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Davis VH, Nixon SA, Murphy K, Cameron C, Bond VA, Hanass-Hancock J, Kimura L, Maimbolwa MC, Menon JA, Nekolaichuk E, Solomon P. How the Term 'Self-Management' is Used in HIV Research in Low- and Middle-Income Countries: A Scoping Review. AIDS Behav 2022; 26:3386-3399. [PMID: 35429310 DOI: 10.1007/s10461-022-03668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/25/2022]
Abstract
This scoping review assessed how the term 'self-management' (SM) is used in peer-reviewed literature describing HIV populations in low- and middle-income countries (LMIC). This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. OVID Medline, Embase, CAB Abstracts, and EBSCO CINAHL, Scopus, and Cochrane Library were searched up to September 2021 for articles with SM in titles, key words, or abstracts. Two team members independently screened the titles and abstracts, followed by the full-text. A data extraction tool assisted with collecting findings. A total of 103 articles were included. Since 2015, there has been a 74% increase in articles that use SM in relation to HIV in LMIC. Fifty-three articles used the term in the context of chronic disease management and described it as a complex process involving active participation from patients alongside providers. Many of the remaining 50 articles used SM as a strategy for handling one's care by oneself, with or without the help of community or family members. This demonstrates the varied conceptualizations and uses of the term in LMIC, with implications for the management of HIV in these settings. Future research should examine the applicability of SM frameworks developed in high-income settings for LMIC.
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Affiliation(s)
- Victoria H Davis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, M5T 3M6, Toronto, Ontario, Canada.
| | - Stephanie A Nixon
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kathleen Murphy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cathy Cameron
- International Centre for Disability and Rehabilitation, Toronto, Canada
| | - Virginia A Bond
- Global and Health Development Department, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Jill Hanass-Hancock
- School of Health Science, University of KwaZulu-Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Lauren Kimura
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - J Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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2
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Kietrys D, Myezwa H, Galantino ML, Parrott JS, Davis T, Levin T, O'Brien K, Hanass-Hancock J. Functional Limitations and Disability in Persons Living with HIV in South Africa and United States: Similarities and Differences. J Int Assoc Provid AIDS Care 2020; 18:2325958219850558. [PMID: 31109225 PMCID: PMC6748470 DOI: 10.1177/2325958219850558] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Persons living with HIV (PLHIV) may experience disability. We compared disability among
PLHIV in the United States and South Africa and investigated associations with health and
demographic characteristics. Secondary analysis of cross-sectional data using medical
records and questionnaires including the World Health Organization Disability Assessment
Schedule (WHO-DAS) 2.0 12-item version (range: 0-36, with higher scores indicative of more
severe disability). Between-country differences for the presence of disability were
assessed with logistic regression and differences in severity using multiple regression.
Eighty-six percent of US participants reported disability, compared to 51.3% in South
Africa. The mean WHO-DAS score was higher in the United States (12.09 ± 6.96) compared to
South Africa (8.3 ± 6.27). Participants with muscle pain, depression, or more years since
HIV diagnosis were more likely to report disability. Being female or depressed was
associated with more severity. Being adherent to anti-retroviral therapy (ART) and
employed were associated with less severity. Because muscle pain and depression were
predictive factors for disability, treatment of those problems may help mitigate
disability in PLHIV.
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Affiliation(s)
- David Kietrys
- 1 Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers - The State University of New Jersey, Blackwood, NJ, USA
| | - Hellen Myezwa
- 2 Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Lou Galantino
- 2 Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa.,3 Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, NJ, USA.,4 Clinical Center for Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Scott Parrott
- 1 Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers - The State University of New Jersey, Blackwood, NJ, USA
| | - Tracy Davis
- 1 Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers - The State University of New Jersey, Blackwood, NJ, USA
| | - Todd Levin
- 5 School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Kelly O'Brien
- 6 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,7 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,8 Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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3
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Stevens ME, Parsons JA, Read SE, Bond V, Solomon P, Nixon SA. The relationship between stigma and a rehabilitation framework [international classification of functioning, disability and health (ICF)]: three case studies of women living with HIV in Lusaka, Zambia. Disabil Rehabil 2019; 43:2149-2156. [PMID: 31766899 DOI: 10.1080/09638288.2019.1693640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore how the International Classification of Functioning, Disability and Health, a rehabilitation framework, can provide a holistic understanding of stigma experiences of three women living with human immunodeficiency virus in Lusaka, Zambia. METHODS A secondary analysis of three cases by drawing on interview transcripts collected as part of a larger longitudinal study with eighteen women living with the virus. The interview tool used the rehabilitation framework to ask questions about the impact of the virus on the body, daily activities, social participation and the future. Vignettes were produced for each of the eighteen women including information on stigma and the rehabilitation framework. Three case studies were developed from women who provided comprehensive accounts of stigma and the International Classification of Functioning, Disability and Health. RESULTS Stigma experiences aligned well with three dimensions of the International Classification of Functioning, Disability and Health: participation restrictions, environmental and personal factors. These domains were used to understand stigma in three forms (i.e. enacted, self and structural stigma) as experienced by these women. CONCLUSIONS More research is needed to ascertain how stigma and rehabilitation are related in other environments and populations and to explore how to mitigate stigma within the rehabilitation context.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals deal with aspects of stigma and discrimination in their clinical work and this analysis offers a way to consider HIV-related stigma within rehabilitation in an organized and theoretically-informed way.The insights from this study are important for the field of HIV and for advancing understanding of the complexities of stigma in the context of rehabilitation more broadly.This analysis offers guidance to rehabilitation providers about the nuanced and multi-faceted ways that stigma can occur in the context of rehabilitation, including within their own clinical practice.
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Affiliation(s)
- Marianne E Stevens
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,International Centre for Disability and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Janet A Parsons
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Virginia Bond
- Department of Global and Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Patricia Solomon
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Stephanie A Nixon
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,International Centre for Disability and Rehabilitation, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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4
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Hanass-Hancock J, Bond V, Solomon P, Cameron C, Maimbolwa M, Menon A, Nixon S. Perspectives on ART adherence among Zambian adults living with HIV: insights raised using HIV-related disability frameworks. AIDS Care 2019; 32:623-629. [PMID: 31416343 DOI: 10.1080/09540121.2019.1653441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Anti-retroviral treatment (ART) has improved the survival of people living with HIV in Africa. Living with chronic HIV comes with new health and functional challenges and the need to manage ART adherence. The Sepo Study applied disability frameworks to better understand living with chronic HIV while using ART. The study followed 35 people (18 women, 17 men) living with HIV and on ART 6 months or longer in private and public health facilities in Lusaka, Zambia over 18-months (2012-2015). A total of 99 in-depth interviews were conducted. Conventional content analysis and NVIVOv10 were applied to analyse the data. Participants were adhering to ART at the times of the interviews and therefore less likely to report major challenges with adherence. Three main themes emerged from the data related to adherence. Firstly, ART was regarded as "giving life", which underscored adherence. Secondly, all participants described strategies for to managehealth and functional limitations, which they attributed as side-effects or chronicity. Thirdly, participants described experiences of uncertainty, including the efficacy of new regimens, potential loss of functioning, risk of new health problems, and death. Long-term ART managment in Africa needs to integrate rehabilitation approaches to address functional limitations, uncertainties, strengthen and support for adherence.
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Affiliation(s)
- Jill Hanass-Hancock
- School of Health Science, University of KwaZulu-Natal, South Africa.,South African Medical Research Council, Cape Town, South Africa
| | - Virginia Bond
- School of Public Health, University of Zambia, Zambart, Zambia.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Patricia Solomon
- International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cathy Cameron
- International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada
| | | | - Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Stephanie Nixon
- International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Myezwa H, Hanass-Hancock J, Ajidahun AT, Carpenter B. Disability and health outcomes - from a cohort of people on long-term anti-retroviral therapy. SAHARA J 2018; 15:50-59. [PMID: 29635976 PMCID: PMC5917329 DOI: 10.1080/17290376.2018.1459813] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human-immunodeficiency virus (HIV)/Acquired immunodeficiency Syndrome (AIDS) remains a major health problem in South Africa - even after two decades since the introduction of antiretroviral therapy (ART). Long-term survival with HIV is associated with new health-related issues and a risk of functional limitation/disability. The aim of this study was to assess functional limitation associated with HIV/AIDS among people living with HIV (PLHIV) in South Africa. This study is a cross-sectional survey using a cohort in an urban area in Gauteng province, South Africa. Data were collected using questionnaires through an interview process. The information collected included aspects such as demographics, livelihood, the state of mental and physical health, adherence and disability. A total of 1044 participants with an average age of 42 ± 12 years were included in the study, with 51.9% of the participants reporting functional limitations (WHODAS ≥ 2). These were reported mainly in the domains of participation (40.2%) and mobility (38.7%). In addition, adherence to ART, symptoms of poor physical health and depression were strongly associated with their functional limitations/disability. HIV as a chronic disease is associated with functional limitations that are not adequately addressed and pose a risk of long-term disability and negative adherence outcomes. Therefore, wellness for PLHIV/AIDS needs to include interventions that can prevent and manage disability.
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Affiliation(s)
- Hellen Myezwa
- a Department of Physiotherapy, Faculty of Health Sciences , University of the Witwatersrand , 7 York Road, Parktown , Johannesburg , South Africa
| | - Jill Hanass-Hancock
- b School of Health Science, Westville Campus , University of KwaZulu-Natal , Durban , South Africa.,c South African Medical Reesarch Council , 123 Jan Hofmeyer Road, Durban , South Africa
| | - Adedayo Tunde Ajidahun
- a Department of Physiotherapy, Faculty of Health Sciences , University of the Witwatersrand , 7 York Road, Parktown , Johannesburg , South Africa
| | - Bradley Carpenter
- b School of Health Science, Westville Campus , University of KwaZulu-Natal , Durban , South Africa.,c South African Medical Reesarch Council , 123 Jan Hofmeyer Road, Durban , South Africa
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6
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Schenk KD, Tun W, Sheehy M, Okal J, Kuffour E, Moono G, Mutale F, Kyeremaa R, Ngirabakunzi E, Amanyeiwe U, Leclerc-Madlala S. " Even the fowl has feelings": access to HIV information and services among persons with disabilities in Ghana, Uganda, and Zambia. Disabil Rehabil 2018; 42:335-348. [PMID: 30282493 DOI: 10.1080/09638288.2018.1498138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities.Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors.Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and - by denying their circumstances - leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities.Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response.Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability. Implications for RehabilitationPersons with disabilities are vulnerable to HIV infection but have historically been excluded from HIV and AIDS services, including prevention education, testing, treatment, care and support. Fundamental change is needed to address practical and attitudinal barriers to access, including provider training.Rehabilitation professionals and HIV service providers alike must acknowledge the two-way relationship between HIV and disability: people with disability are vulnerable to HIV infection; people with HIV are increasingly becoming disabled.Peer participation by persons with disabilities in the design and implementation of HIV services is crucial to increasing accessibility.Addressing political will (through the National Strategic Plan for HIV) is crucial to ensuring long-term sustainable change in recognizing and responding to the heightened vulnerability of people with disability to HIV.
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Affiliation(s)
- Katie D Schenk
- Department of Global and Community Health, George Mason University, Fairfax, VA
| | - Waimar Tun
- Department of Global and Community Health, George Mason University, Fairfax, VA
| | | | - Jerry Okal
- HIVCore/Population Council, Nairobi, Kenya
| | | | | | - Felix Mutale
- Zambia Agency for Persons with Disabilities, Lusaka, Zambia
| | - Rita Kyeremaa
- Ghana Federation of Disability Organisations, Accra, Ghana
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7
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Myezwa H, Hanass-Hancock J, Pautz N. Investigating the interaction between human immunodeficiency virus, nutrition, and disability: A cross-sectional observational study. Afr J Prim Health Care Fam Med 2018; 10:e1-e8. [PMID: 29943613 PMCID: PMC6018130 DOI: 10.4102/phcfm.v10i1.1663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 01/02/2023] Open
Abstract
Background The average lifespan of people with human immunodeficiency virus (HIV) has increased because of the enhanced access to anti-retroviral treatment. This increased longevity has led to a heightened focus on the comorbidities which may arise, allowing a clearer understanding of the contextual, personal, psychological and functional problems and their interrelations. Disability (functional limitations) and insufficient nutritional intake may interact cyclically with HIV and/or acquired immunodeficiency syndrome (AIDS); however, no research to date has investigated this interaction. Aims The objective of this article was to report on the nutritional outcomes using albumin and body mass index outcomes as a subset of a larger study among adults living with HIV and/or AIDS. Setting This study was conducted at a large HIV clinic based in an urban area in Johannesburg, South Africa, which provides HIV treatment and support to over 6000 persons with HIV and TB. This clinic is part of a large public health regional hospital where extensive HIV research is undertaken. Methods This study was a cross-sectional observational study. The sample composed of 278 participants between 18 and 65 years of age and had been on highly active antiretroviral therapy (HAART) for more than six months. Statistical analyses were performed using the Statistical Package for the Social Sciences. Results The results indicated that albumin level had significant inverse associations with functional limitations and physical health symptoms. Women were significantly more likely to have lower nutritional levels. A logistic regression analysis suggested that gender and physical health symptoms were the primary predictors of albumin levels. Conclusion The findings presented in this article can be applied to HIV and/or AIDS treatment programmes, such as HAART. It re-emphasises the importance of providing individuals on anti-retroviral therapy with affordable and adequate nutrition, education on the importance of nutritional intake and the benefits of potentially adopting supplement programmes. As females seem to be more adversely affected by low nutritional levels, with the findings showing an increased likelihood of developing physical health symptoms, focus also needs to be given to cultural or social factors that impact nutritional intake in women.
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Affiliation(s)
- Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand.
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8
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Stevens ME, Parsons JA, Read SE, Nixon SA. The conceptualization of stigma within a rehabilitation framework using HIV as an example. Disabil Rehabil 2017; 41:235-243. [PMID: 28978242 DOI: 10.1080/09638288.2017.1385099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Stigma theory is concerned with inclusion and opportunities that influence well-being. Rehabilitation is also concerned with social inclusion and well-being. This is a central concern in one of the leading rehabilitation theories, the World Health Organization's International Classification of Functioning, Disability and Health. Despite these shared concerns, the relationship between the fields of stigma and rehabilitation has not been well theorized to date. Using human immunodeficiency virus (HIV) as an example, this article presents an analysis of three ways that stigma may be conceptualized within the context of the International Classification of Functioning, Disability and Health. Three broad spheres of stigma are described: enacted, self, and structural stigma. These three forms of stigma are then aligned in unique ways with three particular constructs of the International Classification of Functioning, Disability and Health: participation restrictions, environmental, and personal contextual factors. This conceptualization illustrates how rehabilitation professionals and other practitioners, policy makers and researchers can better understand the dynamic and nuanced forms of stigma and how they relate to rehabilitation. Implications for rehabilitation This article enables rehabilitation professionals to better understand stigma as it relates to rehabilitation and human immunodeficiency virus. Rehabilitation professionals have the important job of allies and advocates for persons experiencing restrictions in these domains as a result of stigma.
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Affiliation(s)
- Marianne E Stevens
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b International Centre for Disability and Rehabilitation , University of Toronto , Toronto , Canada
| | - Janet A Parsons
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , Canada.,d Applied Health Research Centre , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
| | - Stanley E Read
- e Division of Infectious Diseases , The Hospital for Sick Children , Toronto , Canada.,f Department of Pediatrics , University of Toronto , Toronto , Canada
| | - Stephanie A Nixon
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b International Centre for Disability and Rehabilitation , University of Toronto , Toronto , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , Canada
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Nixon SA, Bond V, Solomon P, Cameron C, Mwamba C, Hanass-Hancock J, Maimbolwa MC, Menon JA, Simwaba P, Sinyinza R, Siwale M, Tattle S, Yates T. Optimism alongside new challenges: using a rehabilitation framework to explore experiences of a qualitative longitudinal cohort of people living with HIV on antiretroviral treatment in Lusaka, Zambia. AIDS Care 2017; 30:312-317. [PMID: 28826230 DOI: 10.1080/09540121.2017.1363365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Previous research has demonstrated increased comorbidities related to the chronic effects of HIV. Rehabilitation science offers a useful approach for studying chronic illness. This longitudinal qualitative study used a rehabilitation science approach to explore the experiences over time of women and men living with HIV and on antiretroviral therapy (ART) in the high HIV-prevalence setting of Lusaka, Zambia. Thirty-five participants participated in a total of 99 in-depth interviews from 2012 to 2015. The central pattern that emerged across the participants' narratives was the paradoxical experience of profound optimism alongside significant new challenges. Participants' stories of hopefulness in the face of ongoing struggles played out in three interconnected themes: (1) impacts on my body and life; (2) interventions I am grateful to have and new interventions I need; and (3) stigma reduced and created by ART. Results reflected the ups and downs of life with HIV as a chronic illness. Participants, whilst committed to and healthier on ART, typically experienced multiple physical, psychological and sensory impairments that varied in type, severity and trajectory. Participants valued improved relationships enabled by ART, but yearned for support for living long-term with HIV. Frequently participants reflected that their needs were overlooked related to managing side-effects, exercise, family planning and healthy sexuality. ART strengthened acceptance by self and others through improved health and productivity and through becoming a source of support for others. However, being on ART also led to stigma, driven by persistent associations with sickness, death, lack of productivity and uncertainty. This study points to shortcomings in the current focus of HIV care in Zambia and the region, which centres on initiating and adhering to ART. Findings call for evolution of the HIV care continuum to embrace a more holistic and long-term approach to living with HIV as a chronic and episodic condition.
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Affiliation(s)
- Stephanie A Nixon
- a Department of Physical Therapy and Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| | - Virginia Bond
- b Global and Health Development Department, Faculty of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK.,c Zambart , School of Medicine , Lusaka , Zambia
| | - Patricia Solomon
- d School of Rehabilitation Science, Institute for Applied Health Sciences , McMaster University , Hamilton , ON , Canada
| | - Cathy Cameron
- e International Centre for Disability and Rehabilitation , Toronto , ON , Canada
| | | | - Jill Hanass-Hancock
- g South African Medical Research Council , University of KwaZulu-Natal School of Health Science , Durban , South Africa
| | | | - J Anitha Menon
- i Department of Psychology , University of Zambia , Lusaka , Zambia
| | | | | | | | - Stephen Tattle
- l Realize (Formerly Canadian Working Group on HIV and Rehabilitation) , Toronto , ON , Canada
| | - Tammy Yates
- l Realize (Formerly Canadian Working Group on HIV and Rehabilitation) , Toronto , ON , Canada
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10
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Cobbing S, Chetty V, Hanass-Hancock J, Myezwa H. "Knowing I can be helpful makes me feel good inside, it makes me feel essential": community health care workers' experiences of conducting a home-based rehabilitation intervention for people living with HIV in KwaZulu-Natal, South Africa. AIDS Care 2017; 29:1260-1264. [PMID: 28278572 DOI: 10.1080/09540121.2017.1290208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
People living with HIV (PLHIV) are living longer lives on antiretroviral therapy and are prone to a wide range of disabilities. Innovative strategies are required to meet the rehabilitation needs of PLHIV, particularly in resource-poor communities where HIV is endemic and access to institution-based rehabilitation is limited. Home-based rehabilitation (HBR) is one such approach, but there is a paucity of research related to HBR programmes for PLHIV or the experiences of community care workers (CCWs) involved in these programmes. Following a four month randomised controlled trial of a HBR intervention designed specifically for PLHIV in KwaZulu-Natal, South Africa; four CCWs were interviewed. This study employed a qualitative research design, using semi-structured interviews to explore these workers' experiences of being involved in carrying out this intervention. Participants reported how their personal development, improvement in their own health and increased feelings of self-worth enabled them to successfully implement the intervention. Participants also described a number of inhibitors, including stigma and environmental challenges related to the distances between patients' homes, the steep terrain and the hot climate. Despite this, the participants felt empowered by acquiring knowledge and skills that enabled them to shift roles beyond rehabilitation provision. The findings of this study should be considered when employing a task shifting approach in the development and implementation of HBR interventions for PLHIV. By employing a less specialised cadre of community workers to conduct basic HBR interventions, both the relative lack of qualified rehabilitation professionals and the high levels of disability in HIV-epidemic communities can be simultaneously addressed.
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Affiliation(s)
- Saul Cobbing
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Verusia Chetty
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Jill Hanass-Hancock
- b HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa
| | - Hellen Myezwa
- c Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
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11
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De Beaudrap P, Beninguisse G, Pasquier E, Tchoumkeu A, Touko A, Essomba F, Brus A, Aderemi TJ, Hanass-Hancock J, Eide AH, Mac-Seing M, Mont D. Prevalence of HIV infection among people with disabilities: a population-based observational study in Yaoundé, Cameroon (HandiVIH). Lancet HIV 2017; 4:e161-e168. [PMID: 28126484 DOI: 10.1016/s2352-3018(16)30209-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. METHODS In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. FINDINGS Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaoundé, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9-5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0-8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6-5·6 for sexual violence and 12·3, 4·4-34·6 for sex work). Analyses were done in men and women. INTERPRETATION The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population. FUNDING Agence nationale de recherches sur le sida et les hépatites virales (ANRS-Inserm) and the 5% Initiative.
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Affiliation(s)
- Pierre De Beaudrap
- IRD, CEPED, UMR 196, INSERM U1244, Université Paris Descartes-Institut de Recherche pour le Développement, Paris, France.
| | - Gervais Beninguisse
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Estelle Pasquier
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon; Initiative 5% Sida, Tuberculose, Paludisme/Expertise France, Paris, France
| | - Alice Tchoumkeu
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Adonis Touko
- Forum Camerounais de Psychologie, Yaoundé, Cameroon
| | - Frida Essomba
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Aude Brus
- Handicap International, Lyon, France
| | | | - Jill Hanass-Hancock
- Medical Research Council & University of KwaZulu-Natal, Durban, South Africa
| | | | - Muriel Mac-Seing
- Handicap International, Lyon, France; School of Public Health, University of Montreal, London, UK
| | - Daniel Mont
- Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK
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Cobbing S, Hanass-Hancock J, Myezwa H. Home-based rehabilitation interventions for adults living with HIV: a scoping review. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016; 15:77-88. [PMID: 27002360 DOI: 10.2989/16085906.2016.1159968] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed, involving systematic search techniques and appraisal of appropriate evidence. English-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases, six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV, the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures, including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular, more research on HBR is required in resource-poor environments, such as sub-Saharan Africa where HIV is endemic, to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most.
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Affiliation(s)
- Saul Cobbing
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Jill Hanass-Hancock
- b Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal
| | - Hellen Myezwa
- c Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
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Sharmin R, Jung B, Shimmell L, Solomon P. Benefits and challenges of role-emerging placements of student occupational therapists in HIV service organisations. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.12.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background and aims: Recognising the importance of occupational therapy for people with Human Immunodeficiency Virus (HIV) has led to the possibility of promoting and integrating services in HIV service organisations through role-emerging placements for student occupational therapists. The objective of this study was to investigate the benefits and challenges of role-emerging placements of student occupational therapists in HIV service organisations. Methods: This study employed qualitative methods to understand the perspectives of student occupational therapists, HIV service organisation staff, an occupational therapy preceptor, and people with HIV following 8-week role-emerging placements of student occupational therapists in HIV service organisations. Transcribed interviews were analysed using content analysis to identify themes. Findings: Results highlighted the following benefits: 1) Reinforcing professional skills; 2) Developing competency in providing rehabilitation services for people with HIV; 3) Shining a light on the role of occupational therapy; and 4) Empowering HIV service organisations. Challenges included: 1) Starting the groundwork; and 2) Building relationships. Conclusion: The placements of student occupational therapists in HIV service organisations can foster the integration of occupational therapy services in these organisations to maintain the optimum community responses. Findings also demonstrated the value that role-emerging placements have in increasing the competencies of the student occupational therapists as future rehabilitation professionals.
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Affiliation(s)
- Rabeya Sharmin
- Graduate student, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Bonny Jung
- Associate professor, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Lorie Shimmell
- Director of clinical education (occupational therapy), assistant professor, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Patricia Solomon
- Professor and associate dean, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Cobbing S, Hanass-Hancock J, Myezwa H. A Home-Based Rehabilitation Intervention for Adults Living With HIV: A Randomized Controlled Trial. J Assoc Nurses AIDS Care 2016; 28:105-117. [PMID: 27686717 DOI: 10.1016/j.jana.2016.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/26/2016] [Indexed: 11/17/2022]
Abstract
A randomized controlled trial was conducted to investigate the effects of a 16-week home-based rehabilitation (HBR) intervention on the quality of life, functional mobility, and functional capacity of adult people living with HIV (PLWH) on antiretroviral therapy in KwaZulu-Natal, South Africa. The intervention was carried out by community health care workers under the supervision of a qualified physical therapist. Participants in the control group received the standard of care as well as written health advice. While participants in the intervention group showed greater improvements across all outcome measures, between-group differences were nonsignificant. HBR for PLWH is a safe means of addressing the functional deficits experienced by PLWH and appears likely to improve quality of life. A task-shifting approach may be a feasible method of meeting the varied needs of PLWH, while at the same time potentially minimizing costs to already overburdened health care systems.
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Nixon S, Cameron C, Mweshi M, Nkandu EM, Okidi C, Tattle S, Yates T. "It Is an Eye-Opener That There Is a Relationship between Rehabilitation and HIV": Perspectives of Physiotherapists and Occupational Therapists in Kenya and Zambia on the Role of Rehabilitation with Adults and Children Living with HIV. Physiother Can 2016; 68:290-297. [PMID: 27909379 DOI: 10.3138/ptc.2015-42gh] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To present the perspectives of rehabilitation providers-physiotherapists and occupational therapists-in Kenya and Zambia on the role of rehabilitation in the care of adults and children living with HIV. Methods: This qualitative, interpretivist study was part of a broader project to adapt a Canadian e-module on HIV-related disability for rehabilitation providers in Sub-Saharan Africa (SSA). Focus groups, demographic questionnaires, and knowledge-attitude-belief surveys were conducted with rehabilitation providers in Kenya and Zambia. Focus group data were analyzed inductively using an iterative content analysis. Results: Sixty-three rehabilitation providers (52 physiotherapists, 11 occupational therapists) participated in 10 focus groups in Nyanza Province, Kenya, and Lusaka, Zambia. The participants described the role of rehabilitation in HIV care in terms of missed opportunities related to (1) HIV disclosure; (2) inter-professional and inter-sectoral collaboration; (3) community-based rehabilitation; (4) training for rehabilitation providers; (5) pediatric rehabilitation; and (6) the connections among disability, HIV, and poverty. Conclusions: The results point to the need for HIV policy and practice leaders to develop new models of care that recognize the crucial role of rehabilitation in the long-term management of HIV to address the shifting needs of the 25 million people living longer with HIV in SSA.
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Affiliation(s)
| | - Cathy Cameron
- International Centre for Disability and Rehabilitation, University of Toronto
| | - Margaret Mweshi
- Physiotherapy Department, University of Zambia, Lusaka, Zambia
| | | | | | - Stephen Tattle
- Canadian Working Group on HIV and Rehabilitation, Toronto
| | - Tammy Yates
- Canadian Working Group on HIV and Rehabilitation, Toronto
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Hanass-Hancock J, Misselhorn A, Carpenter B, Myezwa H. Determinants of livelihood in the era of widespread access to ART. AIDS Care 2016; 29:32-39. [PMID: 27350256 DOI: 10.1080/09540121.2016.1201192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We have only just begun to understand the long-term impact of living with chronic HIV on health and livelihood after a decade of widespread access to treatment in southern Africa. This paper explores health and well-being, disability, and livelihood dynamics among people living with HIV (PLHIV) in a public healthcare setting in South Africa. We undertook a cross-sectional survey among a cohort of 1042 people on ART and explored associations between socio-demographic characteristics, treatment adherence, measures of disability (functional and activity limitations), livelihood resources (capitals) and outcomes, including food security, and exposure to livelihood shocks. A range of dynamic relationships relevant for decision-makers is evident. Age, gender, and marital status all had significant associations with levels of livelihood capitals and outcomes. Those who had been on ART for longer periods of time also had significantly higher aggregate livelihood capital. This was particularly driven by social and financial capital. Livelihoods are built within specific social and health contexts. Of particular importance is that the resources drawn on to build a livelihood differ significantly between men and women, and that different forms of disability also have gender-specific pathways in influencing livelihood and livelihood outcomes. Our results support the need for a gender-sensitive approach to supporting the well-being and livelihoods of PLHIV. Of equal importance is an approach that considers more comprehensively the new experiences of comorbidities and disabilities that may occur with a long life on ART.
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Affiliation(s)
- Jill Hanass-Hancock
- a Health Economics and HIV and AIDS Research Division , University of KwaZulu-Natal , Durban , South Africa
| | - Alison Misselhorn
- a Health Economics and HIV and AIDS Research Division , University of KwaZulu-Natal , Durban , South Africa
| | - Bradley Carpenter
- a Health Economics and HIV and AIDS Research Division , University of KwaZulu-Natal , Durban , South Africa
| | - Hellen Myezwa
- b Department of Physiotherapy, Faculty of Health , University of the Witwatersrand , Johannesburg , South Africa
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van Egeraat L, Hanass-Hancock J, Myezwa H. HIV-related disabilities: an extra burden to HIV and AIDS healthcare workers? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016; 14:285-94. [PMID: 26439603 DOI: 10.2989/16085906.2015.1084938] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Healthcare workers have been at the forefront of dealing with the impact of HIV and AIDS at all stages of the pandemic. This brings new challenges to include disability into HIV care. However, the implications for healthcare workers in an already fragile health system along with HIV-related disabilities in persons living with HIV are little understood. This study examined the healthcare workers' perspective on disability in HIV care. METHOD This article describes a qualitative study using in-depth interviews with 10 healthcare workers in a semi-urban hospital setting in KwaZulu-Natal, South Africa. The study aimed to understand healthcare workers' experiences with disability in the context of HIV. The International Classification of Functioning Disability and Health (ICF) was used as a guiding framework to understand disability. RESULTS Healthcare workers described HIV-related disabilities on all three levels of disability, namely impairments/ body function, activity limitations and participation restrictions, as affecting the livelihood of their patients and household members. Issues also arose from disability and stigma that were perceived as affecting adherence to antiretroviral treatment. In addition, healthcare workers encounter challenges in dealing with the increased needs of care and support for those people living with HIV who experience HIV-related disabilities. They indicated a limited ability to cope and respond to these needs. Primarily they arrange additional referrals to manage complex or episodic disabilities. Participants also identified issues such as excessive work load, lack of resources and training and emotional challenges in dealing with disability. CONCLUSION Healthcare workers need support to respond to the increased needs of people living with HIV who have HIV-related disabilities. Responses need to reflect: 1) increase in rehabilitative staff including in community outreach programmes; 2) skills training in HIV-related disability; and 3) psychosocial support for healthcare workers.
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Affiliation(s)
- Leonie van Egeraat
- a Health Economics and HIV/AIDS Research Division (HEARD) , University of KwaZulu-Natal , South Africa.,b VU University , Amsterdam , The Netherlands
| | | | - Hellen Myezwa
- c University of the Witwatersrand , Johannesburg , South Africa
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18
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Mitchell MM, Maragh-Bass AC, Nguyen TQ, Isenberg S, Knowlton AR. The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS. AIDS Care 2016; 28:1280-6. [PMID: 27050708 DOI: 10.1080/09540121.2016.1168916] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronic pain and substance use can strain the supportive relationships of persons with serious chronic illness, which may increase the likelihood of receiving negative, rather than positive, social support from informal caregivers and social network members. To our knowledge, this is the first study to longitudinally examine the effects of chronic pain and substance use on negative social support. The sample (N = 383) comprised disadvantaged, primarily African-American, persons living with HIV/AIDS with a history of injection drug use, 32.4% of whom reported frequent or constant pain in the prior 6 months. Using factor analysis and structural equation modeling, current substance use and greater levels of chronic pain positively predicted negative social support 12 months later, after controlling for baseline negative support, viral load, age and sex. We also found a significant interaction effect such that among those not using substances, there was a significant positive association between pain and negative support, but no such association among those currently using substances. The findings emphasize the importance of treatment of chronic pain and substance use in the supportive functioning of social networks of a disadvantaged population with serious chronic conditions and persistent health disparities.
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Affiliation(s)
- Mary M Mitchell
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Allysha C Maragh-Bass
- b Department of Surgery, Harvard School of Medicine, Harvard School of Public Health, Center for Surgery and Public Health , Brigham and Women's Hospital , Boston , MA , USA
| | - Trang Q Nguyen
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sarina Isenberg
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Amy R Knowlton
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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De Beaudrap P, Pasquier E, Tchoumkeu A, Touko A, Essomba F, Brus A, Desgrées du Loû A, Aderemi TJ, Hanass-Hancock J, Eide AH, Mont D, Mac-Seing M, Beninguisse G. HandiVIH--A population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations. BMJ Open 2016; 6:e008934. [PMID: 26846895 PMCID: PMC4746454 DOI: 10.1136/bmjopen-2015-008934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities. METHODS AND ANALYSIS The HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaoundé (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents' life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled people's organisations is collected separately. ETHICS AND DISSEMINATION This study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities. TRIAL REGISTRATION NUMBER NCT02192658.
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Affiliation(s)
- Pierre De Beaudrap
- IRD, CEPED, UMR 196, Université Paris Descartes—Institut de Recherche pour le Développement (IRD), Paris, France
| | - Estelle Pasquier
- Initiative 5% Sida, Tuberculose, Paludisme/Expertise France, Paris, France
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Alice Tchoumkeu
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Adonis Touko
- Forum Camerounais de Psychologie, Yaoundé, Cameroon
| | - Frida Essomba
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Aude Brus
- Handicap International, Lyon, France
| | - Annabel Desgrées du Loû
- IRD, CEPED, UMR 196, Université Paris Descartes—Institut de Recherche pour le Développement (IRD), Paris, France
| | | | | | | | - Daniel Mont
- Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK
| | | | - Gervais Beninguisse
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
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Hanass-Hancock J, Myezwa H, Carpenter B. Disability and Living with HIV: Baseline from a Cohort of People on Long Term ART in South Africa. PLoS One 2015; 10:e0143936. [PMID: 26625001 PMCID: PMC4666651 DOI: 10.1371/journal.pone.0143936] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Through access to life saving antiretroviral treatment (ART) in southern Africa, HIV has been reconceptualised as a chronic disease. This comes with new challenges of HIV-related co-morbidities and disabilities. We still lack an understanding of the types and scope of disabilities experienced by people on long term ART and how this impacts health, adherence, and livelihood. This paper describes the results of a cohort study examining the new health- and disability-related needs of the millions of people on ART in the region. METHODS Data was collected from a cohort of people who had been on ART for six months or longer in a semi-urban public health care setting in South Africa. 1042 adults (18 and older) participated in the cross-sectional study which investigated disabilities/activity limitations, health, ART adherence, depression symptoms, and livelihood. We analysed the associations between these constructs using descriptive statistics, and bivariate and multivariate analyses. RESULTS A large number of participants (35.5%) obtained a weighted score of two or more on the WHODAS 2.0 indicating possible activity limitations. A positive relationship was found between activity limitations and depression symptoms, adherence, and worse health outcomes, while none was found for BMI or CD4 count. These associations varied by type of activity limitations and, in some cases, by gender. CONCLUSION Activity limitations are potentially experienced by a large portion of people on ART in southern Africa which impacts health and ART adherence negatively. These results highlight the importance of better understanding the new health-related needs of people who are on long term ART, as well as the nuances of the disability they experience. This is urgently needed in order to enable HIV-endemic countries to better prepare for the new health-related needs of the millions of people on ART in southern Africa.
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Affiliation(s)
- Jill Hanass-Hancock
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bradley Carpenter
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Chetty V, Hanass-Hancock J, Myezwa H. Expert Consensus on the Rehabilitation Framework Guiding a Model of Care for People Living With HIV in a South African Setting. J Assoc Nurses AIDS Care 2015; 27:77-88. [PMID: 26585032 DOI: 10.1016/j.jana.2015.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/23/2015] [Indexed: 11/28/2022]
Abstract
Disabilities and treatments related to HIV are a focus for rehabilitation professionals in HIV-endemic countries, yet these countries lack guidance to integrate rehabilitation into a model of care for people living with HIV. We asked HIV and rehabilitation experts in South Africa to engage in a modified Delphi survey based on findings from (a) an enquiry into stakeholder perspectives of a context-specific rehabilitation framework at a semi-rural setting and (b) an analysis of international models of care-guiding rehabilitation. Consensus was determined by an a priori threshold of 70% of agreement and interquartile range (≤ 1 on criterion) to be included as essential or useful in the model of care framework. Experts agreed that improving access to care, optimal communication between stakeholders, education and training for health care workers, and home-based rehabilitation were essential for the model. Furthermore, task shifting and evidence-based practice were seen as fundamental for optimal care.
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Hanass-Hancock J, Alli F. Closing the gap: training for healthcare workers and people with disabilities on the interrelationship of HIV and disability. Disabil Rehabil 2015; 37:2012-21. [PMID: 25524557 DOI: 10.3109/09638288.2014.991455] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND HIV and disability are interrelated providing a double burden to HIV endemic countries in East and Southern Africa and their already fragile health systems. Although literature reveals that people with disabilities are particularly vulnerable to HIV and that HIV, its opportunistic infections and treatments can cause disability, only few interventions target this issue and none have been evaluated in this region. METHODS Formative evaluation was undertaken with regard to the effectiveness of a workshop-based intervention for healthcare workers and people with disabilities on the intersection of disability and HIV in order to inform the further development of this intervention. The formative evaluation assessed participants' perception of the inclusion of disability in HIV services and of opportunities to initiate change after the workshops. It also captured their experiences in utilising knowledge and skills after the workshops using quantitative (short checklist and ranking exercise) and qualitative (semi-structured interviews) methods of inquiry. Frequencies and conventional content analysis were used in the analysis of the data. This study presents an example of applied research conducted under real-world conditions. RESULTS 60 healthcare workers and people with disabilities took part in this pilot workshop training and participated in the formative evaluation. Healthcare workers and people with disabilities alike identified various barriers to access health services. Reasonable accommodation was perceived as being mainly absent by most participants, while some participants indicated a lack of physical accessibility in the form of universal design. Participants also identified a lack of integration of services and disability-related skills within the healthcare staff. Participants reported a number of enablers, success and challenges while implementing the knowledge from the workshops related to structural issues, service provision and integration. While participants worked on health workers' attitudes and accessibility of services, screening and referrals practice was not improved through the workshops. CONCLUSIONS Formative evaluation indicates that the workshops can be effective not only in sensitising healthcare workers and people with disabilities to opportunities to improve services for people with disabilities but also to provide knowledge and skills to initiate improvements. Skills that need more practical training (e.g. screening for disability) need to be trained in more detail, and this will inform the adaptation of the workshops. However, the workshop evaluation also revealed that without policy implementation and budget allocations this change would only be limited. Implications for Rehabilitation HIV, its co-morbidities and treatments cause health conditions and impairments that have the potential to develop into disability. People with disabilities are at increased risk of exposure to HIV. Rehabilitation professionals, healthcare workers and people with disabilities can be sensitised in a three-day workshop on the relationship of disability and HIV. However, the trained participants can only implement no or low-cost elements of interventions, while high-cost interventions need budget allocations at provincial and national level.
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Chetty V, Hanass-Hancock J. The need for a Rehabilitation Model to address the disparities of public healthcare for people living with HIV in South Africa. Afr J Disabil 2015; 4:137. [PMID: 28730023 PMCID: PMC5433471 DOI: 10.4102/ajod.v4i1.137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 02/16/2015] [Indexed: 11/06/2022] Open
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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Affiliation(s)
- Verusia Chetty
- Discipline of Physiotherapy, University of KwaZulu-Natal, South Africa
| | - Jill Hanass-Hancock
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, South Africa
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Hanass-Hancock J, Myezwa H, Nixon SA, Gibbs A. "When I was no longer able to see and walk, that is when I was affected most": experiences of disability in people living with HIV in South Africa. Disabil Rehabil 2014; 37:2051-60. [PMID: 25524661 DOI: 10.3109/09638288.2014.993432] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE HIV-related disability is an emerging issue in countries where HIV is endemic. This study aimed to understand experiences of disability in patients living with HIV in South Africa using the International Classification of Functioning, Disability and Health (ICF) as a guiding framework. METHODS In-depth interviews were conducted with 19 HIV-positive people receiving ART through a public hospital in KwaZulu-Natal. Data were analyzed using collaborative qualitative content analysis. RESULTS Participants described a variety of impairments related to mental, sensory, neuromusculoskeletal, skin, cardiovascular, digestive or reproductive systems. A tenuous relationship was evident between HIV and mental health impairments and the experience of other disabilities. Impairments affected participants' activity levels, especially mobility, domestic life, self-care and ability to work. Activity limitations affecting livelihood were often of more concern to participants than the impairments. Furthermore, women and men appeared to experience disability related to activities relevant to gendered norms in their cultural context. CONCLUSIONS More understanding of the intersections among HIV, disability, gender and livelihood is needed. To respond to the increased need to manage disability within HIV care in Africa, HIV programs should include rehabilitative approaches, address concerns related to livelihoods in households with disability and consider gender differences in the experience of disability. IMPLICATIONS FOR REHABILITATION HIV, its opportunistic infections and the treatments associated to them are related to health conditions and impairments that have the potential to develop into disability. Rehabilitation professionals in HIV endemic countries have therefore a larger and changing number of people living with HIV and need to consider the impact of the disease on the rehabilitation process. Mental health issues and disability might be interrelated and affect antiretroviral treatment (ART) adherence. Hence, rehabilitation has to use a holistic approach and integrate different therapy approaches (e.g. physiotherapy and mental health). The experience of living with HIV and developing disability has unreflected gender dynamics that need to be considered in rehabilitative care. Hence, the rehabilitation process has to consider the cultural realities and gendered experience of the condition. The study highlights the interrelationship between disability levels, the influence of environmental and social factors, and the changing experience related to gender. Hence, rehabilitation professionals in resource-poor settings have to go beyond the clinical response and therapy approaches in order to improve the activity and participation of people with disabilities and those living with HIV in their homes and communities. Community or home-based care might be avenues to further explore.
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Affiliation(s)
- Jill Hanass-Hancock
- a Health Economics HIV and AIDS Research Division (HEARD) , UKZN , Durban , South Africa
| | - Hellen Myezwa
- b Department of Physiotherapy , University of Witwatersrand (WITs) , Johannesburg , South Africa
| | - Stephanie A Nixon
- a Health Economics HIV and AIDS Research Division (HEARD) , UKZN , Durban , South Africa .,c Department of Physical Therapy , University of Toronto , Toronto , Canada , and.,d International Centre for Disability and Rehabilitation, University of Toronto , Toronto , Canada
| | - Andrew Gibbs
- a Health Economics HIV and AIDS Research Division (HEARD) , UKZN , Durban , South Africa
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De Beaudrap P, Mac-Seing M, Pasquier E. Disability and HIV: a systematic review and a meta-analysis of the risk of HIV infection among adults with disabilities in Sub-Saharan Africa. AIDS Care 2014; 26:1467-76. [PMID: 25033274 DOI: 10.1080/09540121.2014.936820] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
More than one billion people worldwide are estimated to be living with a disability. A significant proportion of them lives in Sub-Saharan Africa where they are reported to be at increased risk of HIV. However, quantitative evidence on this remains scarce. A systematic review and a meta-analysis of the risk of HIV infection among people with disabilities living in Sub-Saharan Africa were undertaken. We searched all published or unpublished studies and national surveys reporting HIV prevalence among adults with disabilities living in Sub-Saharan Africa between 2000 and 2013. The risk ratio (RR) of HIV infection in people with disabilities versus people without disabilities was estimated through a random-effects meta-analysis. Of the 12,252 references screened, 13 studies were selected. HIV prevalence varied widely across studies from 1.1% to 29%. Pooled RRs of HIV infection in people with disabilities compared to the general population were 1.31 (1.02-1.69) overall; 1.16 (0.71-1.87) among people with mental illness or intellectual disabilities and 1.07 (0.58-1.95) among people with hearing disabilities. This meta-analysis provides evidence that people with disabilities do not have a lower risk of HIV when compared to the general population, and that women with disabilities are especially affected. A clear increasing gradient in the risk of HIV according to gender and disability status was also observed. The important heterogeneity across studies and their varying quality warrant a closer look at the intersection between disability and HIV. Additional studies with more systematic approaches and with higher-quality methodologies are required to further address this knowledge gap.
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Affiliation(s)
- Pierre De Beaudrap
- a Institut de Recherche pour le Développement , Université de Montpellier I , Montpellier , France
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