“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.

KEYWORDS:

• HIV
• home-based rehabilitation
• community care worker
• task shifting

Acknowledgements

The authors would like to thank the four women who agreed to participate in this study. The pseudonyms chosen are all common female isiZulu names; Thembi means “hope”, Nolwazi means “knowledgeable”, Hlengiwe means “to help or nurse” and Thobeka means “humble”. We feel that these names are appropriate in that they acknowledge and recognise the qualities and dedication shown by these women and many other unsung community care workers in Africa.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Verusia Chetty http://orcid.org/0000-0003-2934-8687

Jill Hanass-Hancock http://orcid.org/0000-0003-3662-8548

Additional information

Funding

This work was supported by the South African Medical Research Council’s National Health Scholars Programme (NHSP) and partially funded by the National Research Foundation’s Thuthuka Programme.