Implementation of HIV Palliative Care: Interprofessional Education to Improve Patient Outcomes in Resource-Constrained Settings, 2004–2012

Abstract

Palliative care (PC), introduced early in the management of chronic illness, improves patient outcomes. Early integration of a palliative approach for persons with HIV has been documented to be effective in identifying and managing patient-level concerns over the past decade in African settings. The experience of implementing PC in multiple African and other resource-constrained settings (RCSs) emphasizes the need for essential palliative competencies that can be integrated with chronic disease management for patients and their families facing life-limiting illness. This article is an historical description of how basic palliative competencies were observed to be acceptable for health workers providing outpatient HIV care and treatment during eight years of U.S. implementation of "care and support," a term coined to represent PC for persons living with HIV in RCS. The need for team building and interprofessional education is highlighted. The model is currently being tested in one U.S. city and may represent a mechanism for expanding the palliative approach into management of chronic disease. Such competencies may play a role in the development of the patient-centered medical home, a critical component of U.S. health care reform.

HIV and an Ageing Population—What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions

“…[17,18,126,146,148] herapeutic relationship factor Noted in individuals with HIV and chronic diseases that they do not prefer to see new clinicians and prefer to be reviewed by clinicians they know. [157,158] Disease factors Complex disease with different complex co-morbidities and clinical presentations that necessitate input from different medical specialities. [1,6,7,9,11] Spiritual and religious factors and those related to customs and traditions…”

Early Use of the Palliative Approach to Improve Patient Outcomes in HIV Disease: Insights and Findings From the Care and Support Access (CASA) Study 2013-2019

“…This investigation examined the comparative effectiveness of integrating the international palliative approach to care early in disease management, 3 rather than being used solely at the end-of-life, 18,19 to improve the likelihood of one HIV sub-population remaining engaged-in-care and adhering with medical treatment. 20,21 There is, and may continue to be, a shortage of palliative care specialists, the CASA (Care and Support Access) Study was implemented as translational science from international settings to Baltimore, Maryland, targeting needs of one high-risk HIV population to demonstrate how palliative skills might be introduced for non-palliative specialists earlier in disease management. 22 The approach and curriculum underpinning the CASA Study grew from 9 years’ experience with implementation of HIV care and treatment in resource-constrained international settings.…”