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Cross-sectional examination of service delivery and costs of community- and home-based care in Tanzania

Research & Evaluation Study Profiles
Hobokela S, Broughton E, Coly A, Massanga J, Abdulrahman S
Organization: USAID Health Care Improvement Project/URC

Topics: Community and home-based care for PLWHA, HIV/AIDS

Region and Country: Africa, Sub Saharan, Tanzania

Tanzania Red Cross Society, National AIDS Control Program of Tanzania, Family Health International

In Tanzania, like many developing countries, the provision of HIV/AIDS home-based care (HBC) services is not standardized. Few standards exist to guide providers and managers to assess whether HBC services meet desired quality targets. It is for this reason that the Ministry of Health and Social Welfare (MOHSW) and HBC implementing partners are developing Standard Operating Procedures (SOP) to provide guidelines to providers and managers for the delivery of quality HBC services in Tanzania.

The aim of this assessment is to evaluate the current scope of HBC services and associated roles and responsibilities among various stakeholders in Tanzania in order to inform the development of SOPs for HIV/AIDS HBC programs.
The USAID Health Care Improvement Project (HCI) in collaboration with the MOHSW and other HBC implementing partners conducted a cross-sectional study in Tanga city to examine, describe and systematically analyze HIV/AIDS HBC practices from the perspective of patients, providers, supervisors, and implementing partners. Both quantitative and qualitative data collection methods were used. Quantitative data related to socio-demographic characteristics of patients, HBC providers and supervisors, and the details of the home visits. Qualitative data included expectations and perceptions of HBC services and perceived problems hindering HBC service delivery as identified by HBC clients, providers, supervisors, and implementing partners.
The most commonly provided HBC services included: medicines, nutritional counseling, drug adherence counseling, hygiene and sanitation education, and psychological/emotional support. Referrals to facilities and community providers, education on prevention of new infections for both people living with HIV (PLHIV) and their families, counseling for adherence to treatment and formation of support groups for PLHIV were rarely provided. Interviewed clients expressed concern with the potential disclosure of their HIV status by the HBC providers and cited HIV logos as potential sources of disclosing their status to the public.
Overall, HBC providers and supervisors lacked guidance on how to provide and integrate most HBC services. HBC providers reported deficiencies in deficiencies in benchmark, training and supplies. Although HBC supervisors had adequate qualifications and a few years of experience, they supervise a large number of HBC providers and   do not conduct supervisory visits very frequently.  HBC stakeholders acknowledge the ground-shift in scope of HBC practices for PLHIV following the introduction of antiretroviral therapy (ART) from being predominantly medical and palliative towards prevention, linkage with other HIV/AIDS programs, health promotion and advocacy.
Conclusions and Recommendations
While important needs are being addressed by the HBC program, many needs are not being met due to a lack of practical guidance. Areas where further guidance would be beneficial include linking PLHIV with Income Generating Activities (IGA), referrals and linkages, food support and psychosocial services.  Current HBC practices should be revised to embrace unmet needs