Assessment of knowledge, attitudes and practice on home based care of HIV/AIDS patients in Butula division, Busia district
In Busia District, Western Kenya, the estimated HIV prevalence is 14.2% (NASCOP, 2005), with 90% of people living in rural areas where access to medical facilities is inadequate. The number of people falling ill as a result of HIV infection is rising dramatically regardless of existing prevention efforts. Since. AIDS is a chronic disease lasting months or years, home based care is increasingly the option of choice for care for PLWAs. In response to the growing demands the HIV epidemic has placed on the people and communities in Busia, community health workers have been trained to provide home-based care to sick or dying PLWAs in rural areas. The purpose of this study was to assess knowledge, attitudes and practices in home based care of PLWAs patients in Butula division, Busia district. A descriptive cross-sectional study was carried out among the rural communities (n=393) comprising of CHWs, widows, PLWAs, caregivers and other community members randomly selected. Data was collected using both quantitative and qualitative methodologies. The level of education of respondents was found to be highly associated with knowledge on home based care (X2 = 24.43, P value =.000). Those with no formal education were almost five times (OR=4.513) more likely to have inadequate knowledge on home based care as compared to those with tertiary education. Fifty two percent of the respondents had adequate knowledge, which was a significant increase (z =15.01 with p<0.05) from 30% (REEP's baseline). This translated into 50% of respondents practicing good skills in nursing and counseling of PLWAs. Fifty percent still practiced poor nursing skills owing to high turnover of trained CHWs (no incentives), limited refresher trainings and lack of logistical backup due to budgetary constraints. Referral of patients to health institutions was reported by 66% of respondents to be norm, although stigmatization was said to be rife in these institutions. The attitude towards home based care was found to be positive (77.6 %), with 98.6% of the respondents saying that PLWAs should be given sympathy, material support, care and love at home. This has not translated into corresponding reduction in stigma due to prevailing poverty, overstretching of the traditional cushioning structures and caregiver burden/burnout. This affects mostly the women, who are the primary care givers amid limited resources. Major conclusion. From the study, it can be concluded that, although attitudes of communities are positive this is yet to translate into adequate knowledge, skills and good practices to care for PLWAs at home, amid prevailing poverty, caregiver burnout and limited training for CHWs/caregivers. Major recommendation: Initiating home based care fund or allocating specific funds from community development fund (CDF) for community groups while operationalizing the district home based care team and Constituency Aids Control Committee (CACC) to mobilize communities and additional funds for continued CHW training and incentives. Introduction of health insurance for all through National Hospital Insurance Fund (NHIF) should be reconsidered at national level.