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BACKGROUNDConcepts of Home-Based Care for PLHA 1.2The common misconception that people withHIV/AIDS will only benefit from highlyspecialised treatment, coupled with a generalfear of contagion, has often resulted in verticalAIDS programmes, with a disproportionateemphasis on prevention, and with care beingrestricted to dedicated institutions. Evidencefrom other countries indicates that this approach,which encourages the attitude that PLHA shouldbe segregated from the community, is inappropriate,unsustainable and unethical.1.2.1 Comprehensive CareAcross the ContinuumIn an effort to address this issue WHO andothers have, for the past decade, been promotingthe concept of "Comprehensive CareAcross the Continuum". This approach aims tolink a network of providers and services tocomprehensively address the care needs ofPLHA and their caregivers in a range of environments.Comprehensive care should also includereferrals between home or community and thehospital, and vice versa, effective dischargeplanning, and appropriate follow-up. As far aspossible, the approach should consist of fourinterrelated elements 6 :• Clinical Management, including earlydiagnosis and rational treatment of HIVrelatedillnesses and follow-up care• Nursing Care to promote and maintainhygiene, nutrition and infection control,to provide palliative care and healtheducation to home carers• Counselling, including psychosocialsupport to PLHA and their families, toreduce stress and anxiety, to promotepositive living and risk reduction strategies,and to empower individuals tomake informed choices for their futures• Social Support, including materialassistance, information and referral,linking into support groups and services.The continuum of care was envisaged as adynamic set of support services that PLHA andtheir families can access. It should be noted thatthis is an idealised situation; the approachadopted in a particular country will depend onthe prevailing needs of patients and the realitiesof health care provision.1.2.2 Lessons learned from otherhome care programmesThe limited number of evaluations of homecare programmes to date have revealed a numberof lessons learned:• ensure that any new initiative is integratedinto existing or planned governmenthealth systems• strong linkages should be establishedat the onset of the programme withhospitals and other health services• home care staff should have an appropriatemix of clinical and psychosocial skills5 Ministry of Health/NCHADS Draft Strategic Plan for HIV/AIDS and STI Prevention and Care in Cambodia, 2001-20036 Osborne et al. "Models of care for patients with HIV/AIDS". AIDS 11, 1997pg 9