the community and on the use of local community and nongovernmental organizations (166-14-PCNGO; 934-10-PCGOV; 272-32/35-PCNGO; 935-19-PCGOV; 240-15-USG). In addition, many programs are implemented using community volunteers or community health workers, many of whom are also PLHIV. These workers provide such services as case management; adherence monitoring and counseling; personal care; palliative care; pain assessment; nutritional assessment; assistance in navigating health services; and referrals to help lines, health facilities, and other program linkages, including to facilities known to be ‘friendly’ to high-risk targeted populations (272-7-USG; 272-32/35-PCNGO; 166-23-USG; 396-31-PCGOV; 461-13-USACA; 240-15-USG; 240-2-USG; 272-18-PCNGO; 331-14-USG; 331-16-USG). In an example in one partner country, a restructuring was taking place to shift to community care provided by a cadre of workers with the capacity to do ART management and counseling (272-7-USG). In another example, an NGO partner provided traditional healers and community authorities with education about HIV and associated diseases since these individuals played an integral role in community health care; this was described as an important approach because a large proportion of the population used traditional healers for care (331-19-USNGO).

Linkages Between Home- and Community-Based Care and Facility-Based Care

One of PEPFAR’s aims for care and support activities has been to support the implementation of different approaches to link facility-based care services with community- and home-based care services. Several interviewees described home-based care programs that emphasized promoting linkages between home-based care and HIV care and treatment clinics, health facilities, and providers who can make appropriate referrals (272-32/35-PCNGO; 331-10-PCGOV; 396-25-PCGOV; 166-23-USG). In other cases, programs for home-based care or home visits for adherence support and reducing loss to follow-up are based out of outpatient facilities or other care and treatment programs and are therefore directly linked to patients enrolled in clinical care and treatment (935-15-ONGO; 935-25-PCGOV; 396-29-PCGOV; 396-21-USG; 240-19-USACA; 240-25-PCGOV). There were also a few examples involving children and adolescents in which community and nonclinical services were linked with clinical services in health facilities, such as age-specific clubs for children in HIV care and treatment clinics; youth-friendly services for HIV-positive youth that include support groups; education, and programs for youth in school and those not in school; and community workers who focus on helping children stay in treatment (636-17-PCGOV; 935-13-PCGOV; 272-14-PCNGO). (See Chapter 7 for a further discussion of services for children and adolescents.)

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