From Provider-Oriented to Client-Driven Care: Report on the Development and Testing of a Take-Home Monitoring Tool for People Living With HIV in Cameroon
This report provides client-driven care information and tools to program staff who work with people living with HIV.
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Significance of the report
This report presents possibly the first comprehensive self-monitoring tool designed for people living with HIV (PLHIV) in a resource-limited setting. It provides an opportunity for a critical review of the various systems in place and a transition from provider-oriented to client-driven care that needs further exploration.
Purpose of the take-home monitoring tool
Traditionally, clinical and biological follow-up of PLHIV is provider-oriented. There is little client education and limited involvement in clinical monitoring. This might explain cases of late initiation of therapy, poor adherence to care and treatment, and antiretroviral (ARV) resistance.
Faced with this challenge, Catholic Relief Services Cameroon decided to develop and test a client-oriented, pocket-size, take-home patient monitoring guide principally for PLHIV. This is a joint report of the two-phase process that covers the period from April 2008 to May 2010.
Development of the tool
The tool was designed and developed during three successive workshops that brought together people from various backgrounds with experience offering care to PLHIV.
The expert consultative group identified HIV and AIDS indicators understandable to the clients themselves that provide a snapshot of the client's health over time. These indicators included weight, signs and symptoms, CD4 cell counts, ARV regimens, medication refills, medication side effects, nutrition and hygiene.
The indicators were incorporated into a 16-page, 14-centimeter by 10-centimeter pocket-size booklet (the tool) to be used mainly by PLHIV in monitoring their own health over a five-year period. Home and facility-based care providers can also complete sections in the booklet.
Three hundred volunteers from four treatment centers in Cameroon were invited to use the tool for three to four months. At the end of the period, 200 participants were interviewed to assess the use of the tool. Another 130 volunteers from the same centers, who did not use the tool, were interviewed to assess the classical follow-up approach and compare any effects the use of the tool might have produced.
Eighty-five percent of participants used the tool correctly. Illiteracy and low educational levels were one of the main reasons for poor understanding and use.
Exposure to the tool significantly increased users' self-management behaviors and practices with specific regard to weight monitoring, CD4 testing and adherence to ARV drugs compared to nonusers. Some key suggestions were made by users to help improve the tool.
About 85 percent of nonusers of the tool expressed dissatisfaction over the classical follow-up approach, mentioning lack of understanding by patients of the condition for which they were receiving care, the criteria for initiating treatment and the indicators used for evaluating treatment outcome as the key reasons. Of the 33 percent of nonusers who reported going home with a document outlining their care and treatment, only 15 percent understood the information in the document.
Authors: Peter N. Ngang, Leslie C. Chingang, Kenneth N. Muko, Oliver C. Mokom
Publisher: Catholic Relief Services (March 2013)
Booklet: 56 pages
Dimensions: 8.5 x 11 inches
Posted on March 13, 2013