Document Detail

Delivering comprehensive home-based care programmes for HIV: a review of lessons learned and challenges ahead in the era of antiretroviral therapy.
MedLine Citation:
PMID:  20144935     Owner:  NLM     Status:  MEDLINE    
Home-based care (HBC) programmes in low- and middle-income countries have evolved over the course of the past two decades in response to the HIV epidemic and wider availability of antiretroviral therapy (ART). Evidence is emerging from small-scale and well-resourced studies that ART delivery can be effectively incorporated within HBC programmes. However, before this approach can be expanded, it is necessary to consider the lessons learned from implementing routine HBC programmes and to assess what conditions are required for their roll-out in the context of ART provision. In this paper, we review the literature on existing HBC programmes and consider the arguments for their expansion in the context of scaling up ART delivery. We develop a framework that draws on the underlying rationale for HBC and incorporates lessons learned from community health worker programmes. We then apply this framework to assess whether the necessary conditions are in place to effectively scale up HBC programmes in the ART era. We show that the most effective HBC programmes incorporate ongoing support, training and remuneration for their workers; are integrated into existing health systems; and involve local communities from the outset in programme planning and delivery. Although considerable commitment has so far been demonstrated to delivering comprehensive HBC programmes, their effectiveness is often hindered by weak linkages with other HIV services. Top-down donor policies and a lack of sustainable and consistent funding strategies represent a formidable threat to these programmes in the long term. The benefits of HBC programmes that incorporate ART care are unlikely to be replicated on a larger scale unless donors and policymakers address issues related to human resources, health service linkages and community preparedness. Innovative and sustainable funding policies are needed to support HBC programmes if they are to effectively complement national ART programmes in the long term.
Alison Wringe; Fabian Cataldo; Nicola Stevenson; Ade Fakoya
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2010-02-08
Journal Detail:
Title:  Health policy and planning     Volume:  25     ISSN:  1460-2237     ISO Abbreviation:  Health Policy Plan     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-27     Completed Date:  2011-01-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610614     Medline TA:  Health Policy Plan     Country:  England    
Other Details:
Languages:  eng     Pagination:  352-62     Citation Subset:  H    
London School of Hygiene & Tropical Medicine, UK.
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MeSH Terms
Antiretroviral Therapy, Highly Active
Comprehensive Health Care / organization & administration*,  trends
Delivery of Health Care / organization & administration*
HIV Infections / drug therapy
Health Plan Implementation / organization & administration
Home Care Services / organization & administration*,  trends

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