HIV-Related Disability in HIV Hyper-Endemic Countries: A Scoping Review

Background: In the era of enhanced access to ART, many people live longer lives but with episodes of disability resulting from HIV, HIV-related conditions, and/or as side-effects of ART. It is crucial to understand the extent of disability among people living with HIV in high-prevalence settings to inform choices regarding care, policy and research. This article presents the results of the first scoping review to examine the extent, nature and range of disability among people living with HIV in HIV hyper-endemic countries. Methods: This scoping review used the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) to conceptualize “disability”. A systematic search of electronic databases was conducted using specific keyword and subject heading combinations. Identified publications were screened and reviewed according to inclusion/exclusion criteria. Data were systematically extracted and reviewed for quality. Extracted data were reviewed for patterns related to methods or results. Results were aligned with the corresponding ICF code. Results: Forty-one articles were included, reporting data from 38 unique studies. Most (78%) of the studies were conducted in South Africa; five in Botswana, one in Zimbabwe and Lesotho, and none in Swaziland. Almost all studies recruited more females than males. All studies except two were in adults. The studies indicate that people living with HIV experience a variety of disabilities. Impairments in body structure/function comprise the majority of data, with particular focus on mental function. Data on activity limitations and participations restriction were limited, however, they were recorded. They indicate severe impact on people’s life and possible adherence. Conclusions: We argue that the time has come to elevate the focus holistically on health and life-related consequences of living with HIV and to integrate disability into the discussions and approaches to HIV care.