Strength exercise for balance and gait in HIV-associated distal symmetrical polyneuropathy: A randomised controlled trial

Background: HIV-associated peripheral neuropathy (PN) is a common neurological complication associated with HIV infection. Distal symmetrical polyneuropathy (DSPN) is the most commonly occurring type, which is associated with symptoms such as numbness, unsteady gait and, in some cases, muscle atrophy and weakness when myelinated nerve fibres are affected. If unmyelinated nerve fibres are affected, a painful neuropathy and autonomic symptoms may occur.Objectives: This research study assessed the effects of a strength exercise intervention on balance impairment and gait disturbance amongst individuals living with HIV-associated DSPN.Method: The study was a single-blinded, randomised controlled trial (RCT) with participants sourced from four HIV centres in Kano metropolis, Nigeria. The intervention was supervised and included progressive resistance exercise (PRE) (three 40-min sessions per week for 12 weeks) using a quadriceps bench (n = 44). The control group (CG) included the non-exercise group (n = 47). The two groups continued to receive routine care. Data were summarised and analysed using inferential statistics (SPSS version 20 program) with the alpha level set at 0.05.Results: At 12 weeks, the results revealed significant improvement with regard to balance performance (p = 0.001) and walking ability (p = 0.001) in the training group. In contrast, no significant differences in balance (P = 0.677) or gait (P = 0.578) were observed in the CG.Conclusion: The findings suggest that PRE is beneficial for balance impairment and gait disturbance caused by neuropathy in persons living with HIV and receiving antiretroviral drugs.

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Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania

BMJ Global Health ◽

10.1136/bmjgh-2018-000946 ◽

2019 ◽

Vol 4 (3) ◽

pp. e000946 ◽

Cited By ~ 5

Author(s):

Mary C Smith Fawzi ◽

Hellen Siril ◽

Yuanyuan Liu ◽

Keith McAdam ◽

Donald Ainebyona ◽

...

Keyword(s):

Social Networks ◽

Randomised Controlled Trial ◽

Hiv Risk ◽

Controlled Trial ◽

Risk Behaviour ◽

Dar Es Salaam ◽

People Living With Hiv ◽

Stepped Wedge ◽

Randomised Controlled ◽

Living With Hiv

IntroductionNAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members.MethodsA stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV.ResultsFor people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002).ConclusionThese results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions.Trial registration numberNCT01693458.

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