The Reviewed and
Revised Compendium of Christian Projects
Addressing the Diseases
of Poverty: HIV/AIDS, Malaria, and TB
Hands On Care: HIV/AIDS Care Pilot Program
Project/ Program name: Hands On Care: HIV/AIDS
Care Pilot Program
Country: The Gambia
Church or denomination: WEC International is
an interdenominational, multi-cultural, multi-generational and trans-national
Christian mission working with in partnership with Catholic Relief Services
(CRS) and the National AIDS Control Programme (NACP), the National AIDS
Secretariat and the medical research council (MRC) The Gambia.
Project summary: Hands On Care is a pilot
project that has been designed to provide care and support for people living
with HIV/AIDS (PLWHA), their families and communities in a holistic manner
addressing physical, social, emotional, spiritual and economic needs. It is
based on a strong partnership between government and NGO's and addresses both
HIV prevention and care issues in a comprehensive manner.
Background/ History: HIV in the Gambia has
increased significantly over the past 5 years.
The pressure for hospital beds and the impact of HIV at community level
has started to be seen in terms of an increase of young people sick and
dying. The associated stigma and
isolation of PLWHA makes the situation worse.
Since 1986 the country has a
National AIDS Control Programme (NACP) originally placed under the Ministry of
Health. This initially health oriented programme was recently extended into a
multi-sectoral response to HIV that is now located under the Office of the
President in form of the National AIDS Secretariat (NAS).
Other NGO's are also
involved in wide ranging activities of HIV prevention and the promotion of
sexual health, including the Gambia Family Planning Association, BAFROW a/o.
Most NGO's and government programmes have concentrated over the years on HIV
prevention messages and little had been done in terms of HIV Care.
This pilot program in HIV
Care was developed in order to address specific care issues in HIV in
collaboration with other stakeholders in the program. It is formed in order to
provide a continuum of care from community to hospital level and also in order
to specifically address issues of stigma and discrimination. In fact the
project tries to show that where care is offered, prevention can be enhanced
and also people living with HIV/AIDS can live in a less stigmatising
environment. The project has a time frame of October 2000 - September 2003.
Goals: The
goal of Hands on Care is to increase the ability of young women infected with
HIV/AIDS to live productive lives and better meet their physical,
socio-economic, spiritual and psychological needs.
Objectives: The objectives are listed
below with the corresponding sub-goals:
Improve the physical well being of people living with HIV/AIDS (PLWHA)
§
Increase by 20% the number of PLWHA who are
diagnosed in the early stage of the disease
§
Reduce by 30% the number of unexpected deaths
due to preventable opportunistic infections
§
Improve by 20% the nutritional status among
PLWHA
§
Increase access to appropriate essential health
care for PLWHA by 80%
Improve the psychosocial well being of PLWHA.
§
Increase by 30% the number of PLWHA who
perceive their quality of life improved and acceptable
§
Increase by 30% the number of PLWHA who perform
self-care activities
§
Improve the economic well being of PLWHA
§
Increase by 20% the number of PLWHA who have
increased their income
Who does the work?
The
project is a collaboration between WEC International (implementing agency), CRS
(main funding agency), the Department of State for Health, NACP, NAS and the
Medical Research Council (referral centre).
Project is staffed by the
following:
1 Project
Co-coordinator and 1 administrator
2 Nursing officers at
clinic level
2 Nurses at community
level
2 Social workers for
community activities and support network of PLWHA
2 Lab/technicians for
laboratory support and VCT
Volunteers at community
level: At community level we are working with peer health educators who are
selected by their communities as agents on change in reproductive health. They
work together with other key actors at community level such as traditional
birth attendants, traditional communicators, community leaders and traditional
healers. Each group has been specifically trained to function as an agent for
change at community level in HIV education and destigmatisation of the disease.
Some of the peer health
educators have chosen to also take on the responsibility of a home care
volunteer identifying and caring for chronically ill people at community
level.
There are 1 fulltime and 2
part-time missionaries working with the project, all other employees are
Gambians.
The project is monitored by
a taskforce for the care of PLWHA that has representatives from WEC
International, CRS- The Gambia, National AIDS Control Program, Department of
State for Health, Divisional Health Team- Western Division, and The Gambia
Nurses and Midwives Association.
Main activities:
1. Provision of clinical services in the form of a reproductive health
clinic addressing specific issues such as a comprehensive sexually-transmitted
infection management among others
2. Treatment and Prevention of opportunistic infections for all PLWHA
3. Voluntary Counseling and Testing Centre including immediate laboratory
results and enrolment in care for all patients found to be positive
4. Provision of Nevirapine for the prevention of mother to child
transmission
5. Provision of clinical and home base care for PLWHA
§
Development of management protocols for the
care of PLWHA
§
Home Care manual
§
Voluntary Counselling and Testing manual
6. Provision of psycho-social and economic support for PLWHA and their
families
§
Counselling session
§
Spiritual support
§
Income generating activities
§
Support groups for PLWHA
7. Information, Education and Communication
program development at community level
§
Training of Peer Health Educators and provision
of regular supplies and supervision
§
Training of home care volunteers to care for
chronically ill patients
§
Training of all strata of the community
including community leaders, traditional healers, traditional communicators,
traditional birth attendants, village health workers etc
§
On HIV transmission and prevention
§
Voluntary Counselling and Testing
§
Care for PLWHA and other chronically ill
members of the target community
Expected outcomes: An initial baseline survey
was done at the onset of the project that identified needs of PLWHA and also
included Knowledge, Attitudes and Practices Survey among health workers and
community members. A catalogue of indicators was put together at the beginning
that will allow us to monitor project progress over the three year period
looking at uptake of voluntary counselling and testing, clinical care for
PLWHA, death rates and status of well being. In addition, a mid-term evaluation
and final evaluation will look at the survey results of the main target groups
at community level and within the health delivery system.
Results: The following are the results of the first year:
§
A total of 59 professional trained in HIV
related issues
§
A total of 171 community members trained
§
1471 community members sensitised
§
21 home care-givers and 28 peer health
educators active at village level
§
6588 patients seen at the reproductive health
clinic
§
176 chronically ill patients enrolled in care
across a continuum, 83 of whom are living with HIV.
§
Voluntary counselling and testing centre
established with 153 sessions held in year 1
Lessons learned:
§
Community care is appreciated both by PLWHA and
other chronically ill
§
Stigma is associated with chronic illness in
general and not only with HIV in particular.
§
Home care can alleviate suffering and reduces
stigma and isolation especially where patients are identified at community
level.
§
Community participation is essential in a
successful programme: Key members of the community such as Traditional
communicators, traditional healers, religious leaders a/o need to be trained
and used as communicators at village level. This is a successful way in
ensuring that HIV is less stigmatising at village level.
§
The combination of care and prevention gives
credibility to a programme allowing communities to get involved with directly
benefiting by improved care to chronically ill patients.
§
Community volunteers can be included but cannot
be the sole carers for chronically ill patients.
§
Incentives such as skill training and income
generating schemes are essential in order to keep motivation up among community
volunteers.
Funding and other resources: The
project is supported with funds from CRS- The Gambia and WEC
International.
Further readings or documents produced by the project:
STI Treatment Manual,
Written by Dr. Gisela Schneider, published under: Department of State for Health,
The Gambia. September 2000
HIV treatment Manual,
Written by Dr. Gisela Schneider, published under: Department of State for
Health, The Gambia. September 2000
HIV/AIDS Knowledge, Attitude and Practice in Western Division, The Gambia. Written by Cherno Jallow/ G.
Schneider 2001
Annual reports
available for 1999, 2000 and 2001
HIV/AIDS: Hands on Care Collaborative Project, Report of Mid-term evaluation; written by
Dr. Carl Stecker and Kinday Samba-Ndure; November 2002
Voluntary Counselling and Testing: a manual of users
The prevention of parent to child transmission of HIV: a pilot programme using lay counsellors
Other helpful
literature:
1. Alexander, C.S. Supportive care and support for caregiver.
In AIDS 2000. 2000. Durban, SA.
2. Colebunders, R., et al., Antiretroviral
treatment in Africa. AIDS, 1997. 11(SupplB):
p. S 107- S 113.
3. Enel, C., Social and bahvioural risk factors for STD and HIV transmission in the
Sibanor area of The gambia, . 1995, MRC Laboratories: Fajara.
4. Evian, C., PRIMARY AIDS CARE. 3rd edition ed. 2000, Houghton: Jacana
Education.
5. Flessenkaemper, S., Knowledge of HIV/AIDS and attitude towards HIV testing and caring for
people living with HIV/AIDS
A pilot study using focus group discussions and interviews in Brikama
and Kombo District, The Gambia, in London School Of Hygiene and Tropical
Medicine. 2000, University of London: London.
6. Gilks, C., E. Katabira, and K. DeCook, The challenge of providing effective care
for HIV/AIDS in Africa. AIDS, 1997. 11(Suppl.B):
p. S99- S106.
7. Gilks, C., et al., Sexual Health and
Health Care: Care and Support for people with HIV/AIDS in resource poor
settings. Health and Population, Occassional Paper. 1998: DFID, Liverpool
School of Tropical Medicine.
8. Group, T.v.H.-C.a.t.E., Efficacy
of voluntary HIV-1 counselling and testing in individiuals and couples
in Kenya, Tanzania and Trinidad. Lancet, 2000(356): p. 103-112.
9. Muchiru, S. and J. Froehlich, HIV/AIDS Home Base Care A guide for care
givers. 1999: MOH, Botswana.
10. O'Donovan, D., et al., Maternal plasma viral
RNA levels determine marked differences in mother to child transmission rates
of HIV-1 and HIV-2 in The Gambia. AIDS, 2000. 14: p. 4411-448.
11. Schim van der Loeff, M., HIV-1 and HIV-2 prevalence among pregnant women
in the Gambia. Starting up sentinel surveillance, . 2000, MRC.
Contact information:
Dr. Gisela Schneider
Box 86, Banjul
The Gambia
E-mail: gschneider@gamtel.gm or
114224.2716@compuserve.com