ECI Ten Areas of Care

1. Voluntary HIV Counseling and Testing (VCT)
In the majority of cases, VCT is the initial entry point to care, and the method by which individuals learn their HIV status and are initiated into medical and social services. Ideally, identification of serostatus enables involvement in groups that provide the support and education that is key to improving quality of life and minimizing transmission. Stigma and fear, however, prevent many people from learning their status and accessing these services. To be most effective, counseling and testing must be supplemented with accessible treatment and sufficient care infrastructure, which in turn increases demand for VCT services.

2. Basic Medical Care Services
Insufficient access to medical care continues to be the hallmark of most resource-constrained countries. Primary health care and STD treatment and prevention can form the foundation on which more specialized AIDS service programs are sustained. In order to build this foundation, basic health infrastructure must continue to be a focus of AIDS care and treatment efforts. With sufficient infrastructure, basic medical care and complementary programs such as promotion of balanced nutrition or distribution of micronutrient supplements can be effective ingredients in basic AIDS care. As treatment becomes more accessible, the most effective care will ensure that medications are integrated into basic care according to primary knowledge of the specific needs of target populations.

3. Laboratory and Diagnostic Services
In the context of HIV and AIDS, effective care and treatment requires a detailed clinical knowledge for which basic lab and diagnostic infrastructure are prerequisites. HIV testing, blood screening and hematology, CD4 tracking and viral load are key components of comprehensive lab and diagnostic infrastructure. As once-rare opportunistic infections (OIs) become more common, the need for these basic capabilities increases in rural as well as urban settings. Although basic lab infrastructure is improving in many countries, gaps in coverage persist, especially in rural areas. Cost continues to limit training programs and efforts to scale up lab and diagnostic capacity. Continued research of low cost options for testing and diagnostics such as total lymphocyte counts , is needed in order to make these services more widely available.

4. HIV/AIDS Clinical Management
In integrated clinical settings, trained personnel and clear care guidelines are integral to efficient management of scarce resources. Improvements in management can have a significant impact on care even in the absence of ARV treatment by streamlining clinic scheduling and maximizing the time that physicians can spend with each patient. When staff receive training in administration, management and accounting operational efficiency in clinics improves and staff are better able to support overburdened health care providers.

5. New Therapies, Including Antiretrovirals
In the five years since the launch of the Enhancing Care Initiative, several changes have occurred, including reductions in drug costs, which have increased the availability of ARV therapy in many resource-poor settings. As more patients are treated, research and practice have revealed that comprehensive treatment that pairs ARVs with infrastructure and education, specialized training, vigilant resistance testing, affordable monitoring, and continued research at all levels of health care.

6. Community-Based Care, Including Traditional and Complimentary Therapies
Since the start of the AIDS pandemic, community based care has been a key resource in extending medical care to underserved areas. Patient care within the home (home-based care), traditional medicines and peer adherence monitoring are all part of the medical and social programs that communities have developed to meet their own HIV care needs; it is estimated that traditional health therapies are used by between 60-80 percent of individuals living with HIV in resource-scarce settings . In many settings, however, coverage and quality of home care services are limited by lack of supplies, poor transportation, fatigued family members, and overburdened outreach workers. Long term success in care requires support for the key role that communities play not only in filling gaps in formal health services, but in providing overall care and support.

7. Social Services
When the most productive members of society fall sick and die, the financial impacts of AIDS can overwhelm traditional community resources. Social services that provide food, clothing, housing, transportation, or schooling for affected individuals and families create important safety nets. Varied service providers are necessary to adequately assess and utilize their individual resources and interests to address the economic and social consequences of the pandemic.

8. Care Education and Information Dissemination
One of the most persistent gaps in care is care education. While raising awareness and providing basic prevention education remain central to successfully addressing HIV/AIDS at the local level, training of medical personnel and community health workers for AIDS care has yet to receive sufficient attention. Ideally, efforts should be made to ensure that training is ongoing so that health workers have the most recent information regarding HIV/AIDS care.

9. Supportive Care and Care of the Dying
Several aspects of end of life care including amelioration of pain, communication with physicians and emotional support are often under prioritized. In many resource-poor settings, even the most basic medicines for pain relief are lacking. Respect for the dignity and needs of dying individuals should be standard practice for all systems of care. Because AIDS-related deaths may occur at a time when a family’s resources are depleted, social services may be needed to supplement care for the dying when available.

10. Care of the Caregiver
The HIV/AIDS epidemic has not only challenged the structures of communities and existing health services, it has also placed a significant emotional and psychological burden on health care providers and family members. Care of the caregiver addresses the fact that individuals infected with HIV are not the only people who are affected by the disease, and identifies areas in which caregivers are most in need of support. This can include attention to individual, group, and community support services, education, advocacy, and referral services, and sources for the integration and dissemination of information on care of the caregiver.