Home Based Care

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Home Based Care
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Presentation Objectives

• Explain the role of home based care for PLWHAs
• Explain the 4 components of home based care
• Describe the psychological and socio-economic
  support PLWHAs require
• Describe the role of nutrition in the care of
  PLWHAs.

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Elements of Comprehensive Care, Treatment and
Support Home-based Care (HBC)

• Home Based Care has four main components
• Clinical Care early diagnosis, rational
  treatment and planning for follow up care of HIV
  related illnesses
• Nursing Care includes care to promote and
  maintain good health, hygiene and nutrition
• Counselling and psycho-spiritual care includes
  reducing stress and anxiety and promoting
  positive living
• Psycho-social support includes information
  about and referral to support groups, welfare
  services and legal advice.

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Elements of Comprehensive Care, Treatment and
Support Home-based Care (HBC)

• Who provides HBC
• The patient (who is not very sick)
• Family members
• Health workers
• Where?
• At home and in the community
• At the clinic or health facility

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Psychological support

• HIV/AIDS is often associated with a range of
  psychological complications that must be
  addressed throughout all stages of HIV infection.
• Psychological support is critical for helping
  individuals, couples, and families affected by
  HIV cope with their fears and emotions.
• HIV voluntary counseling and testing (VCT)
  provides the bulk of initial psychological
  support. It also links individuals, couples and
  families to follow-up psychological support and
  other support services such as
• legal, welfare, and spiritual support within
  communities
• peer support groups
• appropriate medical services for early management
  of TB and
• other opportunistic infections
• interventions to reduce mother-to-child
  transmission of HIV.

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Psychological support

• In addition, VCT has proven important in
  promoting safer sexual behavior, thus preventing
  HIV transmission and enabling PLHAs to disclose
  to and involve their significant others.
• Where VCT has become a regular service integrated
  into health and community systems, it it has
  helped to normalize HIV and AIDS and decrease the
  stigma attached to the disease.

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Socioeconomic support

• PLHA and their families are confronted with
  additional challenges throughout the course of
  infection and recurrent episodes of illness.
  These include
• isolation,
• loss of income,
• medical and transport expenses,
• funeral costs
• the unmet needs of orphaned children for
  education, shelter, nutrition, clothing, and
  other necessities.
• With some external support and the involvement of
  PLHA, families, community leaders, volunteers,
  government agencies, nongovernmental and
  religious organizations, existing social networks
  can care for family members and adequately
  support children and spouses in the home.
• Home care programmes are cost-effective and
  sustainable when there is strong community
  support for running them, reinforced by quality
  medical and social services from nearby
  facilities. Major challenges remain in scaling
  up, income generation, and meeting nutritional
  needs of the rapidly increasing number of
  affected families and orphans.

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Effect of HIV and AIDS on Nutrition

• Reduction in Food Intake
• Nutrient Mal-absorption
• Metabolic Alterations

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The Vicious Cycle of Malnutrition and HIV
Insufficient dietary intake Mal-absorption,
diarrhea Altered metabolism and nutrient storage
Increased HIV replication Hastened disease
progression Increased morbidity
Nutritional deficiencies
Increased oxidative stress Immune suppression
Source Semba and Tang, 1999
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Home Based Care and Nutrition

• Malnutrition is a serious danger for people
  living with HIV and AIDS. Even at the early
  stages of HIV infection, when no symptoms are
  apparent, HIV makes demands on the bodys
  nutritional status. The risk of malnutrition
  increases significantly during the course of the
  infection.
• Good nutrition cannot cure AIDS or prevent HIV
  infection, but it can help to maintain and
  improve the nutritional status of a person with
  HIV and AIDS and delay progression of HIV,
  thereby improving the quality of life of PLHA.
• Nutritional care and support are important from
  the early stages of the infection to prevent the
  development of nutritional deficiencies. A
  healthy and balanced diet will help to maintain
  body weight and fitness.

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Home Based Care and Nutrition

• Eating well helps to maintain and improve the
  performance of the immune systemthe bodys
  protection against infectionand thereby helps a
  person to stay healthy.
• Many of the conditions associated with HIV and
  AIDS affect food intake, digestion and
  absorption, while others influence the functions
  of the body.
• Many of the symptoms of these conditions (for
  example, diarrhea, weight loss, sore mouth and
  throat, nausea or vomiting) are manageable with
  appropriate nutrition.
• Good nutrition will complement and reinforce the
  effect of any medication taken.