HIV-Related Disability: Development of a Contextualised Physical Activity Programme

Abstract

Background This thesis investigated the status of physical activity and exercise use among people living with HIV (PLWH) in a Nigerian context. The literature on exercise and physical activity revealed that a considerable number of PLWH encounter several barriers that limit them from being sufficiently active, resulting in their failure to meet globally recommended levels of physical activity. Most of the studies done on intervention programs to improve physical activity level among PLWH were set in a western context. In sub-Saharan Africa, where HIV prevalence is highest, the prevalence of physical activity among PLWH is not well documented. Due to low resources and contextual barriers in sub-Saharan Africa, it is challenging to execute the physical activity intervention programs developed in well-resourced countries to resource-limited settings. Being an effective, and safe strategy, physical activity has been recommended as non- pharmacological management for HIV, as it is beneficial to the physical, mental, and overall well-being of PLWH. However, despite these benefits, the prevalence of physical activity among PLWH in Nigeria is low. It has been suggested that a physical activity intervention program be developed taking into consideration contextual factors in Nigeria. Therefore, a contextualised physical activity program could improve the physical activity levels of PLWH in Nigeria. Aim This study aimed to develop a contextualised physical activity program that can be integrated into existing healthcare systems and community support networks for PLWH in Nigeria. Method This study used a mixed-method approach with four studies to address the study aim. The first study was a cross-sectional study which was conducted to determine the prevalence of HIV- related disability, the perceived health status and physical activity level among people living with HIV. The second study sought to explore the barriers and facilitators influencing physical activity participation among people living with HIV using a qualitative study. To improve health outcomes and create an effective rehabilitation plan, a scoping review was conducted as xvii the third study to identify rehabilitation strategies implemented in the management of HIV- related disability. The data from the studies were triangulated and integrated to guide the development of the physical activity program. The integration involves synthesizing findings from the three studies, identifying common themes and patterns, and reconciling any discrepancies. By combining insights from different sources, a more comprehensive understanding of the needs, preferences, and challenges faced by PLWH in relation to physical activity was achieved, and a draft physical activity program was designed. Finally, the fourth study was a Delphi study which was conducted to reach a consensus among a panel of experts on the content of the developed physical activity program. Results Study 1: Three hundred and eighty-five PLWH participated in this study. The results showed a 39.5% prevalence of HIV-related disability, with participants experiencing the most disability in the participation domain (31.75%). The health-related quality of life score was 55.8±5.3 and 56.3±6.7 for the physical health summary (PHS) and mental health summary (MHS) respectively. The prevalence of physical activity level was low in 45% of the participants. Most of the participants experienced multiple medical symptoms, especially headaches, weight loss, and muscular pain (36.6%, 27.8% and 16.9%, respectively). Study 2: Twenty PLWH were interviewed in this study. The participants perceived physical activity as beneficial to their health. However, the factors influencing participation in physical activity are multifactorial and complex. The commonly reported barriers to physical activity were lack of time due to busy schedules, persistent feelings of fatigue associated with living with HIV, an environment that did not foster physical activity, financial limitations hindering access to resources or facilities, and competing social commitments that took precedence over exercise routines. The facilitators of physical activity included perceived benefits of exercise, such as improved physical and mental health outcomes, habitual behaviours that integrated physical activity into daily routines, encouragement and support from family, friends, or healthcare providers, and the recognition of the preventive and pain-relieving effects of physical activity in managing HIV-related symptoms. Study 3: The scoping review included 22 articles, of which the majority (68.2%) were randomised control trial (RCT) study designs. Rehabilitation intervention strategies included xviii physiotherapy, occupational therapy, supportive psychotherapy, education programs, and other methods. Most of the studies reviewed used strategies related to health promotion in exercise and health education. The scoping review highlights some knowledge gaps in the field of rehabilitation interventions such as the need to explore the long- term effectiveness of diverse rehabilitation strategies, and the bridge between interventions tailored to individual needs and a one-size-fits-all approach. Study 4: The modified Delphi approach had twenty-eight (28) panel members from eight countries who were experts in the field of physical activity, HIV, and rehabilitation. The experts practised in research, academic and clinic settings. Consensus (>85%) was achieved for all sections (exercise information booklet, pre-screening questions, program structure, implementation strategy) of the developed exercise program for people living with HIV in Nigeria. The Delphi study involved two rounds of surveys aimed at integrating research findings and expert knowledge to create a feasible physical activity program for PLWH in Nigeria. Conclusion The overall aim of this study was to develop a contextualised physical activity program for people living with HIV in Nigeria. The findings from the studies shed light on the intricate interplay between HIV-related disability, health perceptions, and physical activity among PLWH in Nigeria. Despite relatively good Health-Related Quality of Life (HRQoL), participants faced challenges in the participation domain and reported poor general health perceptions. The majority did not meet WHO-recommended physical activity guidelines, citing various barriers such as lack of time, fatigue, and unsupportive environments. However, amidst these challenges, there exists a clear recognition of the benefits of physical activity among PLWH. The findings underscore the pressing need for tailored interventions that account for individual preferences and contextual barriers. Central to this study is the development of a tailored intervention program designed to bridge these gaps and empower PLWH to engage in regular physical activity. With insights from previous research, views from PLWH and opinions from experts, the developed physical activity program addresses individual preferences while navigating the unique challenges of the Nigerian context.