Care for children infected and those affected by HIV/AIDS. A training manual for CommunityHealth workers

Transcription

1 Care for children infected and those affected by HIV/AIDS A training manual for CommunityHealth workers

2 Published by Save the Children UK P.O. Box 1124 Kampala Uganda Tel: / Fax: First Published 2003 Printed by Graphic Systems (U) Ltd Factory 8 Buvuma Road Luzira Portbell P.O. Box Kampala, Uganda Tel: /4 Fax: ii Care for children infected & those affected by HIV/AIDS

3 Table of Contents Acronyms i Foreword II Acknowledgements iii Introduction iv Module One : Introduction To The Course 13 Session 1 : Getting Started (Total Duration 1 Hour 30 Mins.) 13 Activity 1 : Paired Self-Introduction (35 mins.) 14 Activity 2 : Pre-course exercise (20 mins.) 15 Activity 3 : Course objectives and reviewing timetable and handbook (10 mins.) 15 Activity 4 : Setting course rules (10 mins.) 16 Activity 5 : Course Introduction (15 mins.) 17 Module Two : General Facts about HIV/AIDS 19 Session 2.1 : Facts about HIV/AIDS (Total Duration 1 hour 20 mins.) 19 Activity 1 : Meaning of HIV and AIDS (20 mins.) 19 Activity 2 : Ways in which HIV is transmitted (20 mins.) 21 Activity 3 : Ways in which HIV is not transmitted (20 mins.) 21 Activity 4 : Prevention of HIV (20 mins.) 23 Session 2.2 : HIV Infection in Children (Total Duration 45 Mins.) 25 Activity 1 : HIV infection in children (45 mins.) 25 Module Three: HIV Counselling and Testing 27 Session 3.1 : HIV counselling and testing (Total Duration 1 hour 20 mins.) 27 Activity 1 : What is HIV voluntary counselling and testing? (40 mins.) 27 A training manual for Community Health workers iii

4 Activity 2 : HIV testing (40 mins) 30 Module Four : Nursing Care for Children with HIV 34 Session 4.1 : Nursing care for children with HIV (Total Duration 2 hours 20 mins.) 34 Activity 1 : Home based care (20 mins.) 35 Activity 2 : Helping children stay well (30 mins.) 37 Activity 3 : Nutrition for children (20 mins.) 38 Activity 4 : Common illnesses and health problems (40 mins.) 39 Activity 5 : Special medical treatments for children with HIV (30 mins.) 40 Module Five : Managing Children s Emotional Health 41 Session 5.1 : Managing children s emotional health (Total Duration 3 hours 30 mins.) 41 Activity 1 : Helping children to cope with sickness in the family (40 mins.) 41 Activity 2 : Talking with children (40 mins.) 43 Activity 2 : Children and grief (40 mins.) 44 Activity 3 : Caring for orphans (30 mins.) 45 Activity 4 : Caring for Children in school (30 mins.) 46 Activity 5 : Caring for the carer (30 mins.) 47 Module Six : Conclusions and Future Planning 49 Session 6 : Conclusions and future planning (Total Duration 1 hour 30 mins.) 49 Activity 1 : Post-course exercise (30 mins.) 49 Activity 2 : Immediate concerns and problems (30 mins.) 49 Activity 3 : Identifying a support network (30 mins.) 50 iv Care for children infected & those affected by HIV/AIDS

5 Glossary References for further reading Appendix 1 51 Questionnaire 51 A training manual for Community Health workers v

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7 Acronyms AIC AIDS ARV BCG CDC CHW DPT HIV mls NACWOLA ORS PCP SSS STI TASO VCT AIDS Information Centre Acquired Immune Deficiency Syndrome Anti Retro-Viral Therapy Bacille Calmette Guerin Centre for Disease Control and Prevention Community Health Worker Diptheria Pertucis Tetanus Human Immuno-deficiency Virus Millilitres National Community of Women Living with HIV/AIDS Oral Rehydration Salts Pneumocystic Carini Pneumonia Salt, Sugar Solution Sexually Transmitted Infections The AIDS Support Organisation Voluntary Counselling and Testing WBC White Blood Cells A training manual for Community Health workers vii

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9 Foreword Uganda has received international recognition for its fight against HIV/AIDS that has led to the reduction of HIV prevalence throughout the country. This positive trend is however continually threatened by the long-term impact of the epidemic on the lives of children. A majority of children affected by this epidemic are growing without the right to education, health, social protection and care, thus curtailing their capacity to develop into meaningful adults. This situation is precipitated by, among other things, the lack of access to quality guidance on how to care, counsel and share information with HIV/AIDS affected and infected children. This handbook has been developed to help increase these children s access to proper care and support within the communities in which they live. The application of paediatric HIV/AIDS care, counselling and prevention contained in this handbook, will improve the quality of lives of children infected and affected by HIV/AIDS. These guidelines take a community based approach and are intended for community based health workers who interface regularly with families affected by HIV/AIDS. It is my expectation that this handbook will increase the chances of children with and those affected by HIV/ AIDS to access their right to proper growth and development. I trust that lessons that will be learnt through operationalising these guidelines, will continue to inform and strengthen the fight against HIV/AIDS and its consequences. The implementation should challenge policy makers and other key stakeholders at all levels of government and within communities to strengthen community-based initiatives and structures to respond more efficiently and effectively to the needs of children infected and affected by HIV/AIDS. Zoe Bakoko Bakoru Minister of Gender, Labour and Social Development. Government of Uganda. A training manual for Community Health workers ix

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11 Acknowlegdements Many people contributed information, ideas and practical guidance to the development of this training manual for community heath workers. Thanks go to the following organisations and ministries for their participation in reviewing this training manual. A list of individual persons is attached at the appendix. 1. Ministry of Gender, Labour and Social Development 2. Ministry of Health 3. Ministry of Education 4. Mulago Hospital 5. The AIDS Support Organisation 6. AIDS Information Centre 7. Mildmay Uganda 8. AIM Project 9. Save the Children UK Special thanks go to David Mawejje, the HIV/AIDS Project Manager, Save the Children UK - Uganda Programme, for his hard work in coordinating the contributions and and providing other support for the production of this handbook. Lastly, special gratitude is extended to CDC for providing funds and practical guidance for the development of this care handbook. A training manual for Community Health workers xi

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13 Introduction Uganda has made great strides towards reduction of HIV infection over the period. HIV prevalence rates among antenatal mothers has continued to decline to 6.1%. 1 The Good News is outstripped by the increasing number of children affected by HIV/AIDS. The cumulative number of children, aged 12 years and below infected with HIV is estimated at 4,286, with a mean age of 2.3 years 2. The current cumulative number of AIDS orphans is approximately 2.3 million 3. HIV/AIDS is one the greatest threats to child development in many parts of the world. Families in Uganda are overwhelmed with the numbers of children living with HIV/AIDS and those orphaned by the disease, in terms of ensuring their nutritional and health needs, provision of social protection and ensuring development of their mental capacities. Stigma and the sense of hopelessness associated with HIV/AIDS greatly undermines the provision of care to children infected/affected by HIV/AIDS. Discrimination, neglect and isolation of children infected and affected by HIV/AIDS becomes eminent in households with persons suffering from HIV/AIDS. Most children affected by HIV/AIDS tend to have limited access to health, education and welfare services. Accessible public health services are just one part of the broad developmental approach needed to support such children; their psychological support and acceptance in a non discriminatory environment is just as important as their material needs for food, shelter and clothing. 1 HIV/AIDS Surveillance Report, June HIV/AIDS Surveillance Report, June Situational Analysis of Orphans in Uganda, February 2002 Course overview The operationalisation of this training manual will definitely contribute to mitigating the psychosocial impact of children infected with and/or affected by HIV/AIDS in Uganda. A training manual for Community Health workers xiii

14 Introduction Given the fact that access to medical care is difficult, coupled with the stigma and unsupportive attitudes towards HIV/AIDS prevalent in the communities, Home Based Care and Counselling remain the most appropriate form of intervention to improving the quality of lives of children infected and affected by HIV/AIDS. The rational for this training manual and its corresponding handbook is based on the findings of a survey conducted in Arua and Kasese districts, to assess community s perceptions on care for children infected and affected by HIV/AIDS. The survey revealed gaps in accuracy of knowledge about HIV /AIDS. Discrimination and rejection of children infected and affected by HIV/AIDS was reportedly influenced by the prevailing stigma associated with HIV/AIDS. Community based health care workers lacked adequate skills and understanding to support children suspected to be infected by HIV. Furtherstill, households affected by HIV/AIDS faced socio-economic problems that challenge their capacities in managing HIV/AIDS. In this respect therefore, this training manual and the accompanying handbook try to address some of the prevailing inadequacies in skills and understanding among community based health workers and other carers in supporting and caring for children infected and affected by HIV/AIDS. This trainers manual is intended to enhance knowledge, skills and practices of community based health workers and family members (carers) in providing care and support to children infected and affected by HIV/AIDS, in a manner that will alleviate their physical and psychological pain. The trainers manual should be used hand in hand with the care handbook and provides detailed procedure on delivering meaning and application of the basic concepts of care to HIV/AIDS infected and affected children in a community setting. The trainers manual contains six modules that address essential knowledge and skills community health workers and carers should poses. xiv Care for children infected & those affected by HIV/AIDS

15 Introduction Module One The module provides an overview to the course, highlighting the rational and objectives of the course. It also starts the team building process of participants that is essential for the successful accomplishment of the course objectives. Module Two The module introduces general facts about HIV/AIDS with special reference to children. The module reinforces understanding of facts about HIV and AIDS, including transmission and prevention and also helps to demystify myths surrounding HIV/AIDS and children. Module Three The module explains HIV counselling and testing and other information people should know about HIV testing for children (within the Ugandan context). It goes further to identify HIV counselling and testing facilities where people need go for more information, HIV testing or further support. Module Four The module introduces the concept of home based care, explaining the rational and importance in the context of HIV/AIDS. It further equips participants with skills in applying nursing care to children with HIV related diseases, nutrition among children with HIV related diseases and the general hygiene and sanitation principles. Focus has been put on utilization of available human and material resources in homes. The module suggests case study scenarios, to engage participants into critical thinking while at the same time demonstrating nursing skills. Module Five The module provides an understanding of psychosocial related issues affecting HIV/AIDS infected and affected children and further builds participants skills in communication with A training manual for Community Health workers xv

16 Introduction children in view of addressing grief, stigma, sexuality and the day to day concerns of such children. The module further guides participants on strategies of caring for themselves as carers in order to cope with their responsibilities. Module Six The module concludes and evaluates the course. It provides opportunity for participants to develop plans of care and support to children in their respective areas of responsibility. While the course focuses on community based health workers, the knowledge and skills that are taught can also be applied to other categories of carers like family members, teachers and community AIDS workers. We believe that the roll out of this trainers manual, will improve the level of confidence and skills among family members, health service providers and the general community, in promoting care and alleviating the suffering of children infected and affected by HIV/AIDS. xvi Care for children infected & those affected by HIV/AIDS

17 The overall purpose of the course is to improve understanding of knowledge and develop skills of community based health workers so as to enable them improve the provision of home based care and support to children infected and affected by HIV/AIDS. By the end of the course, participants should be able to.. Course Objectives Establish a common understanding of the basic facts about HIV/AIDS including HIV transmission and prevention Establish a common understanding about HIV counselling and testing and its importance to adults, adolescents and children Establish an understanding of basic aspects home based care to children with HIV infection, including nursing care, nutritional care, hygiene and sanitation and referrals Establish an understanding about managing emotional concerns of children infected and affected by HIV/AIDS Discuss immediate concerns and identify networks and available resources for participants work plans. A training manual for Community Health workers xvii

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19 The following is a suggested outline of modules and activities to be conducted during the course. Two weeks are recommended for the course, to allow sufficient time for skills development. The actual length of the course can be adjusted according to participants needs and schedule. The amount of time allocated for each activity is an estimate to allow for maximum flexibility. Module One : Introduction to the Course Activity 1 : Paired self introduction Activity 2 : Pre-course exercise Activity 3 : Course objectives and review timetable and handbook Activity 4 : Setting course rules Activity 5 : Course introduction Module Two : General Facts about HIV/AIDS Session 2.1 : Facts about HIV and AIDS Activity 1 : Meaning of HIV and AIDS Activity 2 : Ways in which HIV is transmitted Activity 3 : Ways in which HIV is not transmitted Session 2.2 : HIV infection in Children Activity 1 : HIV infection in children Module Outline Module Three : HIV Counselling and Testing Session 3.1 : HIV counselling and testing Activity 1 : What is HIV voluntary counselling and testing A training manual for Community Health workers xix

20 Activity 2 : HIV testing Module Four : Nursing Care for Children With HIV Session 4.1 : Nursing care for children with HIV Activity 1 : Home based care Activity 2 : Helping children stay well Activity 3 : Nutrition for children Activity 4 : Common illnesses and health problems Activity 5 : Special medical treatments for children with HIV Module Five : Managing Children s Emotional Health Session 5.1 : Managing children s emotional health Activity 1 : Helping children to cope with sickness in the family Activity 2 : Talking with children Activity 3 : Caring for orphans Activity 4 : Caring for the carer Module Six : Conclusion and Future Planning Session 6.1 : Conclusion Activity 1 : Post - course exercise Session 6.2 : Future Planning Activity 1 : Concerns Activity 2 : Identifying support networks xx Care for children infected & those affected by HIV/AIDS

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