Integration of water, sanitation and hygiene into HIV programs: Lessons from Malawi

Background

Research demonstrates that improvement of water, sanitation, and hygiene (WSH) for people living with HIV in resource-poor settings may significantly improve health outcomes. However, few programs have explored how to effectively integrate WSH into home-based care (HBC) and other HIV services. The current research aims to identify feasible strategies for integration via a pilot study in rural Malawi.

Methodology

The research design collected pre-/post-test data on WSH knowledge, attitudes and practices (KAP) of HBC clients. A barrier analysis was also conducted. Data was collected from HBC and non-HBC households. Based on baseline data, WSH interventions were implemented within the communities over a one-year period. The post-test examines changes over time in KAP within HBC households.

Results

Baseline results demonstrated significant WSH differences between HIV-affected and non-affected households. In households without latrines, a higher percentage of HBC household (55.6%) than non-HBC household (44.4%) reported indiscriminate defecation. Prevalence of diarrhea among non-HBC households was 2.5% and 7.1% among HIV-affected households. However, HBC households had better access to water sources than non-HBC households. The post-intervention data collection begins March 2009, consisting of a cross-sectional household survey of HBC households.

Conclusions

Based on findings, the presenter will comment on the impact of community-based WSH activities, including borehole construction; community training on sanitary platform construction; construction of demonstration latrines; and alternative latrine-designs for HBC clients. The presenter will also discuss utilization including the negotiation of do-able actions for HBC households and highlight successful strategies.