Home-based care for people living with HIV/AIDS in the city and province of Maputo, Mozambique

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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- Home-based care (HBC) is a crucial strategy to tackle the HIV/AIDS pandemic in Mozambique, covering over 85,000 People Living with HIV I AIDS (PL WHA). This study aimed to describe types of HBC interventions for symptom management performed by different categories of care providers and PL WHA themselves, from five (two rural and three urban) non-governmental organisations (NGOs). All NGOs were credentialed by the Ministry of Health of Mozambique (MOH) to provide care, and were delivering care for symptom management, not just home visits. Although HBC is provided under the MOH and the World Health Organisation (WHO) guidelines, little is known about the actual care interventions performed. PL WHA were randomly recruited from each NGO. Family members, community volunteers, and nurses were back recruited from their PL WHA. Of the 130 participants, 47 were PLWHA, 38 family members, 25 community volunteers, and 10 nurses. Sixty-four percent of PL WHA were aged 24 to 44 years, whilst 70% of care providers were 55 years or older; 72.3% of PLWHA women and 27.7% were men. Seven two per cent of PL WHA were receiving anti-retroviral treatment and 28% were ineligible. Data were collected through structured interviews with PL WHA, family members that provide care at home, and trained community volunteers. Nurses were asked to fill-in questionnaires. The same structured data tool was used to collect data from all the categories of respondents, as response matching was to be performed. Fifty five HBC interventions were investigated. Interviewees reported that 96% of the interventions were provided; however, only two interventions were confirmed as being done by 40% of care providers; 16 interventions were confirmed by 29% of care providers; and 37 interventions by less than 20% of care providers. Barriers to HBC provision included non-existent or poor HBC guidelines; poor coordination between and within NGOs; limited HBC knowledge and skills; HBC personnel shortage; and limited resources. Contributing factors to lower standards of HBC were high illiteracy rates, poverty, and high demand for HBC. Although the MOH and WHO guidelines and training manuals indicate a holistic scope of HBC, the care actually provided does not reflect this holistic but rather a fragmented approach due to lack of capacity and tools.
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