HIV home-based care produces positive outcomes in Uganda

Providing home-based anti-HIV care is associated with multiple positive social outcomes, research conducted in rural Uganda and published in the January 2^nd edition of the Journal of Acquired Immune Deficiency Syndromes shows. Home-based HIV care did not appear to lead to stigmatisation or an increase in negative experiences. Although there was a non-significant increase in the incidence of domestic violence against women participating in the home-based care programme, the investigators believe that home care could help identify women at risk of domestic violence and provide interventions to reduce violence against women.

There has been a significant increase in the funding of HIV treatment, care and prevention in resource-limited settings, including sub-Saharan Africa. Home-based care has been used for tuberculosis (TB) and leprosy, and it has been suggested as a possible model for the delivery of HIV care. It is thought that advantages would include the opportunity to provide support to multiple family members, adherence support, and ease use of healthcare facilities. However, set against these possible advantages are concerns that home-based care could lead to the identification in the community of HIV-positive individuals. Investigators therefore wished to obtain empirical data regarding the impact of home-based HIV care.

Participants in the Home-Based AIDS Care project in the Toro and Busia districts of rural Uganda were asked about positive and negative aspects of their lives three months before entering into the home-based HIV care programme and three months after. A total of 654 individuals participated in baseline interviews, and 598 of these took part in the follow-up interviews. The study ran between May 2003 and May 2004.

At baseline, 72% of participants were women, and the mean CD4 cell count was 172 cells/mm³, indicating significant HIV disease progression. Nearly all (96%) of participants had disclosed their HIV status to someone other than a healthcare professional before entering the study.

In the three months before entry to the study, 76% of individuals reported one or more positive outcome, including 66% who felt emotional support from their family, 62% who thought that they received emotional support from their community and 16% who said that their relationship with their spouse was strengthening. Three months after entering the home-based care programme, there had been a significant increase in the proportion of individuals reporting a positive outcome to 87% (p

By contrast, there was no change in the proportion of patients reporting negative outcomes after entering the home-based HIV care programme. At baseline, 12% reported any negative outcome, and after three months of home-based care this figure was largely unchanged at 10%.

In a final set of analyses, the investigators restricted their attention to women in the study and asked them if they had experienced physical abuse from their partner. At baseline, 1% of women reported abuse, and although this had increased to 2% by the time of the follow-up interview. This increase was not statistically significant (p = 0.063) bit it nevertheless concerned the investigators.

“Among participants in an antiretroviral programme with weekly home visits in rural Uganda, the vast majority - over 80% - experienced positive social outcomes and very few experienced negative outcomes”, write the investigators. They add that, “the overall frequency of negative outcomes did not change. These findings suggest that the provision of treatment and care services through home-based delivery in resource-poor settings can result in multiple positive social outcomes.”

The investigators do, however, write that even though there was not a statistically significant increase in the number of women reporting domestic violence, “concern...is merited.” All the women who reported domestic violence after participating in the home-based HIV care programme had a previous history of domestic violence. The investigators believe that home-based care could help identify women at risk of domestic violence. Home care could also offer “an excellent opportunity for couple counselling, which facilitates disclosure and may minimise violence against women.”