Community and Home-Based Care for COVID 19 patients: Lessons from HIV/AIDS Care & Support programs. Author: Joydeep Sen

Community and Home-Based Care for COVID 19 patients: Lessons from HIV/AIDS Care & Support programs

The COVID-19 pandemic has challenged the entire health system in India. The recent second wave has overwhelmed the healthcare system, leaving hospitals struggling to cope and critical drugs and oxygen were in short supply.

This scenario is familiar to health care workers, social sector professionals, and communities impacted by HIV/AIDS in the 1980s and 1990s. Mortality was high due to lack of availability and affordability of treatment, underprepared health system, fear and stigma, and discrimination.

The Covid-19 pandemic has been more severe for the poor and marginalized with challenges that I find common to those in HIV/AIDS.

Inequitable Access to vaccines and ARV (Anti Retro Viral) drugs: ?WHO (World Health Organisation) in June 2021 said that 75% of 2 billion Covid-19 vaccines have been distributed among only 10 countries. Until the generic ARV’s from India reached LMICs (Low and Middle-Income Countries); PLHIVs (People Living with HIV/AIDS) found it extremely difficult to afford or have access to ARVs. ?

Stigma and Discrimination very much evident in Covid-19 is similar to HIV when the affected could not access ARV drugs and the recovery process was longer. People are afraid as Covid-19 as it is highly infectious resulting in many of the patients left to their own without anybody to help.

Lack of community support also resulted in social fabrics getting strained. Many of the families that lost their earning members in HIV/AIDs and now in COVID have been left to fend for themselves. Children, orphans, and women have become much more vulnerable in families with Covid-19 patients.

Mental health has emerged as an area of concern in the Covid-19 scenario. Caregivers, affected people, and their families have become more vulnerable to mental health problems due to the stress, challenges of health care, and stigma and discrimination.

Benefits of Home-Based Care and Support in Covid-19 management; learning the steps from HIV programming

Experience and evidence from HIV programs show that home or community-based programs are an effective way to deliver basic and essential care and lead to engagement and empowerment of communities in relation to their health. Covid-19 crisis has highlighted that home-based prevention care and support programmes conducted by health professionals are as effective as hospital-based treatment and considerably lower in cost. It increases the number of people who receive appropriate treatment and may reduce all-cause mortality.

As a ?part of the team at International HIV/AIDS Alliance in India/Frontline AIDS (https://frontlineaids.org/ ,?https://allianceindia.org/?which implemented the ?GFATM (the Global Fund https://www.theglobalfund.org/en/ ) supported Round 6- CHAHA program, I have several take away lessons from the program which may be adopted for Covid-19 test, track and treat approach.

?Need Assessment: People with confirmed Covid-19 symptoms should be assessed as per the government guidelines for their eligibility for home-based care and support (HBCS). It is also important to assess the infrastructure and setting at home for providing HBCS. Caregivers should be also identified and their knowledge on caregiving assessed and provided required information for safe and quality care.

Strengthening community health workers: In the village and community settings, the community health worker (CHW) plays a pivotal role in ensuring timely medical care and linking patients with health care services. ?They need training, equipment, and PPE for providing quality services at the doorstep. This helps in early testing and treatment.

Use of exiting community platforms: At the community level many institutions both formal and informal can be tapped to reduce the information and digital divide. Institutions like Common Service Centres( CSCs) in India are the access points for delivery of essential public utility services and government schemes can be utilised to help communities to register on the COWIN website for vaccination.

Psycho-social counseling focus on mental health: Covid-19 may have a long-term impact in terms of mental health therefore psycho-social counseling by community health workers can play an important role in supporting individuals, families, and communities to have an optimistic mindset to rebuild their lives.

More on this in my next write article which is upcoming soon.

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