Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

246 Abstracts WePeF6638-WePeF6642

XIV International AIDS Conference

WePeF6638I Towards an effective home based care model for
poor communities
M. Nnaluyange Ssemukasa. Concern Worldwide, Concern Uganda, Kampala,
Uganda
Issues: HIV/AIDS has a great impact on people living in poor areas, especially
where access to testing and treatment is limited, and awareness still low. This
leads to stigmatisation and inadequate care for those infected and a lack of support for family members.
Description: Concern has developed a model of Community Based Care that
has been successful in meeting the needs of infected people in poor communities. This model was established in 1994 in Mpigi District, Uganda and aims to
address the needs of those affected by HIV/AIDS by strengthening community
capacity to care for them. The model is built on the practice of providing support to community members during funerals, through groups called 'munomukabi' (a friend in need). Community members were trained in patient care, counselling, nutrition, herbal medicine, home hygiene and income generation. These
volunteers provide support, care and treatment to those infected with HIV/AIDS
and provide support to those affected such as orphans, the elderly and care
givers.
Major successes include improved handling of bedridden patients, a significant
reduction in stigmatisation, improved health status of clients, and positive living. It
is hoped that experiences can be used to develop best practice for home-based
care. Other AIDS groups are keen to replicate the model in their own programmes.
Lessons learned: Communities are willing and able to take on the role of caring
for their fellow members and it is very important that community resources and
knowledge are utilised
PLWA find more consolation when cared for in their own communities
Raising awareness on HIV/AIDS is not enough, general health information is
equally important
Recommendations: Best practice should be shared
Implementers should build on community knowledge and skills for better results
External support should be appropriate to the community
Home care models need to be developed withth e clients for maximum effectiveness
Presenting author: Margaret Nnaluyange Ssemukasa, Concern Uganda, PO
Box 6599, Kampala, Uganda, Tel.: + 256 41 268021, Fax: + 256 41 268054, Email: concern @ africaonline.co.ug
WePeF6639 A self-help group of HIV infected or affected
women - a care and support initiative in rural India
L.F Garda, V.N. Rao, A. Bopardekar, P.B. Raut. Hospital, KEM Hospital
Research Centre, Rasta Peth, Pune - 411 011, Maharashtra, India
Issues: The research paper presents a care and support initiative for rural widowed women who are infected or affected by HIV/AIDS.
Description: The findings of a study in rural Maharashtra are the base for initiation of these care and support activities. This care and support initiative involving
formation of a self-help group carried out at a rural hospital started a year ago with
2 women and has now 18 women. A group of qualified persons cater to the physical, psychological, nutritional and socio-economic needs of rural women who are
infected or affected. Loans for income generation, micro- credit facilities, treatment for opportunistic infections, placement of their children and supplementary
nutrition are important activities.
Lessons learnt: This self-help group has brought women together under one roof
sharing their problems and building a strong bond between themselves for each
other. Talking about the disease had helped to reduce stigma amongst themselves and in the family. Overall, this initiative has helped women to have a more
positive outlook about their status and aims towards improving their quality of life.
Recommendations: Developing a comprehensive model in rural areas for replication linking prevention with the broad framework of care and support involving
medical care, socio-economic independence, and psychological support especially for vulnerable rural women needs to be considered.
Presenting author: Laila Garda, KEM Hospital Research Centre, Rasta Peth,
Pune -411 011, Maharashtra, India, Tel.: [phone] Ext. 336, Fax: [phone], E-mail: [email protected]
WePeF6640 Improving medical history taking and proper
medication provision among non-pharmacist
drugstore personnel in Lampang, Northern
Thailand
P. Rumakom1, P. Chainuban2, S. Pluempitiwiriyawej2, P. Harinwan2,
J. Leesawat2, N. Maneewong2, T. Siraprapasiri3, S. Baker4, T. Kantayaporn5.
1 Horizons Project, Population Council, Population Council, South & East Asia -
Thailand Office, RP0. Box 138 Pratunam, Bangkok 10409, Thailand; 2 Lampang

Provincial Health Office, Lampang, Thailand; 3AIDS Division, Ministry of Health,
Thailand, Bangkok, Thailand; 4Horizons Project, Program for Appropriate
Technology in Health, Bangkok, Thailand; 5Program for Appropriate Technology
in Health, Bangkok, Thailand
Background: In Thailand, as in many countries, non-trained drugstore personnel
sell drugs to people living with HIV/AIDS (PLHA) to combat opportunistic infections (Ols). This study evaluates a diagnostic flowchart and an accompanying

training for these sellers to improve their medical history taking and to ensure the
proper provision of drugs.
Methods: To measure the effectiveness of the flowchart and training 180
simulated-client visits were undertaken over six rounds; divided into baseline,
intermediate and impact data. The simulated clients were PLHA trained to visit
drugstores seeking treatment. Pharmacists, as part of the research team, interviewed the simulated clients as soon as they left the drugstore to record their
interaction with the drugstore personnel.
Results: The original flowchart and training did not improve the drugstore personnel history taking or their ability to provide proper provision of medication.
23% of drug sellers correctly asked the simulated clients about their symptoms,
while 51% and 50% of them provided the correct medication in the baseline and
intermediate rounds.
Following this the flowchart was redesigned to be less medical oriented and more
suitable for drugstore personnel by focusing on the key OI symptoms. This was
combined with regular training opportunities so to enhance the drug sellers' skills.
After these changes the proportion of drugstore personnel correctly taking the
history of their clients' medical complaints rose to 59% (p< 0.001) and those
providing the correct provision of medication increased to 61% (p= 0.096).
Conclusion: A flowchart accompanied by regular training can improve the ability of drugstore personnel to provide services to PLHA. However, these must be
designed to meet the needs of the drug sellers who usually have no medical background. It must inform them when and how to sell drugs correctly, and also when
to refer people to doctors when the symptoms are severe.
Presenting author: Patchara Rumakom, Population Council, South & East Asia
- Thailand Office, P.O. Box 138 Pratunam, Bangkok 10409, Thailand, Tel.: +66
02653 8586, Fax: [phone], E-mail: [email protected]
WePeF6641 Home-based care workers' self-research and
action learning
A. Pistorius. Department of Psychology, PO Box 182, Medunsa, 0204, South
Africa
Issues: Peer counsellors and home-based care workers are promoted by health
and community groups in support of people living with HIV/AIDS. Funding usually
supports their training in peer counselling and home based care. Yet, little attention is given to their personal and community development challenges. Support
workers encounter many incidents and conditions that make them feel traumatised and powerless.
Description: The need for debriefing was identified by a peer support training organisation together with HIV/AIDS counsellors and home based care workers in
Gauteng, South Africa. They were subsequently engaged in small group discussions, using action learning and each keeping a personal journal. The approach
assumed a developmental orientation, promoting more than mere crisis intervention.
Lessons learned: The sessions gave support workers the opportunity to reflect
on and share experiences, appreciate their services, and deal creatively with their
problems. They also voiced common experiences pertinent to policy-making and
funding. Common themes included: care workers deal with divergent needs of
the patient/client; their services are dependent on good co-operation with multisectors of society; voluntarism requires incentives and material support; care
givers are not always given recognition yet are co-opted for selfish needs by the
health sector.
Recommendations: This study recommends action learning and action research
as a valuable tool for HIV/AIDS practitioner self-development and for providing
collective reports on development needs to policy-making and funding bodies.
Presenting author: Annalie Pistorius, Department of Psychology, PO Box 182,
Medunsa, 204, South Africa, Tel.: [phone], Fax: [phone], Email: [email protected]
I WePeF6642 What are the lessons learned from the past 15
years of home based care in developing
countries?
B.W.V. Victor. Danish Red Cross, 14, Stengadevej, 5953 Tranekaer, Denmark
Issues: Since the first home based care (HBC) programs for AIDS patients were
established in the late 80's in some developing countries, the concept and models
of care have undergone substantial changes, mostly based on practical lessons
learned. Such programs are, however, not always based on knowledge of "stateof-the art" and most often lack scientific documentation of their effects and cost.
Description: A comparison is made between characteristics of the first HBC programs in Africa (Uganda and Zambia) in the late 80's (WHO, 1991) and the HBC
programs presented at the Chiang Mai Conference in December 2001, based on
a review of documents and of all the abstracts.
Lessons learned: HBC has moved from being marginal to being the norm in
many countries. Despite the persisting lack of evaluative research and compara
tive studies, changes in focus and scope of HBC can be seen from this review.
They illustrate a move
- from separate to integrated prevention and care
- from hospital to community initiated and based care
- from an individual to a family focused
- from nursing and pastoral care to addressing basic family needs
- from individual to community action