HIV knowledge and access to testing for people with and without disabilities in low- and middle-income countries: evidence from 37 Multiple Indicator Cluster Surveys.

INTRODUCTION: Disability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV, and living with HIV can lead to impairments and disability. Despite this well-established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities. METHODS: We used cross-sectional data from 37 Multiple Indicator Cluster Surveys. Surveys were from six UNICEF regions, including East Asia and Pacific (n = 6), East and Central Asia (n = 7), Latin America and the Caribbean (n = 6), Middle East and North Africa (n = 4), South Asia (n = 2) and sub-Saharan Africa (n = 12). A total of 513,252 people were eligible for inclusion, including 24,695 (4.8%) people with disabilities. We examined risk ratios and 95% confidence intervals for key indicators on HIV knowledge and access to testing for people with disabilities by sex and country. We also conducted a meta-analysis to get a pooled estimate for each sex and indicator. RESULTS: Men and women with disabilities were less likely to have comprehensive knowledge about HIV prevention (aRR: 0.74 [0.67, 0.81] and 0.75 [0.69, 0.83], respectively) and to know of a place to be tested for HIV (aRR: 0.95 [0.92, 0.99] and 0.94 [0.92, 0.97], respectively) compared to men and women without disabilities. Women with disabilities were also less likely to know how to prevent mother-to-child transmission (aRR: 0.87 [0.81, 0.93]) and ever have been tested for HIV (aRR: 0.90 [0.85, 0.94]). CONCLUSIONS: Men and women with disabilities have lower overall HIV knowledge and in particular women with disabilities also indicate lower testing rates. Governments must include people with disabilities in HIV programmes by improving disability-inclusion and accessibility to HIV-related information, education and healthcare services.

Peer-to-Peer Chain Recruitment for Enrolling Young South African Women into an HIV Pre-exposure Prophylaxis (PrEP) Intervention Study: How Did It Perform?

Peer-to-peer chain recruitment has been used for descriptive studies, but few intervention studies have employed it. We used this method to enroll sexually active women ages 18 to 25 into an online Pre-Exposure Prophylaxis (PrEP) information and motivation intervention pilot in eThekwini (Durban), South Africa. Seeds (N = 16) were recruited by study staff and randomized to Masibambane, Ladies Chat, a Gender-Enhanced group-based WhatsApp Workshop (GE), or Individual-Access (IA), a control condition that provided participants with online information/motivation materials only. Each seed could recruit up to three women to participate in the same study condition, with an incentive for each enrolled woman; participants in subsequent waves could choose to recruit or not. We evaluated if peer-to-peer recruitment was self-sustaining and resulted in enrolling women who, in subsequent waves, had less contact with the health care system and less knowledge about PrEP than the initial seeds. Over three recruitment waves beyond the seeds, 84 women were recruited. Almost 90% of women became recruiters, with each recruiting on average 1.90 women and 1.26 eligible enrolled women. The approach was successful at reaching women with less education but not women with less health system contact and PrEP knowledge across waves. IA participants had a slightly higher, though non-significantly different, percentage of individuals who became Peer Health Advocates (PHAs) than GE participants and, on average, they recruited slightly more women who enrolled. Our findings demonstrated that peer-to-peer recruitment is a feasible and self-sustaining way to recruit SA young women into a PrEP intervention study.

What cut-off(s) to use with the Washington Group short set of questions?

The Washington Group short set (WG-SS) questions are increasingly integrated into national household surveys, censuses, and international survey programs. They enable the monitoring of disability rights and the production of internationally comparable statistics. Disability statistics on prevalence and inequalities can be estimated using different cut-offs on the degree of functional difficulties based on the WG-SS. This commentary discusses what cut-offs to adopt for the purpose of investigating and monitoring disability gaps. We recommend a three-way disaggregation comparing persons with (a) no difficulty, (b) some difficulty and (c) a lot of difficulty or unable to do. In cases where sample sizes are small for disaggregated analysis, we recommend comparing persons with no difficulty to persons with any level of difficulty (i.e. persons with any disability).

"A frightening experience, especially at our age": Examining the neglect and abuse of older persons in HIV prevention and care programs.

Background: As the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services and how those experiences translate into the neglect and abuse of older persons. The study also explored older people's perspectives on community responses to HIV in older people. Methods: This qualitative analysis used data from 37 individuals who participated in focus group discussions conducted in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analyzed. Results: The study participant's mean age was 59.6 years. Major themes emerging from the data included factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to the abuse of older people, and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV at an older age as they feared judgment and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system that fueled community stigma. Participants also experienced neglect, verbal and emotional abuse at healthcare facilities. Conclusion: Although there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programs in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of people age and live longer with HIV, the neglect and outright abuse of older persons need urgent policy and program interventions.

Masibambane-Ladies Chat: Developing an Online Gender-Enhanced PrEP Information-Motivation Workshop for Young South African Women.

This article describes the processes of transforming an in-person group-based intervention to promote uptake of PrEP among young woman in South Africa to an online interactive "workshop" during the COVID-19 pandemic. Beginning in person and continuing virtually, we used a step-by-step participatory approach with multiple stakeholder groups to develop nine activities to increase knowledge about, as well as motivation and intention to take PrEP, and to address gender-based barriers to PrEP. Activities were informed by our theoretical framework and formative work with young women ages 18-25. We demonstrate how we developed a gender-enhanced online PrEP workshop that was interactive, group-based, and in accordance with elements of established successful intervention design; why WhatsApp emerged as the most accessible application for the young women in our workshop; and how an intervention with a hybrid approach-alternating between chat box and live sessions-combined with verbal, written, and emoji-based communication enabled interaction among participants.

How the Term 'Self-Management' is Used in HIV Research in Low- and Middle-Income Countries: A Scoping Review.

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.

Intersections between disability, masculinities, and violence: experiences and insights from men with physical disabilities from three African countries.

BACKGROUND: Gender-transformative work in the Global South often focuses on transforming 'toxic masculinities' to prevent intimate partner violence (IPV), but there has been little research on whether and how constructions of masculinities by men with disabilities shape their experiences and perpetration of violence. METHODS: We used repeated in-depth interviews and content analysis to understand whether and how physical disability intersects with the construction of masculinities and experience/perpetration of violence among 15 adult men with physical disabilities participating in interventions to prevent IPV in Ghana, Rwanda, and South Africa. RESULTS: Societal expectations and participants' aspirations around masculinity impacted their vulnerability to violence mainly by men without disabilities. Participants reported experiences of disrespect and social exclusion in their communities and felt incapable of protecting themselves when being violated. Most participants felt they were not providing for their families and perceived themselves as having lost decision-making and positions of power in their homes. They expressed their disappointment with having reduced stamina, virility, and sexual prowess in intimate partnerships as a result of their disability. While participants reported that they could not attain key markers of idealized masculinity, placed upon and often internalized by themselves, they longed to achieve these markers to facilitate their inclusion and acceptance in their communities. CONCLUSIONS: Programmers addressing violence need to engage with men with physical disabilities and consider the intersectionality of masculinities and disability, how these reinforce patriarchal norms and how men with disabilities can be included and enabled to overcome their conflict between disability and masculinities.

"You tell him that 'baby, I am protecting myself'": Women's agency and constraint around willingness to use pre-exposure prophylaxis in the Masibambane Study.

OBJECTIVES: To explore women's willingness to consider using pre-exposure prophylaxis for HIV prevention in the context of gendered relationship dynamics, in Durban, South Africa. METHODS: As formative research prior to development of a gender-informed intervention to introduce pre-exposure prophylaxis to young, urban, educated women, we conducted six focus-group discussions and eight in-depth interviews with 46 women ages 18-25 years, who were not current pre-exposure prophylaxis users. Women were recruited from clinic and community settings using a criterion-based snowball sampling technique. Qualitative data were coded and analyzed thematically, with a team-based consensus approach for final coding, analytical decisions, and data interpretation. RESULTS: Women clearly understood the benefits of pre-exposure prophylaxis for themselves and their partners, focusing on promoting health and their right to protect themselves from HIV infection. At the same time, and in accordance with findings from other studies, women were realistic about the concerns that would arise among male partners, including disapproval, loss of trust, possible loss of the relationship, and in some instances, the potential for violence, if they were to propose pre-exposure prophylaxis use. To resolve this tension, some women advocated for covert use as the best option for themselves and others argued for disclosure, proposing various approaches to working with partners to adopt pre-exposure prophylaxis. The suggestion that both partners use pre-exposure prophylaxis was made repeatedly. Thus, women sought to avoid discussions of trust or lack of trust and a partner's possible infidelities, choosing instead to focus on preserving or even building a relationship through suggesting pre-exposure prophylaxis use. CONCLUSION: Women offered diverse narratives on agency and constraint in relation to choosing pre-exposure prophylaxis as a future prevention strategy, as well as ways to engage with their male partners about pre-exposure prophylaxis. These findings speak to the need for interventions to bolster women's confidence, sense of empowerment, and their communication and decision-making skills for successful HIV prevention.

Left behind: persons with disabilities in HIV prevalence research and national strategic plans in east and Southern Africa.

PURPOSE: To assess recent estimates of HIV prevalence and the inclusion of persons with disabilities in the HIV response in sub-Saharan Africa. METHODS: A systematic literature search was conducted of recent HIV prevalence studies among persons with disabilities in sub-Saharan Africa and National Strategic Plans from 18 countries in east and southern Africa were reviewed. Results were compared to a 2014 literature search and a 2009 National Strategic Plans review that used similar methods. RESULTS: Between 2013 and 2018, four published studies were identified with estimates of HIV prevalence among persons with disabilities in sub-Saharan Africa. In each study, HIV prevalence was higher among persons with disabilities than national population estimates. Fourteen of the 18 National Strategic Plans reviewed identified persons with disabilities as a vulnerable or marginalized population and thirteen National Strategic Plans proposed targeted programs for persons with disabilities. Among seven assessed disability inclusion indicators of National Strategic Plans, four showed some improvement, two showed no change, and one regressed compared to the 2009 analysis. CONCLUSIONS: Data on HIV prevalence among persons with disabilities is rare. In addition, inclusion of this population in National Strategic Plans in East and Southern African countries is often lacking specific detail.Implications for rehabilitationHIV prevalence studies in sub-Saharan Africa among persons with disabilities are rare and community studies do not disaggregate by type of disability.Estimates of HIV prevalence among persons with disabilities are greater than national averages.Government National HIV Strategic Plans often mention persons with disabilities as a vulnerable population but less often identify specific interventions or inclusive strategies for prevention or care.The integration of attention to disability in national HIV bio-behavioral surveys would allow increased understanding of HIV vulnerability and prevalence and could increase attention to persons with disabilities as a key population within National Strategic Plans.

Disability, a priority area for health research in South Africa: an analysis of the burden of disease study 2017.

PURPOSE: Disabilities are increasing globally, which is attributed to the overall ageing of populations in affluent countries. This trend may differ in low and middle-income countries. This paper assesses the change over time in Years Lived with Disability (YLD) for South Africa and how this compares to regional and global trends. MATERIALS AND METHODS: This secondary analysis of the Global Burden of Disease Study 2017 dataset describes the observed contribution of YLD to Disability-Adjusted Life Years (DALYs) per 100 000 people over the period 1990-2016, and forecast to 2030 using simple linear prediction. South African trends are compared to global and sub-Saharan African (SSA) trends to highlight the effect of HIV and policy implications. RESULTS: Globally, the contribution of YLD to DALYs has increased from ±21.7% in 1990 to ±34% by 2016, with high socio-demographic index countries having a higher contribution (49%). HIV, mental health, musculoskeletal, neurological, and sense organ disorders are the five main contributors to YLD in South Africa (54%). Removing the effects of HIV/AIDS and sexually transmitted infections on YLD, South Africa's trend appears similar to the global trend, yet opposite to the SSA trend. CONCLUSION: Our analysis shows there is a growing burden of disability in South Africa. Differences in trends with the regional and global patterns can be attributed to the high burden of HIV and non-communicable diseases in South Africa. Therefore, strategies are urgently needed to increase integration of disability and rehabilitation services into chronic HIV and non-communicable disease management. This calls for disability screening to identify functional limitations in routine data collection and case management.IMPLICATIONS FOR REHABILITATIONSouth Africa has experienced an increase in disability prevalence over time.This requires strengthening of services such as mental health interventions, physiotherapy, optometry, and audiology, and linking major disease clusters, such as HIV and the NCDs, to rehabilitation services.The greatest contributors towards disability adjusted life years in South Africa are currently mental disorders (13.8%), HIV and sexually transmitted infections (11.8%), musculoskeletal disorders (10.4%), neurological disorders (8.2%), and sense organ diseases (7.5%).Routine data collection and case management needs to include disability screening to identify developing functional limitations.

Participants' characteristics and motivations to screen for HIV vaccine and monoclonal antibody trials in KwaZulu-Natal, South Africa.

BACKGROUND: HIV is one of the greatest public health challenges in South Africa. Potential HIV vaccines and antibodies are thought to be cost-effective biomedical HIV prevention methods and are currently under investigation in phase I, II, and III trials. Consequently, current and future clinical trials need to ensure sufficient recruitment and retention. To achieve this goal, clinical trial staff need to understand the socio-demographic and behavioural characteristics of people volunteering to screen for these trials and their reasons for volunteering. METHODS: We conducted a secondary analysis of participant screening data across five vaccine and monoclonal antibody trials at four sites in KwaZulu-Natal, South Africa. Our study reviewed the demographic, behavioural, motivational, and health-related data from the case report forms and screening questionnaires. Descriptive statistics, chi-squared, and one-way ANOVA tests were used to analyse participants' characteristics and motivation to participate in HIV vaccine and monoclonal antibody trials. Analyses were conducted using R version 3.5.2. RESULTS: Screening data from 1934 participants, including 79.2% of women, were obtained across all five trials (1034 enrolled, 900 screened out/declined). Screened participants predominately self-identified as black, heterosexual, cisgender women or men, many with lower educational backgrounds (43.9% did not complete secondary/high school), and several self-reported HIV-risk behaviours among themselves and their partners. 10.8% of the screened participants were living with HIV. Avoiding HIV risk was the main motivation to participate in clinical trials, followed by altruistic reasons such as a desire to help the community or helping to find a vaccine. DISCUSSION: The current recruitment approach of these trials attracts heterosexual participants who seek to reduce HIV risk and support their community. Hence, the data suggest the need for and potential acceptance of continued ongoing HIV prevention efforts. Current trials attract participants with lower educational levels, which may be driven by the site locations, current community mobilisation strategies and research site opening hours. The sites could consider more flexible working hours to accommodate working participants and find ways to connect participants to educational support and opportunities to upgrade education levels for the current clientele. TRIAL REGISTRATION: HVTN 100: A Safety and Immune Response Study of 2 Experimental HIV Vaccines, NCT02404311 . Registered on March 17, 2015. HVTN 111: Safety and Immune Response to a Clade C DNA HIV Vaccine, NCT02997969. Registered on December 16, 2016. HVTN 108: Evaluating the Safety and Immunogenicity of HIV Clade C DNA Vaccine and MF59- or AS01B-Adjuvanted Clade C Env Protein Vaccines in Various Combinations in Healthy, HIV-Uninfected Adults, NCT02915016. Registered on September 22, 2016. HVTN 702: Pivotal Phase 2b/3 ALVAC/Bivalent gp120/MF59 HIV Vaccine Prevention Safety and Efficacy Study in South Africa, NCT02968849. Registered on November 1, 2016. HVTN 703/HPTN 081: Evaluating the Safety and Efficacy of the VRC01 Antibody in Reducing Acquisition of HIV-1 Infection in Women, NCT02568215 . Registered on October 1, 2015.

Trends in health and disability in Botswana. An analysis of the global burden of disease study.

PURPOSE: Globally, years of life lost are declining, while years lived with disability are increasing. In high socio-demographic index countries, this trend has been attributed to an overall ageing population and rehabilitation services have begun to adjust to this change. In low- and middle-income countries, this trend is less well understood. Hence, the WHO's 'Rehabilitation 2030 Call for Action' and 'Rehabilitation in Health Systems Guide' call for better assessment of the situation. In order to understand trends and causes in middle income countries such as Botswana, we examine the change over time in causes and number of years lived with disability and years of life lost. METHODS: We conducted a secondary analysis of the Global Burden of Disease 2017 data, exploring the change over time in Disability Adjusted Life Years per 100 000 people over the period 1990-2016. The descriptive analysis focuses on the contribution of years lived with disability towards the burden of disease within Botswana compared with the world, sub-Saharan Africa, and high-income countries. RESULTS: Our results show that Botswana's top causes of years of life lost are HIV and other sexually transmitted infections, cardiovascular diseases, maternal and neonatal disorders, respiratory infections and tuberculosis, and neoplasms. Years lived with disability have increased over time, which is driven by mental disorders, HIV and other sexually transmitted infections, musculoskeletal disorders, neurological disorders, and skin and subcutaneous diseases. CONCLUSIONS: Botswana needs better data to prepare its emerging health systems to accommodate the increased need for disability support and rehabilitation services caused by communicable and non-communicable diseases.Implications for RehabilitationBotswana has an increase in disability prevalence over time that requires the development of disability and rehabilitation services.The greatest contributors towards disability adjusted life years in Botswana are currently mental disorders (13.7%), HIV and other sexual transmitted diseases, (13.0%), musculoskeletal disorders (9.9%), neurological disorders (8.0%), and sense organ diseases (6.2%).This requires strengthen of services such as mental health interventions, physiotherapy, optometry and audiology as well as linkages from major disease clusters such as HIV to rehabilitation services.

HIV-related disability and rehabilitation: perception of health care workers.

Background: Health care workers play an integral role in the rehabilitation and care of people living with HIV who face multiple impairments and often disabilities. The aim of the article was to understand the perceptions and attitudes of health care workers towards caring for people living with HIV, and experiencing disability. Methods: Fifteen health care workers offering care to people living with HIV were interviewed using a semi-structured guide. These health care workers included doctors, a social worker, a pharmacist, a dietician, an occupational therapist, a physiotherapist, and nurses and HIV couPnsellors who were employed at a public health care facility in KwaZulu-Natal. Data from the interviews were transcribed and analysed using conventional content analysis. Results: Four themes emerged from semi-structured interviews with the health care workers: a holistic disability framework, a multidisciplinary team dynamic, organisational barriers and recommendations by health care workers. Conclusion: Health care workers perceived a shift from a biomedical perspective of disability to a bio-psychosocial interpretation that is influenced by contextual and environmental barriers imposed by communities on people living with HIV. Barriers included stigmatisation that leads to attitudinal barriers and social exclusion of people living with HIV and experiencing disabilities within communities. Lack of resources, including of equipment, and a shortage of health care staff also posed barriers to the care offered to people living with HIV and experiencing disabilities. Participants agreed that improved communication in the multidisciplinary health care team, as well as continuing education and training, would enable health care workers to offer improved, integrated care to people living with HIV who experience disabilities.

Preparedness of civil society in Botswana to advance disability inclusion in programmes addressing gender-based and other forms of violence against women and girls with disabilities.

BACKGROUND: In low-income and middle-income countries women and girls with disabilities are more likely to experience violence than those without disabilities. Non-governmental organisations (NGOs) and disabled people's organisations (DPOs) can help to address this. However, in countries like Botswana we know little about the preparedness of NGOs and DPOs to increase inclusion in and access to programmes addressing violence. OBJECTIVES: To explore the capacity and preparedness of NGOs and DPOs to ensure that women and girls with disabilities can participate in and access programmes addressing violence. METHODS: A qualitative study was undertaken using interviews with 17 NGOs and DPOs in Botswana to understand the organisations' level of and ability to deliver programmes addressing violence against women and girls. RESULTS: Both NGOs and DPOs lack elements of universal design and reasonable accommodation, and thus are inaccessible to some people with disabilities. Some programmes address violence against women but lack skills and resources to accommodate people with disabilities. In contrast, DPOs work with people with disabilities, but lack focus on violence against women with disabilities. Participants identified opportunities to fill these gaps, including adaptation of policies and structural changes, training, approaches to mainstream disability across programmes, development of disability-specific interventions and improved networking. CONCLUSIONS: Botswana's NGOs and DPOs are well positioned to address violence against women and girls with disabilities, but need to increase their accessibility, staff knowledge and skills and disability inclusion. Training, resource allocation and participation of women with disabilities in NGOs and DPOs is needed to drive this change.

Children living with HIV-related disabilities in a resource-poor community in South Africa: caregiver perceptions of caring and rehabilitation.

The care offered to children living with HIV (CLHIV) experiencing HIV-related disability is often challenged by caregiver illness, poverty and poor support structures in and around communities. Since caregiver needs directly influences the care offered to CLHIV this paper aimed to explore the experiences of the caregivers of CLHIV in order to inform an appropriate rehabilitation model in South Africa. A qualitative enquiry using in-depth interviews with 14 caregivers (one male and thirteen females) of CLHIV experiencing disability in a peri-urban setting was conducted. Data were analysed using thematic analysis. Four themes emerged from the interviews: understanding of HIV-related disability and rehabilitation, challengers to care and well-being, enablers to care; and perceived needs of caregivers. The study revealed that caregiver burden is influenced by the availability of resources and social support services. Financial constraints, poor access to rehabilitation and reduced support networks challenged the care offered to CLHIV. The perceived needs of the caregivers in this study included appeals for improved social security, housing, accessible rehabilitation and education. Changes in government policy guiding social support, employment, education and rehabilitation interventions are needed to improve the availability of resources, education, health and well-being of CLHIV and their caregiver's in South Africa.

Perspectives on ART adherence among Zambian adults living with HIV: insights raised using HIV-related disability frameworks.

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.

Looking at antiretroviral adherence through a disability lens: a cross-sectional analysis of the intersection of disability, adherence, and health status.

Background: Antiretroviral adherence is vital to the successful long-term rollout of the antiretroviral therapy program in South Africa. At present, there are no studies that look at the effects of disability on antiretroviral adherence.Methods: Drawing on the baseline data from an existing cohort of 1042 people on antiretrovirals in a public healthcare setting in KwaZulu-Natal, the paper investigated a variety of existing covariates relating to antiretroviral adherence, together with functional limitations, depressive symptoms, and health symptoms. Disability was defined according to the International Classification of Functioning, Disability, and Health framework and measured using the World Health Organization Disability Assessment Schedule.Results: In a proportional odds logistic regression functional limitations, depressive symptoms, health symptoms and gender emerged as significant associated with decreased adherence to antiretrovirals (Odds ratio [95% confidence interval]: 1.86 [1.31, 2.66], 1.61 [1.02, 2.55], 2.33 [1.47, 3.69], and 1.65 [1.16, 2.35], respectively). This was found for both severe and milder forms of functional limitations/disability.Conclusion: The paper highlights the need to better understand the role of these limitations in achieving adequate adherence to antiretrovirals and viral suppression. It also calls for investigations into integrated mitigating services such as integrating rehabilitation into routine human immunodeficiency virus care.Implications for RehabilitationThis study provides a starting point to understand the association between functional limitations and challenges in maintaining adherence to antiretroviral therapy.Addressing functional limitations is currently a neglected factor in efforts targeting HIV-treatment adherence and retention.Rehabilitation is a key intervention that could address this gap.Even mild forms of disability can have profound effects on adherence to antiretroviral therapy, which highlights the need for better screening, early identification, and referrals to rehabilitative support and treatment.

A Rehabilitation Framework for Children Living With HIV in South Africa: Reaching Consensus for a Resource-Poor Community.

Although rehabilitation frameworks for adults living with HIV are developing steadily, interventions to ensure the integration of rehabilitation into the routine care of children living with HIV-related disabilities lags. We sought to explore perceptions of, and gain expert consensus on, a rehabilitation framework for children living with HIV. Experts in HIV pediatric care in South Africa engaged in a Delphi survey, based on findings from a context-specific rehabilitation framework for adults. Consensus was determined by an a priori threshold of 80% agreement and an interquartile range of 1 or lower on criteria to be included as essential or useful in the framework. Experts agreed that enhancing access to patient-centered care through decentralization and training of health care and community care workers in the use of disability screening tools at each point of care needed to be included in the framework. Strengthening multiprofessional team collaboration was also seen as fundamental.