Community home based care for people living with HIV: an overview of client needs, actors and services provided in Ethiopia

Abstract

In Ethiopia, it was shown that funding levels are far from compatible to the needs for care and support services for people living with human immuno-deficiency virus (PLHIV) and orphaned and vulnerable children (OVC). The aim in this study is to map the relationship between client needs, actors, care and support services provided for PLHIV and OVC in Ethiopia. A case study of the Ethiopian community care program was carried out using multiple methods of data collection as part of a multi-country research of four countries. Three program cases providing care and support services throughout the country were studied. A total of 35 in-depth interviews, 9 focus group discussions, 60 guided interviews, and 3 community mapping exercises were carried out. Analysis was conducted using the thematic framework approach with coding and mapping of the transcripts in the ATLAS.ti version 5.0. The expansion of antiretroviral therapy (ART) has reduced the number of bed-ridden PLHIV in need of home based nursing care. Currently, inadequate access to food and lack of income to cover health care and other expenses are the major concerns of PLHIV in Ethiopia. Community Home Based Care (CHBC) in Ethiopia can be categorised into two types; clinical and non-clinical. Non-clinical care (psychosocial, economic, home nursing care, material, food, and other social supports) is mainly provided by non-governmental care-giving organizations. Clinical care was provided mainly by government health facilities which comprised services such as early detection and treatment for opportunistic infections (OIs), ART services and PMTCT. A clear shift of the need of PLHIV from basic nursing care at home to social and material support needs was observed. A coordinated effort from the key players including governmental entities, non-governmental organizations (NGOs) and faith-based organizations (FBOs), the community, associations of PLHIV and volunteers is required to meet the current needs of PLHIV and OVC in the country.   Key words: Caregiver, community home based care, patient needs, service provision, care and support, people living with human immuno-deficiency virus (PLHIV), Ethiopia, qualitative methods, mapping.