Community-based health services for people with HIV/AIDS: A review from a health service perspective

Abstract

Health services for people with HIV/AIDS have been mainly hospital based, but it is now recognized that much care can be provided outside hospitals. There are well documented problems in delivering care in the community to other client groups such as the elderly and the mentally ill, but there are particular difficulties with HIV/AIDS care. These stem in part from the clinical demands of AIDS-related illnesses, but also from the stigma associated with the disease. This review looks at three key areas of relevance to those planning community-based health services for people with HIV/AIDS. These are: the need for collaboration between the statutory and voluntary sectors; the need for co-ordination between providers at the point of service delivery; and whether care should be provided by generic or specialist providers. While certain universal principles apply, and are necessary to ensure a good standard of care, patterns of service delivery will inevitably vary according both to the local prevalence rates and the existing service infrastructure. There is more than one good model of care; all models must be flexible enough to deal with needs on an individual basis.

Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study

“…Commentators have failed to acknowledge either the complexity of the relationship between patients with sickle cell disease and health professionals, or the attendant implications for experiences of pain and treatment seeking. Principles of palliative care26 and models of care for other chronic conditions 23 27 could enhance this discussion: issues of communication, continuity of care and home care, intersectoral collaboration, and a holistic understanding of pain, are of particular relevance. Models of care for patients with sickle cell disorders should also be informed by the recognition of this population's diversity.…”

Health systems’ responses to 25 years of HIV in Europe: Inequities persist and challenges remain

“…Hospitalcentred services have given way to community-and home-based care in line with user needs [58,[62][63][64][65][66]. Greater involvement of PLWHA in care decisions, along with a more prominent role for nurses in HIVprevention activities and coordination of care, led to improved service uptake and enhanced satisfaction [67][68][69][70][71].…”

Funding policies for HIV and AIDS: time for change.

“…Patients with AIDS and HIV infection are becoming more widely distributed and it is time to disestablish specialist teams and ensure higher standards in generic care services. 6 Special funding arrangements for palliative and terminal care have also contributed to separating AIDS patients from other district services. Since 1990 regions have been given special funding to support independent hospice and palliative care services,7 but this money could not be used for services provided by the NHS.…”