Using the family-centered approach to increase HIV testing, enrollment, and adherence to ART, an experience from Mubende Regional Referral Hospital

December, 2015; Studies on the impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have focused mainly on the individual, especially in regards to prevention and strategies for those who are HIV-positive to cope with the disease. However, for most people facing a serious illness like HIV, the family is regarded as the primary source of support.1 For example, children, adolescents, and adults infected with HIV may have difficulties in living a normal life because of their status, their medical treatment, and problems that stem from disclosure. Cognizant that parents’ positive coping style is important for HIV-positive children’s adherence to treatment, the family-centered approach is being piloted at Mubende a Regional Referral Hospital (RRH). This approach has increased the identification of new HIV-positive individuals, improved enrolment, and encouraged adherence to treatment.

family members meeting with a counselor at Mubende RRH

A male client presents his self-identified family for HIV testing and counseling at Mubende Regional Referral Hospital  @URC 2016 USAID/SUSTAIN/Bernadeta M.Nagita

 

In 2014, the USAID/SUSTAIN worked with the Mubende RRH HIV care team to pilot the approach at the hospital HIV clinic. This approach aims to ensure all family members of an index client are identified, tested, counseled, and enrolled into HIV care. In addition to creating a family matrix reporting tool, HIV counseling and testing (HCT) teams from the project and the Ministry of Health conducted skills and knowledge transfer activities so that health workers know how to implement this new approach. Through onsite supervision, mentoring and coaching, the staff have been able to counsel index on disclosure and encouraged them through health education to bring their family members to hospital for testing. The approach is implemented on a designated day for families called a ‘family clinic day’ with an attendance ranging from 130 to 150 clients.

Conducted within the antiretroviral therapy (ART) clinic space, the day starts off with health education sessions where counselors emphasize the benefits of disclosure and the importance of adherence to HIV treatment. From the counseling room, to the laboratory, to the enrolment desk, clients are served together as a family. Clinic staff have found providing counselling to clients as family units to be very beneficial. As one volunteer counselor puts it, by providing services together “family members aid us to discover their members’ psychosocial support needs. In turn, they benefit from the counseling.”

Nanyazi Madina (44) tested HIV positive in 2014. Through the family clinic day, she was encouraged to return to the hospital with her self-considered family. Two of her daughters and two of her grandchildren got tested for HIV. Also, they were found to be HIV-positive and enrolled in HIV care.

“Initially, I struggled to accept and disclose my status to my children but through the counseling I got here at the hospital, I managed to disclose to them. I also encouraged them to test and they are now on treatment. Knowing our status has enabled us to spend more time together and talk about our experiences with the treatment and about our lives…..but also, this program has cut down on our transport cost because one of my children collects all of our medicine in a single appointment.” said, Nanyazi Madina

Barebereho Aggrey (28) tested HIV-positive in September 2015. Through the family-centered approach, he was encouraged to bring his breastfeeding wife to hospital, both mother and baby tested HIV positive and were enrolled on ART at the mother-baby care point.

“I received counseling on disclosure and that helped me disclose my status to my wife. I have continued to talk to her since then and she is listening to me. That is why she came with me today to enroll. We want to remain in care and support our baby to grow” - narrated, Barebereho Aggrey

According to the HCT focal person of Mubende RRH, most clients who were identified through the family-centered approach are in care and are living positively with HIV.

http://sustainuganda.org/sites/sustainuganda.org/files/FamilyCenteredApproach_pdf.pdf

 
Written by Bernadeta M. Nagita,  Executive and Communications Officer, SUSTAIN; with contributions from Carolyn Hemminger, Knowledge Management Specialist, URC

Bor R, Du Plessis P, Russell M., The Impact of disclosure of HIV on the index patient’s self-defined family. Journal of Family Therapy, 2004, 26(2): 167-192