title: "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.
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.
authors.affiliation: a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Saul
authors.initials: S
authors.lastname: Cobbing
authors.affiliation: a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Verusia
authors.identifier: 0000-0003-2934-8687
authors.initials: V
authors.lastname: Chetty
authors.affiliation: b HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa.
authors.forename: Jill
authors.identifier: 0000-0003-3662-8548
authors.initials: J
authors.lastname: Hanass-Hancock
authors.affiliation: c Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Hellen
authors.initials: H
authors.lastname: Myezwa
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000523:psychology*; D006233:Persons with Disabilities / Q000534:rehabilitation; D004644:Emotions; D015658:HIV Infections / Q000523:psychology / Q000534:rehabilitation*; D018577:Homebound Persons / Q000534:rehabilitation*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011369:Professional-Patient Relations; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D013019:South Africa
keywords: HIV; community care worker; home-based rehabilitation; task shifting