Original Research - Special Collection: Pain Management and Palliative Care

Context counts: Investigating pain management interventions in HIV-positive men living in a rural area

Cameron Reardon, Antonia Wadley, Romy Parker
African Journal of Primary Health Care & Family Medicine | Vol 15, No 1 | a3678 | DOI: https://doi.org/10.4102/phcfm.v15i1.3678 | © 2023 Cameron Reardon, Antonia Wadley, Romy Parker | This work is licensed under CC Attribution 4.0
Submitted: 22 May 2022 | Published: 09 May 2023

About the author(s)

Cameron Reardon, Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Antonia Wadley, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Romy Parker, Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

Background: Pain remains a prevalent and burdensome complaint for people living with human immunodeficiency virus and/or aquired immunodeficiency syndrome (LWHA). Positive Living (PL), a multimodal pain intervention, reduced pain in female South Africans LWHA. We investigated the efficacy of the PL programme in South African males living with human immunodeficiency virus and/or acquired immunodeficiency syndrome (MLWA) in a rural community.

Aim: To determine the effects of a multimodal pain intervention in MLWHA.

Setting: Various primary care clinics in Manguzi, Kwa-Zulu Natal, South Africa.

Methodology: Therapeutic relationship (TR) intervention alone or in combination with the PL programme were allocated to HIV-positive men between the ages of 18–40. Pain intensity and interference were the primary outcome measures. Secondary outcome measures included physical function, health-related quality of life, depressive symptoms and self-efficacy.

Results: Forty-seven men (mean age 35 ± 3 years) were recruited with baseline mean pain severity of 5.02 (± 3.01) and pain interference of 4.6 (± 3.18). Nineteen men were allocated to the TR intervention alone, 28 were allocated to the TR intervention and PL programme. Attendance at the intervention sessions varied from 10% to 36%. No changes in any outcomes were recorded.

Conclusion: Poor attendance at the intervention and follow-up sessions make these results an unreliable reflection of the intervention. Contextual factors including internal migration and issues around employment were identified. These may influence healthcare utilisation for MLWHA living in rural settings.

Contribution: Unmet healthcare needs of MLWHA in a rural community have been identified. If we are to ‘leave no one behind’, healthcare interventions should account for context and be ‘rural-proofed’.


Keywords

primary health care; rural; pain; exercise; education; therapeutic relationship; self-efficacy.

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