Although South Africa has not obtained the 90:90:90 targets, it has made significant strides attributable to political will, civic engagement, activism, and advocacy efforts with regard to HIV/AIDS prevention, treatment, support, and care.7 These efforts have led to policy changes and better implementation strategies. The push for policy changes resulted in effective transparent governance, changes in institutional structures, effective communication, monitoring and evaluation, and research.7 Despite the success, HIV/AIDS management policies and structure still stop short of addressing the sequelae of living with a chronic HIV disease, including ART side effects, multimorbidity, aging, and disability. As such, proponents for the inclusion of rehabilitation to address disability have proposed the 90:90:90 target to include a fourth target of disability so that 100% of patients on HIV/AIDS treatment experiencing disability should obtain rehabilitation services to address the fallout that recent literature and research have described.2 , 8 Therefore, Hanass-Hancock et al9 have proposed the 90:90:90:100 target.
Recognition for the need of rehabilitation among PLHIV has started with the inclusion of rehabilitation needs and services for vulnerable populations in the South African National Strategic Plan.10 Table 1 outlines the literature out of Southern Africa that has the potential to contribute to the future of HIV rehabilitation in the region.
These studies have contributed to understanding disability in people living with HIV, interventions, and policy required in response to HIV/AIDS. The burden of HIV/AIDS-related disability in the region has been established, and interventions to reduce HIV/AIDS-related disability have been tested in small-scale studies.15 , 16 Chetty et al19 have recommended the need to engage stakeholders and integrate rehabilitation in HIV/AIDS care. The call to include disability rehabilitation in response to HIV/AIDS care is increasing. However, a government-supported program to implement rehabilitation strategies for HIV/AIDS-related disability is not yet in place in South Africa. There is definitely an urgent need for the inclusion of HIV/AIDS-related disability management in the continuum of HIV/AIDS care, and immediate strategies now point to the need for wide-scale implementation science and research.20 Regional intervention to facilitate the management of HIV/AIDS-related disability could be impeded by the limited workforce of health care practitioners. The disparate ratio of therapist to population of 1 therapist to 10 000 people is a drawback that requires innovative approaches to service delivery.21
1. Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS Data 2018. Geneva, Switzerland: UNAIDS; 2018.
2. Myezwa H, Hanass-Hancock J, Ajidahun AT, Carpenter BS. Disability and health outcomes—from a cohort of people on long term ART. SAHARA J. 2018;15(1):50–59.
3. Hanass-Hancock J, Myezwa H, Carpenter B. Disability and living with HIV: baseline from a cohort of people on long term ART in South Africa. PLoS One. 2015;10(12):e0143936.
4. Joint United Nations Programme on HIV/AIDS (UNAIDS). 90-90-90: An Ambitious Treatment Target to Help End the AIDS Epidemic. Geneva, Switzerland: UNAIDS; 2014.
7. Health Systems Trust. The 90-90-90 Compendium. An Introduction to 90-90-90 in South Africa. Durban, South Africa: Health Systems Trust; 2016.
8. Myezwa H, Stewart A, Musenge E, Nesara P. Assessment of HIV-positive in-patients using the International Classification of Functioning, Disability and Health (ICF) at Chris Hani Baragwanath Hospital, Johannesburg. Afr J AIDS Res. 2009;8(1):93–105.
9. Hanass-Hancock J, Chappell P, Myezwa H, et al Committing to disability inclusion to end AIDS by 2030. Lancet HIV. 2016;3(12):e556–e557.
10. South African National AIDS Council. The South African National Strategic Plan on HIV, STIs, and TB, 2017-2022. Pretoria, South Africa: South African National AIDS Council; 2016.
11. Hanass-Hancock J, Misselhorn A, Carpenter B, Myezwa H. Determinants of livelihood in the era of widespread access to ART. AIDS Care. 2016;29(1):1–8.
12. Myezwa H, Hanass-Hancock J, Pautz N. Investigating the interaction between human immunodeficiency virus, nutrition, and disability: a cross-sectional observational study. Afr J Prim Health Care Fam Med. 2018;10(1):e1–e8.
13. Van As M, Myezwa H, Stewart A, Maleka D, Musenge E. The International Classification of Function Disability and Health (ICF) in adults visiting the HIV outpatient clinic at a regional hospital in Johannesburg, South Africa. AIDS Care. 2009;21(1):50–58.
14. Petersen I, Hancock JH, Bhana A, Govender K. A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: a randomized controlled pilot study. J Affect Disord. 2014;158:78–84.
15. Roos R, Myezwa H, van Aswegen H, Musenge E. Effects of an education and home-based pedometer walking program on ischemic heart disease risk factors in people infected with HIV: a randomized trial. J Acquir Immune Defic Syndr. 2014;67(3):268–276.
16. Mkandla K, Myezwa H, Musenge E. The effects of progressive-resisted exercises on muscle strength and health-related quality of life in persons with HIV-related poly-neuropathy in Zimbabwe. AIDS Care. 2016;28(5):639–643.
17. Cobbing S, Hanass-Hancock J, Deane M. Physiotherapy rehabilitation in the context of HIV and disability in KwaZulu-Natal, South Africa. Disabil Rehabil. 2014;36(20):1687–1694.
18. Petersen I, Hancock JH, Bhana A, Govender K. Closing the treatment gap for depression co-morbid with HIV in South Africa: voices of afflicted women. Health. 2013;5(3):557.
19. Chetty V, Hanass-Hancock J, Myezwa H. Expert consensus on the rehabilitation framework guiding a model of care for people living with HIV in a South African setting. J Assoc Nurses AIDS Care. 2016;27(1):77–88.
20. Hovmand PS, Gillespie DF. Implementation of evidence-based practice and organizational performance. J Behav Health Serv Res. 2010;37(1):79–94.
21. Health Systems Trust. South African Health Review. Durban, South Africa: Health Systems Trust; 2017.