What are the effects of home-based care on morbidity and mortality in those with HIV/AIDS?
Intensive home-based nursing significantly improved self-reported
knowledge of HIV and medications, self-reported adherence and
difference in pharmacy drug refill. It also significantly impacted
on HIV stigma, worry and physical functioning but not depressive
symptoms, mood, general health or overall functioning. One
study, comparing the proportion of participants with greater than
90% adherence, found statistically significant differences over
time but no significant change in CD4 counts and viral loads.
Comprehensive case management by trans-professional teams
and that provided by primary care nurses had the same impact in
the short term (six months). Two trials comparing computers with
brochures/nothing/standard medical care found no significant
effect on health status, and decision-making confidence and skill,
but a reduction in social isolation after controlling for depression.
Two trials evaluating home exercise programmes found opposing
results. Home-based safe water systems reduced diarrhoea
frequency and severity among persons with HIV in Africa.
Studies were generally small (31–549 participants), and very few
studies were done in developing countries. There was a lack of
studies looking at the effect of home-based care itself or looking
at significant end points (death and progression to AIDS).
Along with tuberculosis and malaria, HIV/AIDS is the major cause
of illness and death in low and middle-income countries where
health services already struggle with limited resources (staff, drugs,
equipment, etc) and poor infrastructure.1 Thirty three million people
are living with HIV and, in 2007, an estimated 2.5 million people
became newly infected with HIV/AIDS and 2.1 million people died.2
Home-based care is used in many countries to promote quality of
life and limit hospital care, especially where public health services