HIV and, furthermore, may be understood as a variation of the second curve. In the original conceptualization, the second curve represented the transition to AIDS; in the era of treatment, we can expect a transition from HIV infection to HIV-related disability for people on ART. Many such individuals may eventually develop AIDS as well, but after a potentially long life that includes fluctuating episodes of illness, wellness and disability. This shift toward chronicity has implications for health and social service delivery, and requires a parallel shift in thinking regarding HIV-related disability. A model providing guidance on such a broader understanding of disability is the World Health Organization's International Classification of Functioning, Disability and Health (ICF). In contrast to a biomedical approach concerned primarily with diagnoses, the ICF includes attention to the impact of these diagnoses on people's lives and livelihoods. The ICF also focuses on personal and environmental contextual factors. Locating disability as a new form of the second curve in the long-wave event calls attention to the new spectrum of needs that will face many people living with HIV in the years and decades ahead.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Afr J Disabil
                Journal ID (iso-abbrev): Afr J Disabil
                Journal ID (publisher-id): AJOD
                Title: African Journal of Disability
                Publisher: AOSIS OpenJournals
                ISSN (Print): 2223-9170
                ISSN (Electronic): 2226-7220
                Publication date (Electronic): 08 June 2015
                Publication date Collection: 2015
                Volume: 4
                Issue: 1
                Electronic Location Identifier: 137
                Affiliations
                [1 ]Discipline of Physiotherapy, University of KwaZulu-Natal, South Africa
                [2 ]Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, South Africa
                Author notes
                Correspondence to: Verusia Chetty Email: chettyve@ 123456ukzn.ac.za Postal address: Private Bag X54001, Discipline of Physiotherapy, University of KwaZulu-Natal, Durban 4000, South Africa

                How to cite this article: Chetty, V. & Hanass-Hancock, J., 2015, ‘The need for a Rehabilitation Model to address the disparities of public healthcare for people living with HIV in South Africa’, African Journal of Disability 4(1), Art. #137, 6 pages. http://dx.doi.org/10.4102/ajod.v4i1.137

                Article
                Publisher ID: AJOD-4-137
                DOI: 10.4102/ajod.v4i1.137
                PMC ID: 5433471
                SO-VID: 22d3e715-a3d2-40d1-b98c-228134d98929
                Copyright © © 2015. The Authors
                License:

                Licensee: AOSIS OpenJournals. This work is licensed under the Creative Commons Attribution License.

                History
                Date received : 06 June 2014
                Date accepted : 16 February 2015
                Categories
                Subject: Opinion Papers

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