Home-based care for reducing morbidity and mortality in people infected with HIV/AIDS
Home-based care (HBC), to promote quality-of-life and limit hospital care, is used in many countries, especially where public health services are overburdened. The objectives of this review was to assess the effects of HBC on morbidity and mortality in those with HIV/AIDS. A comprehensive search for clinical trials of HBC including all forms of treatment, care and support offered in the home was done. Eleven completed and two ongoing studies were identified. Studies were generally small and very few studies were done in developing countries. There was a lack of studies truly looking at the effect of home based care itself or looking at significant end points (death and progression to AIDS). Intensive home-based nursing significantly improved self-reported knowledge of HIV and medications, and self-reported adherence to medication. Another study, comparing proportion of participants with greater than 90% adherence, found statistically significant differences over time but no significant change in CD4 counts and viral loads. A third study found significant differences in HIV stigma, worry and physical functioning but no differences in depressive symptoms, mood, general health, and overall functioning. Comprehensive case management by trans-professional teams compared to usual care by primary care nurses had no significant difference in quality-of-life after 6-months of follow-up and average length of time on service. Home total parenteral nutrition had no significant impact on overall survival and rate of re-hospitalisation. Two trials comparing computers with brochures/nothing/standard medical care found no significant effect on health status, and decision-making confidence and skill, but a reduction in social isolation after controlling for depression. Two trials evaluating home exercise programmes found opposing results. Home-based safe water systems reduced diarrhea frequency and severity among persons with HIV in Africa.
Young, T.; Busgeeth, K. Home-based care for reducing morbidity and mortality in people infected with HIV/AIDS. Cochrane Database of Systematic Reviews (2009) (Issue 1) Art. No.: CD005417. [DOI: 10.1002/14651858.CD005417.pub2]