HIV counselling and care programmes at the district level in Ghana

The district hospital is the focus for the presentation of HIV-related disease in rural sub-Saharan Africa. Patients require not only medical care, but often economic support and counselling for themselves and their families. Psychosocial support should be provided at the hospital and in the home, the latter often being the preferred option. A team approach to HIV disease care and counselling, with careful selection and support of staff, and appropriate training in counselling skills is essential. A primary health care approach at the district level, mobilizing community participation and intersectoral support is necessary. Community Health Outreach Departments, as integral parts of the district hospital, are recommended and could pilot low-cost HIV hospital and home-care programmes.