Palliative Care and Support for Persons with HIV/AIDS in 7 African Countries

Abstract

To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of life for individuals. Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.

International palliative care research in the context of global development: a systematic mapping review

“…For example, a study where the first (and contact) author is based in the USA explores palliative care for persons with HIV/AIDS in Africa 32. Additionally, one UK study moves beyond contributing to the evidence-base in a developing setting (Uganda) and aims to increase the research capacity of local researchers 33…”

Spirituality and Religion among HIV-Infected Individuals

“…Several themes emerge in this literature: religion as a source of support [29], spirituality as a barrier to/facilitator of treatment [30, 31], personal faith as a coping strategy [28, 30], and spirituality in palliative AIDS care [27]. Although these themes are similar to those found in the West, it is encouraging to see such research in various geographic settings.…”

A discussion of HIV/AIDS family interventions: implications for family‐focused nursing practice

“…In summary, the proposed HIV/AIDS-FIs span from health promotion and prevention strategies to interventions that promote family adjustments and adaptation across the disease trajectory (Danielson et al 1993). The proposed interventions evidently reflect the current needs for psychosocial and spiritual aspects in HIV/AIDS care (Alexander et al 2012). Therefore, the following implications can be drawn from the above discussion.…”