HIV Live: HIV-related disability and livelihood in resource-poor settings (2014 onwards)
Since the onset of life saving Antiretroviral therapy (ART) in southern Africa for People Living with HIV (PLHIV), the disease has been re-conceptualised as a chronic condition. This comes with new experiences of co-morbidities and disabilities creating new demands on already fragile health systems and health care workers in the region. We do not yet however, understand the full scale of the health-related needs of millions of people now needing chronic and rehabilitative care. It is also not understood how the experience of disablement impacts on individual livelihood but also, at a macro level, on fragile health and social systems. The HIV Live study is the first population-based study that investigates this health and social concern for Southern Africa. It is led by Dr Jill Hanass-Hancock in collaboration with Hellen Myezwa. The study includes two PhD students, Verusia Chetty and Saul Cobbing.
The study investigates the type and scope of disability among two cohorts in South Africa. In addition, it seeks to investigate the effectiveness of tailored home-based rehabilitation interventions as well as to estimate the costs associated to such interventions. It particular it seeks to:
- Investigate, (1a) the extent and impact of disability among PLHIV in two resource-poor settings in southern Africa and (1b) how does this change over time?
- Determine the level and nature of exposure to disability inclusive interventions between baseline and at 12 months
- Determine the effect of a tailored disability inclusive intervention on Activity Limitation, Quality of life and livelihood security and wellbeing
- Estimate the cost-utility of the home-based rehabilitation intervention (run under sub-study2) to the patient and to the health system and to compare these with standard of care.
The study aims to undertake at least two cohort studies among PLHIV in South Africa. It uses a cross-sectional survey (and repeat) to investigate disability, health, mental health, livelihood and ART adherence as well as the impact of disability on these indicators. In addition, it includes a pilot RCT with a randomly sampled group of patients who experience mobility impairment. Using a cost-utility design, it then estimates the costs associated to such an intervention.