Arm's Reach Care (ARC)

Arm’s Reach Care (ARC) is a pioneering pediatric HIV/AIDS care project focused on strengthening care provided in the home. Arms Reach Care creates a network of community health workers and nurses to provide HIV positive children a wider range of high quality, life saving health care services at home. The central philosophy of Arm’s Reach Care, “Everyone A Caregiver,” emphasizes providing maximum care at or as close to home as possible.

Advances in care and treatment have made HIV/AIDS a manageable disease. With proper nutrition, treatment of opportunistic infections, and adherence to drug regimens, people can live close to normal lives, raising families and contributing to their communities. Our goal is that all the HIV infected infants and children in our Arm’s Reach Care live long and healthy lives.

Power of Love launched its Arm’s Reach Care program in the Matero compound in Lusaka, Zambia in 2004. Matero is a large sprawling slum in Lusaka, Zambia with a population of around 175,000. The community is poor with a high prevalence of HIV/AIDS and rates of unemployment upwards of 65%. It is estimated that in Matero alone, there are 5000 children infected and dying of HIV/AIDS and who would benefit from our services. 

How the Arms Reach Care Program is Structured
Arm’s Reach Care consists of three levels of care service that identify children infected with HIV and help them and their families live with HIV. Each level, from Family Care Givers to Project Nurse, is more skilled medically. Care providers at each level are trained to provide medical care within their capabilities and to quickly recognize situations that require referral to the next level of care providers. The Matero Care Center provides outpatient service for more critical patients needing professional observation and intervention.

Family Care Givers (FCGs) are caregivers (many are grandmothers) of the child enrolled in our program and we provide them with training in caring for a HIV positive child.  Initially, FCGs take part in a 5-day workshop. To learn more about our training program for caregivers click here. Continued education is provided in bi-monthly daylong refresher sessions. In addition to HIV/AIDS education, FCGs are taught simple, yet effective responses to common opportunistic infections such as chronic diarrhea, fever, and cough, and maintenance of good hygiene. They are also taught care-giving specific to patients in the clinical AIDS stage, such as bathing and nurturing.  Monthly support meetings for the FCGs provide ongoing opportunities to teach about HIV/AIDS, to promote Voluntary Counseling and Testing, and to reduce the stigma surrounding AIDS.

Community Care Assistants (CCAs) are trained in medical care-giving specific to HIV/AIDS, particularly in the identification and treatment of opportunistic infections. CCAs are trained in an intensive 8-week workshop, followed by monthly daylong refresher sessions. The refresher sessions allow the CCAs to reinforce their existing skills, reflect on and address challenges encountered in the community, and acquire knowledge on new areas relevant to their practice. CCAs supervise up to 25 patients each. They provide each household with at least one home visit every week, during which they supervise care provided by FCGs, oversee treatment adherence, and counsel the patient and the FCG.

Project Nurses are fully trained, certified nurses. They meet regularly with CCAs to review patient records and visit each patient monthly. Project Nurses make final diagnoses and referrals, and prescribe treatment courses, as per Zambian regulations for community-based healthcare. S/he can dispense medication for common opportunistic infections and transport urgent cases to the local clinic for further treatment.

Key Benefits of the Arms Reach Care model
The Arm’s Reach Care Model is different from existing home-based care projects because it relocates ownership and responsibility for care of persons living with HIV/AIDS back into the home.  It also significantly reduces the cost of operations and allows us to deliver the most care for the dollar.

The FCG program gives the FCG a deeper understanding of the components of care for her patient and of her essential role in providing that care. By training FCGs and CCAs, the Arm’s Reach Care model creates a broad base of trained caregivers in the community, facilitating the management of AIDS-related infections.  With the assistance of CCAs, the Project Nurse is able to focus on the more serious cases requiring his/her advanced skills, and to make decisions on referrals to government clinics. Arm’s Reach Care offers a solution to both the shortage of trained health professionals and to the over-burdening of government clinics. Additionally, the model will implement a data capturing and management tool, CHART, to support the CCAs and Nurses and further increase their efficiency.

With its unique philosophy and structure, Arm’s Reach Care constitutes a radical shift from present models by engaging more community members in care-giving, significantly increasing the range of care provided at home, and increasing the output and impact of individual caregivers and of the overall system.

Implementation
Power of Love launched the Arm’s Reach Care program in 2004 in the Matero,compound in Lusaka, Zambia. To date we have trained over 450 FCG's, provided direct care for over 500 children and indirect care for over 1000. As a result of the FCG training and ongoing counseling during home visits, all patients have been tested for HIV. Children requiring advanced medication have been placed on ARVs (anti retro-viral medication). The nutritional supplements we provided to all patients have also played an indisputable role in supporting patients’ recovery from opportunistic infections and improving their overall condition.

Results
Results of Arm’s Reach Care are undeniable: children who were previously unable to attend school due to debilitating chronic diarrhea or serious fungal infections are now able to resume their studies and have dreams of an adult life.  Mothers and grandmothers who were previously kept away from work by long waits at the clinic and children in need of intensive care at home have now returned to earning money to support these children and take better care of their families.

As a testament to the success of the program, we have lost only 11 children out of a total of 368 children over the last 8 years. Since the life expectancy at birth for a HIV positive child is 5 years, statistically we could have lost many more children each year. However, this was not the case. Additionally, as care givers (grandmothers/grandaunts/mothers) see for themselves the positive effect that quality care has on the children, they themselves have come forward for testing (which, is critical in preventing the further spread of HIV). To date, more than 100 caregivers have come forward for testing for HIV.

The ARC program has been very successful in the Matero compound in Lusaka, Zambia and and the lessons acquired to date are informing both further development of the model and expansion of the existing project in Matero.

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