Fall History and Associated Factors Among Adults Living With HIV-1 in the Cape Winelands, South Africa: An Exploratory Investigation

Berner, Karina; Strijdom, Hans; Essop, M. Faadiel; Webster, Ingrid; Morris, Linzette; Louw, Quinette

doi:10.1093/ofid/ofz401

Cited by 14 publications

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References 36 publications

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“…Therefore, factors related to ageing may have influenced the prevalence of falls in the seronegative participants as well. One Ph.D. thesis 39 showed that falls were a problem in a relatively younger cohort of PLWH (median age of 36.61 years) living in a rural district of South Africa. A higher prevalence of falls in PLWH compared with the SNP was reported (34% PLWH vs 16% SNP; p=0.038).…”

Section: Discussionmentioning

confidence: 99%

Falls in people living with HIV: a scoping review

2020

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ObjectivesRecent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH.MethodsA scoping review was done following Arksey & O’Malley’s methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done.ResultsFourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH.ConclusionMore research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.

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Section: Discussionmentioning

confidence: 99%

Falls in people living with HIV: a scoping review

2020

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“…[17] Three cross-sectional studies [30][31][32] in highincome countries reported falls prevalence ranging from 18.6% -40.7% in middle-aged to older PLWH. In LMIC, falls may be prevalent in younger cohorts of PLWH due to the different sociodemographic profile of PLWH or more virulent strains of Clade C HIV; [33] one recent South African study [34] attesting to this possibility. Hence, while Greene et al [4] recommended routine screening for falls in all PLWH who are 50 years and older, physiotherapists may need to assess for falls in both younger and older PLWH in LMIC.…”

Section: Improve Awareness Of Falls Among Plwh By Physiotherapistsmentioning

confidence: 99%

“…[41] The physiotherapists mostly relied on less precise X-rays; perhaps because they were more available and less expensive. One study [42] demonstrated calcaneal quantitative ultrasound (QUS) as a feasible alternative to DXA in screening BMD in PLWH, and Berner et al [34] used it successfully in a resource-limited setting. Perhaps primary health facilities can consider investing in this 'cost effective, portable and ionizing-radiation free tool' [2] to enable PLWH to be routinely screened for bone loss.…”

Section: Increase Use Of Standardised Screening Tools and Outcome Meamentioning

confidence: 99%

Physiotherapists’ Awareness of Risk of Bone Demineralisation and Falls in People Living with HIV and their Perceptions about Fall Risk Management: A Qualitative Study

Charumbira¹,

Berner²,

Louw³

2020

Preprint

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Background: Recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results. Aim: This study aimed to explore physiotherapists’ awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions about current falls prevention in the care of PLWH in selected regions of sub-Saharan Africa. Method: An interpretative exploratory qualitative research method with a phenomenological approach was employed to explore physiotherapists’ perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8 ® and analysed using inductive thematic analysis. Results: The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention, as perceived by the physiotherapists, were sub-optimal. Conclusion: Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH. Key words: Accidental falls, Bone mineral density, HIV, physiotherapists, sub-Saharan Africa

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“…Increased longevity and increased HIV prevalence resulting from improved ART access implies that more PLWH are ageing with the condition, while fall rates similar to older adults in the general population have been reported in middle-aged PLWH (Ruiz et al, 2013). Studies from high-income countries (HICs) report a fall prevalence in middle-aged and older PLWH ranging from 12 to 41% (Richert et al, 2014;Erlandson et al, 2019); while preliminary findings from a recent South African study reported a prevalence of 34% among a relatively younger cohort of PLWH (median age = 36.61 years) (Berner et al, 2019). Reduction in bone mineral density (BMD) related to exposure to antiretroviral drugs as well as viral infection of osteoblasts have been observed in PLWH (Yin and Falutz, 2017).…”

Section: Introductionmentioning

confidence: 99%

Health system challenges affecting falls prevention in persons living with HIV: perspectives from physiotherapists in four sub-Saharan regions

Charumbira

Berner

Louw

2021

Prim Health Care Res Dev

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Aim: The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH). Background: Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings. Methods: A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis. Findings: The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

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Fall History and Associated Factors Among Adults Living With HIV-1 in the Cape Winelands, South Africa: An Exploratory Investigation

Cited by 14 publications

References 36 publications

Falls in people living with HIV: a scoping review

Falls in people living with HIV: a scoping review

Physiotherapists’ Awareness of Risk of Bone Demineralisation and Falls in People Living with HIV and their Perceptions about Fall Risk Management: A Qualitative Study

Health system challenges affecting falls prevention in persons living with HIV: perspectives from physiotherapists in four sub-Saharan regions

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