• Explain to interested patients that this analysis suggests that home-based care can have benefits for HIV treatment, but more research is needed to determine whether it helps slow progression of disease or improves survival.

Home-based care can improve some aspects of HIV treatment, according to a systematic review of reported studies.

But the evidence is slim, and no studies looked at how home-based care affects AIDS progression or death, according to Taryn Young, MBChB, of the Medical Research Council of South Africa, and Karishma Busgeeth of the Council for Scientific and Industrial Research in Pretoria, South Africa.

In addition, few of the studies evaluated home-based care in developing countries, where it is being considered to alleviate pressure on hospitals, the researchers noted in a Cochrane Systematic Review.

Home-based care is aimed at improving quality of life and reducing the need for hospital care, “especially where public health services are overburdened,” the researchers wrote in the review.

But there has been no systematic evaluation of home-based care in the setting of HIV/AIDS, they said.

To help fill the gap, they found 13 published reports, referring to 11 randomized clinical trials, as well as two such trials currently under way.

Of the 11 studies with published reports, 10 randomized individuals and one (in Uganda, the only one conducted in Africa) randomized households.

The studies looked at a range of interventions:

• Three studies evaluated home-based intensive nursing versus standard care for effects on patient knowledge of HIV and related medication, adherence, viral load, and CD4 counts.
• Two studies compared a transprofessional team versus an independent primary care nurse. One looked at quality of life and survival and the other at the time patients spent in the program, as well as cost.
• Two studies compared the effect of computer-based education versus brochures, nothing, or standard medical care on such outcomes as perceived social isolation, decision-making confidence, health status, quality of life, risk behaviors, and health service utilization.
• Two studies looked at exercise.
• One study looked at two months of home total parenteral nutrition versus dietary counseling.
• One study of diarrhea compared home-based water chlorination, safe storage, and education with education alone.

The researchers reported that intensive home-based nursing significantly improved self-reported knowledge of HIV and medications, self-reported adherence, and differences in pharmacy drug refills.

Another study, which looked at the proportion of participants with greater than 90% adherence, found statistically significant differences over time with home-based nursing. But that study found no significant change in CD4 counts and viral loads.

The third such study found significant differences in HIV stigma, worry, and physical functioning but no differences in depressive symptoms, mood, general health, and overall functioning.

The studies comparing comprehensive case management by transprofessional teams compared to usual care by primary care nurses showed no effect.

The study comparing home total parenteral nutrition and dietary counseling found no significant impact on overall survival and rate of readmission to hospital.

The two computer-based studies found no effect on health status and decision-making confidence and skill, but did find a reduction in social isolation after controlling for depression.

The two trials evaluating home exercise programs found conflicting results.

And the home-based safe water systems reduced diarrhea frequency and severity among persons with HIV in Africa, the researchers reported.

In general, the researchers concluded that there were few studies; study populations tended to be small; and the studies did not address the effect of home-based care on important medical endpoints, such as mortality.

“Further large studies should therefore focus on evaluating these significant endpoints, on feasible interventions for developing countries, and on how home-based care fits into the current treatment context,” they concluded.