POPULATIONS AT RISK ACROSS THE LIFESPAN:POPULATION STUDIES A Needs Assessment of Clients With HIV in a Home-Based Care Program in Guyana Kathryn Boryc, Michael P. Anastario,Grace Dann, Banghee Chi, Barbara Cicatelli, Melanie Steilen, Karen Gordon-Boyle, Shanti Singh, and Miryah Morris ABSTRACT Objectives: To assess the needs of clients in a home-based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara-Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers. Design and Sample: A cross-sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross-sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana. Measures: Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse. Results: The services most commonly received by respondents included nutritional assessment and coun- seling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adher- ence, and support for HIV disclosure. Respondents reported further need of referrals to income-generation opportunities, food and nutritional supplement support, and support for children. Forty-two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem. Conclusions: While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income-generation opportu- nities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV. Key words: HIV/AIDS, home health care, international health, mental health, questionnaires. The Caribbean region is second only to sub-Saharan Africa in its HIV prevalence rates. In Guyana, the adult HIV prevalence rate is estimated to be 1.9% (UNAIDS, 2006), and HIV/AIDS is the number one Kathryn Boryc, M.P.H., is Deputy Director of Interna- tional Programs, Cicatelli Associates Inc., New York, New York. Michael P. Anastario, Ph.D., is Senior Research Scientist, Cicatelli Associates Inc., New York, New York. Grace Dann, B.S., is Research and Evaluation Coordina- tor, Cicatelli Associates Inc., New York, New York. Bang- hee Chi, M.P.H., is Director of Planning and Development, Cicatelli Associates Inc., New York, New York. Barbara Cicatelli, M.A., is President,Cicatelli Associ- ates Inc., New York, New York. Melanie Steilen, R.N., B.S.N., is Director of Nursing, Cicatelli Associates Inc., New York, New York. Karen Gordon-Boyle, M.D., is GHARP II Director of Prevention, Management Sciences for Health, Georgetown, Guyana. Shanti Singh, M.D., is Programme Manager, Guyana National AIDS Pro- gramme Secretariat, Georgetown, Guyana. Miryah Mor- ris, M.P.H., is Project Associate, work was conducted while at Cicatelli Associates Inc., New York, New York. Correspondence to: Michael P. Anastario, Cicatelli Associates Inc., 505 Eighth Avenue, Suite1600, New York, NY 10003. E-mail: manastario@gmail.com cause of death among Guyanese aged 20–49 years (Guyana HIV/AIDS Epidemiology, 2009). To date, there has been little research on home- based care (HBC) needs and service provision among 482 Public Health Nursing Vol. 27 No. 6, pp. 482–491 0737-1209/r 2010 Wiley Periodicals, Inc. doi: 10.1111/j.1525-1446.2010.00888.x