AIDS Combat International (ACI)

"ACI is a non political, non sectorial, non profit making organization working round the clock for HIV positive/AIDS patients in Mumbai, INDIA. ACI got registered in the year 2002 under the Bombay Public Trust Act. Reg: No: E -20263."

Home Based Care

Reaching out these patients to their home and providing them the best of treatment is the mail concept of our organization. The Goal of Home Based Care is to provide hope through high quality and appropriate care that helps family caregivers and sick family members to maintain their independence and achieve the best possible quality of life. Components of Home Based Care.


  • Providing medical and emotional support in a homely environment
  • Establishing a Continuum of Care
  • Developing mechanisms for educating the ill peoples family members, neighbors and caregivers
  • Counseling

As most of the patients are from slums and lower middle class they often avoid attending Health facilities. Home Based Care works wonders in bringing back the lost confidence of the patients and motivates them to live a good quality life. Effective HIV / AIDS treatment is the single activity that can most effectively energize and accelerate the update and impact of treatment. Its purpose is to support the health needs of people with HIV both directly and indirectly.

Home Based Care (HBC) for HIV/AIDS patients

Background

Home based care includes, psychosocial and palliative care. Home care draws on two strengths that exist through out the world; families and communities. Families are the central focus of care and form the basis of the HCB team. Communities are places where people live and a source of support and care to individuals and families in need.

The aim of HBC is to provide hope through high quality and appropriate care that helps family caregivers and sick family members to maintain their independence and achieve the best possible quality of life. Hospital outreach of patient is relatively costly, often fail to mobilize community resources and do not place sufficient emphasis on counseling and social support.

The main features of HBC team are;

  • Conduct assessment of physical needs of patient
  • Conduct assessment of emotional and social needs of patient and family.
  • Show families and patients how to manage symptoms.
  • Prescribe medicine.
  • Help patients and families to understand about the illness
  • Give information about HIV/AIDS
  • Provide financial or material support e.g. transportation cost to hospital, nutrition or fees for their school going children
  • Provide spiritual and psychological help to patient and family. Respond to observed special needs e.g. pregnancy, unsafe housing and children as career, evidence of discrimination from community. Record main points of visit including medication given.

Table 1 & 2 below lists the Goals and Benefits of HBC

Table-1 Goal of HBC

  • Providing physical and emotional support.
  • Establishing a continuum of Care. Developing mechanism for education of the ill people, family member, neighbors and caregivers.
  • Creating awareness and encouraging community involvement.
  • Counseling including social support.


Table-2 Benefits from HBC

  • Give care and support to the patient. Education their family members for proper care of the patients.
  • Reduce stigmas and misconception prevailing in the minds of family members and friends.
  • Educate them about good health and hygiene.
  • During the process there is a strong bond between the families thus giving tremendous sense of security to the patient.
  • Opportunistic infection and even terminally ill patient can be efficiently treated at home.
  • A dying patient can be kept at home amongst the family members and gives them peaceful death.
  • Importantly, it is very much cost effective and cheaper to the patient than private hospital or medical centre.

ACI HOME BASE CARE SUPPORT

Looking from all angles our experience tells that HBC will definitely be one of the most important components in HIV/AIDS management. Nurses are contacted or called upon only when required (This can save money which can be utilized for other purposes.) Counseling by doctor themselves has also played a very important role in HOME BASED CARE.

HIV/AIDS positive people who are suffering from several OI’s(opportunistic infection) can be treated at home with support of family members, where care is likely to be cheaper and more convenient (for both family and patient), and where patient will be less exposed to other infection.

Similarly, as the patient approach the terminal stage of the disease, many people express a preference for palliative care at home amongst family members, rather than anonymity (and expense) of death in hospital.

Positive counseling of the patients can be done to boost up his confidence level, the diseases are explained in a simplest way so that the patient does not panic and accept his/her status. Counseling of the family members and friends is done very carefully so that they develop a positive attitude towards the patient.

THE MAIN FEARS TO HIV/AIDS PATIENTS ARE

  • Isolation and having no one to share their problems with.
  • Rapid deterioration in their health.
  • Increased stress and worries.
  • Feeling hopeless.
  • Loss of confidence.
  • Being unsupported.
  • Feeling discouraged and unsecured.

Home visit to the patient by team members will help them come out from all the above mentioned fears. It will give them improved quality of life.

REDUCE DISCRIMINATION

HCT can be instrumental in reducing discrimination against them in community. Home care visit can improve the way in which they are treated by their families.

FAMILY

HCT can add to their knowledge of HIV/AIDS, particularly method of transmission. It improves the attitude of community towards the family and reduces the discrimination by community.

COMMUNITY

HCT can help to forge links between prevention and care in communities in which they operate.

CHILDREN

Children may have to start working since the parents become sick. They may have to provide care, or take up major household duties. Children may have to go without certain things like food, clothes books etc. Children may have to leave their homes.

HOME CARE TEAM

Home Care Team can help the children in all the above mentioned problems and can give quality of life.

HOSPITALS

Home care team can help to reduce the number of beds needed for AIDS in hospital.

GOAL

Providing effective HIV/AIDS treatment is the single activity that can most effectively (energize and) speed up the update and impact of the treatment. It purposes is to support the health needs of people with HIV, both directly & indirectly.

OBJECTIVES


  • To set up our Holistic OPD center for PLHA and formulate the Home Based Care Team i.e. HBC Team.
  • The prevention and treatment for OI’s, to diagnosis early HIV prevalence and giving treatment for OI’s to the PLHA.
  • To Assist PLHAS coping with illness by giving them counseling as and when required.
  • To cater them quality of life by reducing Stigma and discrimination in the society where the PLHA live and provide them social & economic support.

Prevention of OI’s

Prevention: Opportunistic infections can be prevented by taking good nutrition No to addiction (Tobacco, alcohol, drugs). Remaining away from sick people, avoiding outside food, use of boiled water. Simple regular exercise, yoga , meditation on help the patient to improve their mental condition and remain healthy.


Treatment: Symptomatic treatment should be done to bring the OI’s under control at the earliest e.g. OI’s like Fever, Tuberculosis, Diarrhea, Malaria have to be treated with appropriate medicines.


Control of OI’s: Promote and maintain hygiene, nutrition and infection control, provide palliative care and health education to home care members, Adherence to medicine (no skipping of doses), proper sexual behavioral pattern with the partner (Usage of Condom), Regular health monitory (Blood Profiles CD3 CD4 Counts).

Counseling plays a very important role in HIV/AIDS patients. Counseling of the non-infected partner is very crucial (in case of discordant Couple). Both the partners have to be explained in details about the diseases. Understanding each other and not putting the blame on any one should be explained to both in a positive way. The Couple should also be explained about the MTCT prevention programme if they are willing to have a child.
Crisis Counseling is for people who have lost all the hopes in life. They think that once I am HIV positive it is the end of the road. Suicidal tendency, depression etc. are very common during this crisis time. To bring back the lost confidence & make the patient accept that he has to live with the virus should be our main goal. We all are with you during your Crisis period should be the take home message for the patient & his family member.
Good nutrition is very important in keeping the immunity on the higher side. More stress should be put on taking a Balanced diet. Carbohydrate, Proteins, Iron, and Fats containing diet should be recommended to infected people. Fruits, Fruit juices, Coconut water, Fresh Vegetables & Protein powder should be advised in proper quantity. Patient should be told not have out side food & if required only hot drinks & steamed food is permissible. This will prevent recurrence of opportunistic infection. He should be advised to have boiled or Bisleri water only.
The patient who doesn’t get the support of the family finds it very difficult to cope up with the diseases. Each & every family members should be explained in details about HIV/AIDS. Family members should be told to support the patient both physically & mentally during his bad times. The members should be told about the universal precaution which should be takes during care taking.
Usage of condom is very important in both cord ant & discordant couples. There are different strains of HIV & therefore condom will act as barrier in preventing the transmission. MTCT prevention should also be explained it they wish for children. Prompt treatment of sexually transmitted diseases should be advised. The patient should be advised not to have multiple partners.
Social eco financial Counseling mainly focuses on increasing the confidence level of the patient and helping him out how to live in the society. He should not be scared to mix with other people and carry out his routine activities. He should be told to concentrate more on his business/job so that he can sustain his medicine cost.
Regular prayers, meditations, attending satsangs help out the patient in over coming from the mental agony associated with the diseases. Getting associated with spiritual activities makes the person mentally strong and shows him/her the path to fight out the diseases.
Proper intake of medicines to control opportunistic infection and adherence to anti-retroviral drugs plays an important role in keeping the person healthy. It ensures a good quality life so that he can carry out his routine activities. Non-adherence can result into resistance to drugs leading to further complications.
This includes guiding the patients to proper legal advisors in case of loss of jobs, harassment from family member & neighbors. Information about organizations who work on the legal side (Voluntarily is ) given to the infected people.
Voluntary Counseling & Testing of both the partners should be done before marriage. If one of the partners is infected & wants to get married, he/she should be told to look out for HIV infected partner.