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
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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
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DISABILITY
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!!
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