Final Report for the
AIDSCAP Program in Kenya
September 1992 to December 1997: Subproject Highlights

Care and Management

7. Care and Management

The Owen House Home Care Project

FCO 56367

Background

Owen House was established in 1991 to provide counseling and support for men and women testing positive for HIV-1 in Nairobi. There is an emphasis on establishing ongoing relationships with the clients and their families through trained counselors and health care workers. Over 1500 people have been registered to date, and have been offered post-test HIV-1 counseling, psychological support and medical therapy. A major obstacle to providing consistent care and support has been the difficulty that clients have attending appointments. This arises mostly commonly due to illness or lack of transportation money. To address this issue, funding was requested to explore the feasibility of providing home visitation to selected clients.

The project was funded as part of AIDSCAP's Care and Management Initiative, which was set up in 1994 to explore issues of care through selected pilot projects. The budget was $19,697.

Objectives

The primary objective was to implement a pilot project for home visitation among a selected group of clients. Secondary objectives were to:

• Assess the reception of clients and family members to home visits.
• Determine the feasibility of home visits in the Nairobi Area.
• Calculate the cost of running a home visitation program.
• Determine appropriate materials needs of the clients.
• Evaluate the impact of the visits on the health and well-being of the clients.
• Provide education and support for family members.
• Establish the necessary base-line information to develop a sustainable program of home care and support for HIV infected people in Nairobi.

Accomplishments

Over 200 visits were completed with very few missed appointments. The response to the visits was very positive both from the clients and the staff. Of the 42 clients initially enrolled only four defaulted (two were non-compliant, one left the city and one died). All visits were conducted by a team of at least one counselor and a nurse. Most visits included family members and neighbors, so that the input to the community went well beyond the individual client. Visits took an average of 2 hours each (range 1 to 4 hours). All visits consisted of a discussion of current social concerns, the preparation of food, a review of physical ailments and the distribution of medications if deemed necessary by the visiting nurse. Thirty-eight (90%) of the clients developed a medical problem requiring medication during the 8 months of visits.

The project was evaluated in two ways. A university graduate was hired to accompany the staff for the final month of visits. She completed a form on each client which included information on their experiences during the project. In addition, a final gathering of all the participants was held at the end of the project to hear their thoughts and suggestions. The major conclusions from these evaluations were:

• The program was of great benefit and should be continued and expanded
• Clients acquired valuable information regarding HIV transmission, the importance of nutrition and ways to "live positively" despite their HIV infection.
• Family members were better equipped to deal with chronic and/or recurrent infections
• Clients felt that someone was truly interested in their problems.
• Distribution of antibiotics early in the course of infection may prevent worsening symptoms and possibly hospitalization.

Lessons Learned

This project was a very rich learning experience for the staff and clients at Owen House. Clients were unanimous in their acceptance and appreciation of the visits and this greatly facilitated the relationship they developed with the Owen House staff. The major lessons learned were:

It became clear that people are much easier to educate and counsel about STD/HIV/AIDS in their own surroundings. The spin-offs to the community were difficult to measure, but many people participated in the visits who would otherwise not have been exposed to health information. Following the experience of this project Owen House hoped to become more community based with an emphasis on home visits and other outreach activities.

The feasibility of providing home based care was demonstrated to the staff of Owen House. Through this pilot project, modifications in the scheduling and client selection will be incorporated into future projects. It will be possible, for example, to reach a larger number of clients with similar resources.

Clients have a lot to offer to each other and should be encouraged to participate actively in future studies. A network of volunteer clients could be set up to conduct visits and monitor the progress of the sick in their homes.

The plight of people living in the slum areas of Nairobi is beyond belief. Individuals infected with HIV face the same problems, with the additional burden of poor health, alienation and very uncertain futures. The staff of Owen House were confronted with these desperate life situations which could never be understood without visiting the clients where they live. The commitment of the staff of Owen House grew as a result of this project.