Re: [pronut-hiv] Home-Based Care Could Significantly Reduce Mortality Among HIV-Positive Adults, Families in Developing Countries (2)

["francis khadudu" <fkwere@yahoo.com>]

Indeed Home based care of both  HIV/aids  infected and affected persons has proved cost effective within the resource poor  Sub Saharan countries.This is where we should direct most of the resources.

Regards 

Francis Were
-----------------
ProNut-HIV wrote:
 
Home-Based Care Could Significantly Reduce Mortality Among HIV-Positive
Adults, Families in Developing Countries, Study Says
[Mar 03, 2008] 
 
      The implementation of home-based care could significantly reduce
mortality among adults living with HIV/AIDS in developing countries, as
well as children within their families, according to a study published
in the Feb. 28 issue of the journal Lancet, 
 BBC News reports (BBC
News, 2/29).
 
For the study, Jonathan Mermin of   CDC's office
in Nairobi, Kenya, and colleagues examined a group of HIV-positive
people and their families in rural Uganda through three phases of
treatment from 2001 to 2006 ( 

AFP/Yahoo! News, 2/29). The team employed a network of paid staff with
no clinical training to visit study participants weekly in their homes.
The staff re-supplied participants' medications and documented any side
effects, BBC News reports. People enrolled in the study were not
required to visit a clinic (BBC News, 2/29).
 
During the study's first phase, researchers provided counseling,
diarrhea prevention and hygiene education to 466 HIV-positive adults and
1,481 households with no HIV-positive members over the course of five
months. The second phase involved administering a daily dose of
antibiotics to the HIV-positive participants to prevent infections that
could compromise their immune systems. In the third phase, researchers
enrolled 138 HIV-positive adults from the original group, as well as 907
new HIV-positive people and their households, in an antiretroviral
study. The study used the antiretrovirals lamivudine, stavudine and
nevirapine, as well as three types of reverse transcriptase inhibitors.

 
Findings 
During the first 16 weeks of combined antiretroviral and antibiotic
treatment, mortality among the HIV-positive participants was 55% less
compared with those who received the antibiotic alone, the study found.
In addition, the combination resulted in a 95% decrease in mortality
compared with no intervention at all, according to the researchers
(AFP/Yahoo! News, 2/29). The study also found that the number of orphans
decreased by 93% and that deaths among children younger than age 10
decreased by 81%, 

Reuters reports. In addition, the home visits led to a large decrease in
deaths among HIV-negative children, which showed that providing
antiretrovirals benefits the entire family, Mermin said. 
 
Comments 
Mermin said that the "results were achieved even though no routine
clinic visits were scheduled after initial enrollment, and home visits
were provided by trained lay providers." Although treatment is becoming
more widely available in sub-Saharan Africa, patients still require
constant monitoring and need to learn how to follow medication
instructions, Mermin said, adding that it can be difficult for people
who live long distances from clinics. "We wanted to find a way where
people could avoid going to the health clinic," he said (Kahn, Reuters,
2/28). The authors concluded, "Wide provision of antiretroviral
treatment and care in sub-Saharan Africa could have a profound effect on
prevention of mortality in people with HIV, improve the health and
longevity of their children, and reduce the rate of orphanhood."
 
According to BBC News, the researchers acknowledged the study likely
scheduled more home visits than would be provided by most African health
care systems. Eline Korenromp and Jane Kengeya Kayondo of the 
 Global Fund To Fight AIDS,
Tuberculosis and Malaria said that this factor is an "important
limitation," adding, "At least two-thirds of patients received better
care than can presently be expected in most African antiretroviral
treatment programs." Korenromp and Kayondo suggested that the study be
expanded with less frequent visits. Ade Fakoya, an adviser to the 
 International HIV/AIDS
Alliance, said, "Getting HIV treatment to people who live in rural areas
is difficult, and this could have an impact." She added, "This is
affordable and could be carried out on a larger scale. And if you keep
the parents healthy, you also keep their children healthy" (BBC News,
2/29).
 
 Online  The study
abstract is available 

online.