Working with expert clients to enhance patients' follow up and retention; home care experience of St Raphael of St Francis Hospital, Nsambya, Kampala

Abstract

Background: Nsambya Home Care (NHC) is a department of St Raphael of St Francis Hospital, Nsambya that was established in 1987 to primarily decongest the hospital wards of overwhelming number of AIDS patients. The main beneficiaries are the women and children living with HIV, their families and the communities within 21 km radius. The program provides holistic home-based care quality services to HIV/AIDS-infected and affected persons, their families and communities. Through its HIV facility-based and home-based services, and support with various community linkages, over 13,494 patients and their families have been served since inception. It has built a human resource capacity in community involvement and several community linkages that support the patient identification, home-based care and referrals. Method: In 2001 the program realized a service gap between the facility and the community, identified 50 patients from its clientele who were trained in community mobilization skills, home-based care, use of the first-aid package, basic counseling, monitoring and follow up of patients. They were equipped with home-based care kits, gumboots, umbrellas, bicycles to easy transport, and air time to enable them to communicate and link up with the main facility. Consented clients are linked to respective community volunteers for follow up. Monthly meetings are held to share experiences and address challenges. Refresher courses are carried out to update them on the new method. Results: There has been an increase in clients visited, from 200 (2001) to 1240 in the year 2012 per month leading to increased adherence levels to ART and general care. The volunteers have led to the formation of peer support groups at community level, providing emotional support amongst the members. Lost-to-follow-up cases have reduced from 80 clients to 15 clients per month reduction. The patient missed appointments have also reduced. The community served have been sensitized, mobilized and are now actively involved in HIV prevention, care and support services/ activities being implemented by Nsambya Home Care Program. Male community volunteers have helped in changing attitudes of fellow men to support clients in HIV care, treatment and prevention since 12 of 50 volunteers are male. Conclusion: The community volunteers' efforts have contributed to improved quality of life among people living with HIV/AIDS, therefore should be enhanced and acknowledged as important in HIV programming and care.