title: Disability and Living with HIV: Baseline from a Cohort of People on Long Term ART in South Africa.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
authors.forename: Jill
authors.initials: J
authors.lastname: Hanass-Hancock
authors.affiliation: Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
authors.forename: Hellen
authors.initials: H
authors.lastname: Myezwa
authors.affiliation: Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
authors.forename: Bradley
authors.initials: B
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D000353:Africa, Southern; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000379:methods; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008134:Long-Term Care / Q000523:psychology*; D008297:Male; D010865:Pilot Projects
chemical_list: D044966:Anti-Retroviral Agents