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Family model of HIV care and treatment: a retrospective study in Kenya.

Lewis Kulzer J, Penner JA, Marima R, Oyaro P, Oyanga AO, Shade SB, Blat CC, Nyabiage L, Mwachari CW, Muttai HC, Bukusi EA, Cohen CR - J Int AIDS Soc (2012)

Bottom Line: The family model of care is a feasible approach to broaden HIV case detection and service reach.The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts.Further efforts are needed to increase family member engagement.

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Affiliation: Family AIDS Care and Education Services, Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya. jkulzer@globalhealth.ucsf.edu

ABSTRACT

Background: Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal.

Methods: A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach.

Results: Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively.

Conclusions: The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.

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Related in: MedlinePlus

Family model of care. This diagram illustrates the family model of care approach. It is based on the linkage between index patients and their family members at risk. Index patients are enrolled, assisted disclosure is provided, vulnerable family members are identified and encouraged to come in for HIV testing, HIV-positive members are enrolled, prevention infection counselling is carried out for HIV-negative members, and family support and awareness is raised. Comprehensive services are designed to support the family unit.
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Figure 1: Family model of care. This diagram illustrates the family model of care approach. It is based on the linkage between index patients and their family members at risk. Index patients are enrolled, assisted disclosure is provided, vulnerable family members are identified and encouraged to come in for HIV testing, HIV-positive members are enrolled, prevention infection counselling is carried out for HIV-negative members, and family support and awareness is raised. Comprehensive services are designed to support the family unit.

Mentions: The family model of care is based on the linkage between index patients and their family members at risk. A "family", in this context, is defined as two or more individuals who identify themselves as partners or family members, and "family members at risk" are defined as partners and/or children under 15 years of age of index patients. The family model of care is designed to identify, engage and care for all HIV-positive family members, prevent new infections among family members at risk, and raise family support and awareness within the HIV department at a health facility (Figure 1). Comprehensive family-centred services are built around this process.


Family model of HIV care and treatment: a retrospective study in Kenya.

Lewis Kulzer J, Penner JA, Marima R, Oyaro P, Oyanga AO, Shade SB, Blat CC, Nyabiage L, Mwachari CW, Muttai HC, Bukusi EA, Cohen CR - J Int AIDS Soc (2012)

Family model of care. This diagram illustrates the family model of care approach. It is based on the linkage between index patients and their family members at risk. Index patients are enrolled, assisted disclosure is provided, vulnerable family members are identified and encouraged to come in for HIV testing, HIV-positive members are enrolled, prevention infection counselling is carried out for HIV-negative members, and family support and awareness is raised. Comprehensive services are designed to support the family unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298805&req=5

Figure 1: Family model of care. This diagram illustrates the family model of care approach. It is based on the linkage between index patients and their family members at risk. Index patients are enrolled, assisted disclosure is provided, vulnerable family members are identified and encouraged to come in for HIV testing, HIV-positive members are enrolled, prevention infection counselling is carried out for HIV-negative members, and family support and awareness is raised. Comprehensive services are designed to support the family unit.
Mentions: The family model of care is based on the linkage between index patients and their family members at risk. A "family", in this context, is defined as two or more individuals who identify themselves as partners or family members, and "family members at risk" are defined as partners and/or children under 15 years of age of index patients. The family model of care is designed to identify, engage and care for all HIV-positive family members, prevent new infections among family members at risk, and raise family support and awareness within the HIV department at a health facility (Figure 1). Comprehensive family-centred services are built around this process.

Bottom Line: The family model of care is a feasible approach to broaden HIV case detection and service reach.The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts.Further efforts are needed to increase family member engagement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Family AIDS Care and Education Services, Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya. jkulzer@globalhealth.ucsf.edu

ABSTRACT

Background: Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal.

Methods: A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach.

Results: Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively.

Conclusions: The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.

Show MeSH
Related in: MedlinePlus