Implementation and Effectiveness of Physical Activity to Prevent Disability in HIV-infected Adults Older Than 50 From Côte d'Ivoire

This is is a prospective, randomised, pilot trial with two phases: a 6-month active phase to implement the intervention and a 6-month maintenance phase to evaluate the sustainability of the intervention's effects. This study adopts a type II hybrid design assessing both the effectiveness of the intervention and the implementation outcomes to identify factors influencing its adoption by users, as well as its integration into healthcare practices

It starts with a baseline research combining a cross-sectional study and a qualitative formative research. The cross-sectional study comprises clinical evaluations, functional tests, as well as quantitative evaluations by questionnaire of disability (WHODAS, HDQ) and depression (PHQ-9). It includes 300 people living wiht HIV (PLHIV) receiving antiretroviral therapy and followed at the Avocatier health facility (FSU) and the El Rapha medical health centre (CMS), in the Abobo district, Abidjan. A comparison group of adults without HIV infection of similar sex and age distribution is included as a reference group (n = 150).

The qualitative research explores how the practice of physical activity is perceived culturally and socially and to determine the factors that may influence the implementation of this type of activity.

The intervention consists of a 48-week exercise programme including aerobic, resistance, balance and flexibility exercises twice to three times a week for at least 60 minutes. Two delivery approaches for the exercise programme are proposed. In the group-based arm, participants are invited to participate in group sessions directly supervised by a coach. The other sessions are unsupervised. During the first 24 weeks (active phase), the supervised group sessions are scheduled on a weekly basis while they are more spaced out, on a monthly basis, during the second part of the 48 weeks (maintenance phase). In the home-based arm, participants have to perform the same exercise programme at home. Participants are contacted by phone by a study staff every week to review the activities performed, collect information on their adherence to and perception of the programme and to provide positive feedback, help to addess challenges and reinforce their motivation. Participants of the control group are offered monthly health education sessions and a delayed participation to the programme.

Eligibility criteria for the intervention :

Inclusion criteria

• Age ≥50 years
• Documented HIV infection.
• Receiving antiretroviral therapy for ≥ 12 months.
• Residing in the Abobo district (Côte d'Ivoire).
• Presence of at least one functional limitation or disability criterion among the following:

• Performance in the 6-minute walk test ≤ 300 m.
• Handgrip strength ≤ 35 kg for men or ≤ 24 kg for women.
• WHODAS score ≥ 10.
• SPPB score between 4 and 9.
• Signed informed consent.

Exclusion criteria

• Medical contraindication to physical activity.
• Anticipated unavailability.
• Severe functional limitation (SPPB ≤ 3).
• Another health condition requiring priority care.

Eligibility criteria for the formative research:

Inclusion criteria

People living with HIV:

• Age ≥40 years
• Documented HIV infection.
• Receiving antiretroviral therapy for ≥ 12 months.

Controls:

• Age ≥40 years
• Negative HIV test within the last 12 months;
• Living in Abobo area
• Written consent to participate to the study

Exclusion criteria

Participants living with HIV:

• HIV infection with HIV-2 type only
• Any clinical symptoms suggesting an acute infection
• Any life-threatening pathology in the short term or any pathology not allowing participation in the study

Controls:

• Any clinical symptoms suggesting an acute infection
• Any life-threatening pathology in the short term or any pathology not allowing participation in the study