Home Based Care Services as Strategy to support Anti-Retroviral Adherence: The case of Musoma Municipal, Mara region

Abstract

A descriptive qualitative study was conducted to assess whether Home Based Care services can be used as a strategy to support Anti-retroviral adherence for People living with HIV/AIDS (PLWHA) in Musoma Municipality, Mara region in March 2012. Six public health facilities that are providing ARVs were included in the study; this included the regional hospital, two dispensaries and three health centers. With the national ART scale up, the poor health infrastructures are faced with poor retention of patients into care, as a result maintaining adherence becomes a problem due to a lack of follow up. The goal of the study was to assess the use of home based care services as a strategy to support Anti-retroviral treatment adherence among PLWHA. A total of five Focused Group Discussions (FGDs) were conducted with 30 home based care providers to find out from them whether the HBC intervention had experienced any changes since the advent of ARV scale up in the region, and whether their roles had changed in the delivery of services to PLWHA to include adherence support and management. Key Informant Interviews were conducted with 13 health care providers including the facility in-charges, CTC in-charges, hospital pharmacist and HBC Supervisor from the six health facilities that were included in the study to find out their perceptions towards home based care services and whether HBC is providing support to the formal health care systems in ensuring clients adhere to their ART regimen. Whereas in-depth interviews were conducted with 14 PLWHA who are taking ARTs to find out their perceptions towards home based care services and whether they support them with ART adherence. The study findings revealed that HBC services support the formal health care systems with community care support services such as patient tracking and monitoring clients’ adherence to ARTs. Health care providers revealed that the success of ART up in the region is faced with many obstacles including the poor rates of patient retention due to high rates of patients who miss appointments and those who default on their treatments. They revealed that this obstacle is being tackled by HBC providers who assist them to do the patient tracking and returning defaulters back into care, also they provide community supportive services including ART adherence and patient follow up. PLWHA who were interviewed attributed their goodadherence to the contribution of community support programmes such as HBC. They acknowledged the regular follow up visits, provision of counseling and monitoring that HBC providers conducted has helped them to maintain good adherence. This is because HBC has evolved in response to the roll-out of ARVs, where it has become more medicalised as a result of the drive to sustain PLWHA on ART to adhere to their treatment regimen. It was concluded that HBC services are a key attribute that provides can be used to provide facility-community linkage which will ensure patients receive community care services as well as facility care and at the same time bridging the gap between formal health services and community care. Therefore further studies should be done on adherence interventions in order to develop evidence based strategies that can promote sustained adherence. In order for the national scale up efforts of ARV to be successful, it is important to assess the component of adherence as a contributing factor in ensuring the effectiveness or ARVs in achieving the desired results.