Hanass-Hancock Jill, Alli Farzana
a HEARD, University of KwaZulu-Natal , Durban , South Africa.
Disabil Rehabil. 2015;37(21):2012-21. doi: 10.3109/09638288.2014.991455. Epub 2015 Jul 25.
HIV and disability are interrelated providing a double burden to HIV endemic countries in East and Southern Africa and their already fragile health systems. Although literature reveals that people with disabilities are particularly vulnerable to HIV and that HIV, its opportunistic infections and treatments can cause disability, only few interventions target this issue and none have been evaluated in this region.
Formative evaluation was undertaken with regard to the effectiveness of a workshop-based intervention for healthcare workers and people with disabilities on the intersection of disability and HIV in order to inform the further development of this intervention. The formative evaluation assessed participants' perception of the inclusion of disability in HIV services and of opportunities to initiate change after the workshops. It also captured their experiences in utilising knowledge and skills after the workshops using quantitative (short checklist and ranking exercise) and qualitative (semi-structured interviews) methods of inquiry. Frequencies and conventional content analysis were used in the analysis of the data. This study presents an example of applied research conducted under real-world conditions.
60 healthcare workers and people with disabilities took part in this pilot workshop training and participated in the formative evaluation. Healthcare workers and people with disabilities alike identified various barriers to access health services. Reasonable accommodation was perceived as being mainly absent by most participants, while some participants indicated a lack of physical accessibility in the form of universal design. Participants also identified a lack of integration of services and disability-related skills within the healthcare staff. Participants reported a number of enablers, success and challenges while implementing the knowledge from the workshops related to structural issues, service provision and integration. While participants worked on health workers' attitudes and accessibility of services, screening and referrals practice was not improved through the workshops.
Formative evaluation indicates that the workshops can be effective not only in sensitising healthcare workers and people with disabilities to opportunities to improve services for people with disabilities but also to provide knowledge and skills to initiate improvements. Skills that need more practical training (e.g. screening for disability) need to be trained in more detail, and this will inform the adaptation of the workshops. However, the workshop evaluation also revealed that without policy implementation and budget allocations this change would only be limited. Implications for Rehabilitation HIV, its co-morbidities and treatments cause health conditions and impairments that have the potential to develop into disability. People with disabilities are at increased risk of exposure to HIV. Rehabilitation professionals, healthcare workers and people with disabilities can be sensitised in a three-day workshop on the relationship of disability and HIV. However, the trained participants can only implement no or low-cost elements of interventions, while high-cost interventions need budget allocations at provincial and national level.
艾滋病病毒（HIV）与残疾问题相互关联，给东非和南部非洲的艾滋病流行国家及其本就脆弱的卫生系统带来了双重负担。尽管文献表明残疾人特别容易感染HIV，且HIV及其机会性感染和治疗可能导致残疾，但针对这一问题的干预措施很少，且该地区尚未对任何干预措施进行评估。
针对一项以研讨会为基础、面向医护人员和残疾人开展的关于残疾与HIV交叉问题的干预措施的有效性进行了形成性评估，以便为该干预措施的进一步发展提供信息。形成性评估考察了参与者对在HIV服务中纳入残疾问题的看法以及研讨会后发起变革的机会。它还通过定量（简短清单和排序练习）和定性（半结构化访谈）调查方法，了解了他们在研讨会后运用知识和技能的经验。数据分析采用了频率分析和常规内容分析。本研究展示了在实际条件下开展的应用研究实例。
60名医护人员和残疾人参加了此次试点研讨会培训并参与了形成性评估。医护人员和残疾人都指出了获得卫生服务存在的各种障碍。大多数参与者认为主要缺乏合理便利措施，而一些参与者表示缺乏通用设计形式的无障碍设施。参与者还指出医护人员中缺乏服务整合以及与残疾相关的技能。参与者报告了在实施与结构问题、服务提供和整合相关的研讨会知识时的一些促进因素、成功之处和挑战。虽然参与者致力于改变医护人员的态度和提高服务的可及性，但研讨会并未改善筛查和转诊实践。
形成性评估表明，这些研讨会不仅可以有效地提高医护人员和残疾人对改善残疾人服务机会的认识，还能提供发起改进所需的知识和技能。需要更多实践培训的技能（如残疾筛查）需要更详细地进行培训，这将为调整研讨会内容提供依据。然而，研讨会评估还显示，如果没有政策实施和预算分配，这种改变将非常有限。对康复的启示HIV及其合并症和治疗会导致健康状况和损伤，有可能发展为残疾。残疾人感染HIV的风险更高。康复专业人员、医护人员和残疾人可以通过为期三天的关于残疾与HIV关系的研讨会提高认识。然而，经过培训的参与者只能实施无成本或低成本的干预措施，而高成本干预措施需要省级和国家级的预算分配。
