A high burden of pain, symptoms and other multidimensional problems persist alongside HIV treatment. WHO policy indicates palliative care as essential throughout the disease course. This study aimed to determine whether palliative care delivered from within an existing HIV outpatient setting improves control of pain and symptoms compared to standard care. A prospective, longitudinal controlled design compared patient outcomes at an outpatient facility that introduced palliative care training to clinicians and stocked essential palliative care drugs, to outcomes of a cohort of patients at a similar HIV care facility with no palliative care, in Tanzania. Inclusion criteria were clinically significant pain or symptoms. Patients were followed from baseline fortnightly until week 10 using validated self-report outcome measures. For the primary pain outcome, the required sample size of 120 patients was recruited. Odds of reporting pain reduced significantly more at intervention site (OR=0.60, 95% CI 0.50-0.72) than at control (OR=0.85, 95% CI 0.80-0.90), p=0.001. For secondary outcomes, longitudinal analysis revealed significant difference in slope between intervention and control, respectively: Medical Outcomes Study-HIV (MOS-HIV) physical score 1.46 vs. 0.54, p=0.002; MOS-HIV mental health 1.13 vs. 0.26, p=0.006; and POS total score 0.84 vs. 0.18, p=0.001. Neither baseline CD4 nor antiretroviral therapy (ART) use was associated with outcome scores. These data are the first to report outcomes evaluating integrated HIV outpatient palliative care in the presence of ART. The data offer substantive evidence to underpin the existing WHO clinical guidance that states an essential role for palliative care alongside HIV treatment, regardless of prognosis.

Background of study. Clinical trial investigators and sponsors often underestimate the level of screening necessary to yield a suf®cient inclusion number. Without the resources to manage this, inclusion criteria can be compromised in an effort to recruit from a modest pool of potential subjects.Objective. We show the use of intensive advertising for subject recruitment.Design. Small and large advertisements for a trial of a relatively common indication with wide inclusion and exclusion criteria were placed consecutively in national newspapers, and were broadcast on commercial radio stations.Results. To recruit 145 subjects for the trial, over 500 individual screens from a total of more than 7000 responders were necessary. Observations revealed that more potential subjects responded to the large ads and radio broadcasts, while the response to the small ads was poor.Conclusion. Intensive advertising strategies can positively in¯uence the rate of enrolment and should be considered a necessary expense by any large trial investigator. Depending on demographic targeting factors and trial requirements, different media may be more ef®cient. A critical review of the screening volumes required for successful subject inclusion is necessary.

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study comparing children with skin conditions who attended skin camp to those who did not may yield important insights on the long-term psychosocial benefits of skin camp.Perspectives absent among the pediatric summer skin camp literature were those of parents and siblings, yet we know that children with chronic skin diseases do not experience their condition alone. Compared to parents of children without skin disease, parents of children with atopic dermatitis have less sleep, a higher rate of marital discord, and greater unintended time off from work related to their child's skin condition. 5 Future studies should assess whether pediatric skin camp attendance improves the well-being of other family members. In conclusion, skin camp attendance leads to improvements in self-esteem and body image for campers and counselors alike. Dermatologists should refer appropriate patients to skin camps and consider volunteer opportunities.