1. Home Based Care

2. 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.

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

4. 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

5. 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.

6. 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.

7. 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.

8. Effect of HIV and AIDS on Nutrition Reduction in Food Intake Nutrient Mal- absorption Metabolic Alterations

9. 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 Increased oxidative stress Immune suppression Nutritional deficiencies Source: Semba and Tang, 1999

10. 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 body’s 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.

11. Home Based Care and Nutrition Eating well helps to maintain and improve the performance of the immune system—the body’s protection against infection—and 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.