Aging and HIV-Related Caregiving in Sub-Saharan Africa: A Social Ecological Approach

Cobbing

2022

Preprint

Background: Older people living with HIV (OPLWH) require significant levels of support, including healthcare and rehabilitation interventions. People living with HIV are living longer, but still experience health-related impairments that affect functional activity, participation in day-to-day interactions, livelihoods and overall quality of life. Physical activity and exercise should be included as part of the comprehensive medical management for OPLWH but often a gap exists in understanding and prescription. Our study aimed to explore the perceptions of OPLWH about physical activity and exercise. Methods: The study adopted a phenomenological, qualitative design, using in-depth interviews, to understand OPLWH perceptions of physical activity and exercise, and their need for, and access to, physical activity and exercise programmes in a community in South Africa. Results: Sixteen individuals voluntarily participated in face-to-face, semi-structured interviews which took place the healthcare facility where they received regular treatment. All participants were 50 years and older. The interview data revealed three overarching themes, namely: motivation for physical activity and exercise; barriers to physical activity and exercise; and proposed structure of physical activity and exercise. Conclusion: The qualitative nature of our study provided an in-depth understanding of the perceptions of OPLWH about physical activity and exercise. Our study highlighted the interplay between motivating factors and barriers, and the structural components of physical activity and exercise, that can possibly influence the design and implementation of a physical activity intervention programme for OPLWH.

Section: Resultsmentioning

confidence: 99%

The Perceptions of Older People Living With HIV/AIDS Towards Physical Activity and Exercise

Cobbing

2022

Preprint

“…The results from this pilot feasibility study will provide the critical data to guide and inform whether a larger-scale RCT is warranted. This intervention represents an integrated approach, speci cally designed to target aspects that matter to caregiver's wellbeing in this setting (such as nancial problems, mental health, relational problems, support, physical health) (54). It is designed to be delivered remotely by lay counsellors and thus allows access to care for a vulnerable group who otherwise may not be able to receive such care due to time, transport limitations, lack of state psychosocial support services, along with the national social limitations implemented due to the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

An economic incentive package to support the wellbeing of caregivers of adolescents living with HIV during the COVID-19 pandemic in South Africa: a feasibility study protocol for a pilot randomised trial

Carries

Mkhwanazi

Sigwadhi

et al. 2022

Preprint

Background: The mental and financial strain linked to unpaid caregiving has been amplified during the COVID-19 pandemic. In sub-Saharan Africa, carers of adolescents living with HIV (ALHIV) are critical for maintenance of optimum HIV treatment outcomes. However, the ability of caregivers to provide quality care to ALHIV is undermined by their ability to maintain their own wellbeing due to multiple factors (viz. poverty, stigma, lack of access to social support services) which have been exacerbated by the COVID-19 pandemic. Economic incentives, such as cash incentives combined with SMS reminders, have been shown to improve wellbeing. However, there is a lack of preliminary evidence on the potential of economic incentives to promote caregiver wellbeing in this setting, particularly in the context of a pandemic. This protocol outlines the design of a parallel-group pilot randomised trial comparing the feasibility and preliminary effectiveness of an economic incentive package versus a control for improving caregiver wellbeing. Methods: Caregivers of ALHIV will be recruited from public-sector HIV clinics in the south of the eThekwini municipality, KwaZulu-Natal, South Africa. Participants will be randomly assigned to one of the following groups: (i) the intervention group (n=50) will receive three cash payments (of ZAR 350, approximately 23 USD), coupled with a positive wellbeing message over a three month period; (ii) the control group (n=50) will receive a standard message encouraging linkage to health services. Participants will be interviewed at baseline and at endline (12 weeks) to collect socio-demographic, food insecurity, health status, mental health (stigma, depressive symptoms) and wellbeing data. The primary outcome measure, caregiver wellbeing, will be measured using the CarerQoL instrument. A qualitative study will be conducted alongside the main trial to understand participant views on participation in the trial and their feedback on study activities.Discussion: This study will provide scientific direction for the design of a larger randomised controlled trial exploring the effects of an economic incentive for improving caregiver wellbeing. The feasibility of conducting study activities and delivering the intervention remotely in the context of a pandemic will also be provided. Trial registration: PACTR202203585402090

Journal of Clinical Nursing

“…The scarcity and/or unequal distribution of health services (by geographic area or due to social status) for treating these conditions (especially dementia) (Fang et al., 2015; Hojman et al., 2017) in these regions may render them inaccessible to potential patients, thus imposing a higher caregiving load in these LMICs, while, at the same time, strong feelings of filial obligation, typical of these cultures, can be a source of psychological stress for unpaid caregivers and an obstacle to the acceptability of formal support services for caregivers (Zhang, Clarke, & Rhynas, 2019). In Africa, in contrast, unpaid caregivers from a heterogeneous sample of sick individuals in the community—half of whom had HIV/AIDS—may have been assisted by active family and social support, as suggested by a review of ageing and HIV‐related caregiving (Small, Aldwin, Kowal, & Chatterji, 2019), the stability of the clinical status of the recipients of care (Pinquart & Sörensen, 2007) and religious coping strategies (Awadalla et al, 2005; Ohaeri et al., 2009). Some of the health benefits experienced by the low‐intensity caregiving group in Chen & Liu, (2012), and in repeated and prior unpaid caregivers studied by Zhou et al.…”

Section: Discussionmentioning

confidence: 99%

Health outcomes of unpaid caregivers in low‐ and middle‐income countries: A systematic review and meta‐analysis

Magaña

Loyola

2020

Aims and objectives: To explore differences in health outcomes between unpaid caregivers and noncaregivers living in low-and middle-income countries (LMICs). Background: Previous meta-analyses found worse health outcomes for unpaid caregivers in high-income nations. However, no meta-analysis has considered unpaid caregivers from LMICs. A systematic integration of this topic may contribute to nursing care for unpaid caregivers in LMICs. Design: Systematic review and meta-analysis of observational studies. Methods: Following PRISMA statement, studies were searched for using the CINAHL, PubMed and SciELO databases, limited to publications until 31 December 2019. Random-and fixed-effects meta-analyses were used for data synthesis. Results: Fourteen studies from Africa, Asia and South America were included. Unpaid caregivers of people with ill-health were more anxious and depressed than noncaregivers. Studies conducted in Asia and South America reported poorer health outcomes for unpaid caregivers than noncaregivers, whereas the trend for African studies was the opposite. Unpaid caregivers of healthy individuals may have better health status than noncaregivers, particularly those caring between 1-14 hr per week. Of the six studies which examined gender differences, two studies informed worse health outcomes for women, one presented the opposite effect, and three found no differences. Conclusions: Individual, social, cultural and systemic factors play an important role in the health outcomes of unpaid caregivers in LMICs. More evidence is needed from LMICs. As unpaid caregivers are predominantly female, urgent attention to the health outcomes of female unpaid caregivers is required. Relevance to clinical practice: The management of mental health problems, particularly anxiety and depression, should be an integral part of nursing care for unpaid caregivers living in LMICs. To further promote the health of unpaid caregivers in developing countries, stakeholders should consider launching educational campaigns that assist caregivers in finding ways to meet their cultural obligations while also reinforcing caregiver self-care. K E Y W O R D S gender, health outcomes, low-and middle-income countries, meta-analysis, systematic review, unpaid care | 3951 MAGAÑA et Al.