Amsterdam 2015
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| Abstract #2018 - Poster 1 | ||||
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Session: 58.8: Poster 1 (Poster) on Tuesday in Chaired by Authors: Presenting Author: Mrs Verusia Chetty - University Of KwaZulu-Natal, South Africa |
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| Additional Authors: Dr Kouassi Martin, Mr Brou Sylvain, | ||||
| Aim: A learning in action approach was used to design a comprehensive model of HIV care that also addresses HIV-related disability and that is feasible for resource poor settings. A qualitative approach using expert group discussions with key stakeholders including people living with HIV, the multi-disciplinary healthcare team and community outreach partners at a semi-rural health facility in South Africa was applied. These discussions initiated the development of the potential model. | ||||
| Method / Issue: In the era of widespread access to antiretroviral therapy public health approaches to HIV need to include not only prevention, curative treatment and support but also rehabilitation. In endemic areas of Southern Africa major mile stones have been achieved with regards to treatment. People living with HIV survive however this comes with new experiences of disablement posing new challenges to health and rehabilitation professionals. Some well-resourced countries have developed rehabilitation approaches in the context of HIV. However resource poor settings of Southern Africa focus on acute care and haven’t yet shifted to provide access to a comprehensive care approach. There lacks a model of care that meaningful includes rehabilitation and feasible approaches that provide accessible and comprehensive care to people living with HIV. In South Africa the ‘reduction of disability’ is identified as an issue in the National Strategic Plan on HIV, yet the same plan does not identify which disabilities are common among PLHIV nor strategies to address these additional health issues. | ||||
| Results / Comments: The group of stakeholders discussed barriers to and enablers of access to rehabilitation. Participants identified barriers at various levels, including transport, physical access, financial constraints and poor multi-stakeholder team interaction. The results of the group discussions were used to develop a potential model to guide integration of rehabilitation in HIV care. The model was adapted from established integrated models that use four main categories: objectives, principles, enablers and settings. Stakeholders proposed context specific iterated themes to reflect in these categories. They identified that objectives need to include improved access to patient centred care, a maintained multidisciplinary team approach, and should respond to policy. They believed that communication between all stakeholders, collaboration of all stakeholders and leadership to implement the model as the main principles. Education, training for service providers at all points of care and task-shifting to empower lay personnel were seen as the main enablers. The settings such as hospital, intermediate clinic, home-based care, outreach and community based rehabilitation were seen as important structures that can be harnessed and incorporate a gamut of rehabilitation services. | ||||
| Discussion: Lessons learnt Multi-stakeholder involvement in developing a model of care provides a pragmatic structure to design rehabilitative care in a way that is suitable to communities in resource poor settings. Communication is vital in promoting effective collaboration with healthcare teams and people living with HIV accessing service at all points of care. Training of lay personnel is essential in curbing the lack of accessibility of rehabilitation services to people living with HIV in resource poor settings. | ||||
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