Reaching out, scaling up : eight case studies of home and community care for and by people with HIV/AIDS

The projects, which come from Africa (5), Asia (2), and Latin America (1), include: the Centre for Socio-Medical Assistance (CASM), Abidjan, Cote d"Ivoire; the Kariobangi Community-based Home Care and Home-based AIDS Care Programme, Nairobi, Kenya; Bambisanani, Eastern Cape, South Africa; the Mildmay Centre for Palliative HIV/AIDS Care in Kampala, Uganda; the Partnership for Home-Based Care in Rural Areas, Uganda; the Home Care Program in Phnom Penh, Cambodia; the Continuum of Care Project (COCP), Manipur, India; and the Programme for AIDS Initiatives in Ecuador. Overarching lessons learned are as follows: (1) Provide not just individual services, but comprehensive care to people living with HIV/AIDS. (2) Provide a continuum of care, linked with a referral system and spanning home to hospital. (3) Integrate the model of care into the government health care system. (4) Facilitate close coordination and cooperation between NGOs, government health services, and communities. (5) Include a prevention component. (6) Utilize the existing community resources with sustainable support mechanisms. Constraints to scaling up local AIDS programs include lack of resources, the host government"s administrative structure, institutional competition between professional organizations, and inadequate management skills. The concluding section of the report discusses examples of successful partnerships between existing services; the benefits of decentralization; the importance of building management capacity and, among local health workers, technical capacity; the centrality of providing palliative care to AIDS sufferers; the dual threat posed to public health by the AIDS and tuberculosis epidemics; and the impact of AIDS on families.