Palliative care as an essential component of the HIV care continuum

Harding, Richard

doi:10.1016/s2352-3018(18)30110-3

Cited by 33 publications

(36 citation statements)

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“…Research on palliative care needs including end-of-life care and quality of care provided to PLHIV is underdeveloped [47]. The World Health Organization (WHO) has deemed that palliative care is an essential component of the comprehensive package of care for PLHIV.…”

Section: Gap 4: Palliative Care Needs Of Oalhiv Who Use Drugsmentioning

confidence: 99%

“…The World Health Organization (WHO) has deemed that palliative care is an essential component of the comprehensive package of care for PLHIV. Nevertheless, existing research points to inequitable access to palliative care among PLHIV [47]. People who use drugs are frequently restricted from accessing palliative care due to abstinence-based approaches adopted by many providers [48].…”

Section: Gap 4: Palliative Care Needs Of Oalhiv Who Use Drugsmentioning

confidence: 99%

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Addressing treatment and care needs of older adults living with HIV who use drugs

Chayama

McNeil

2020

J Intern AIDS Soc

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Introduction Older adults living with HIV (OALHIV; ≥50 years) who use drugs face unique needs and challenges that compromise their health and wellbeing due to the structural and environmental barriers they experience, in addition to being disproportionately affected by comorbidities. Nevertheless, research on this population is limited and work is needed to tailor and optimize their care and services. The purpose of this commentary is to address the key research gaps pertaining to OALHIV who use drugs. Discussion We identified four key research gaps specific to OALHIV who use drugs. Gap 1: Increased understanding of how older adults manage HIV alongside comorbidities in the context of substance use is critical to optimize their care management. Gap 2: More information on the geriatric characteristics of OALHIV who use drugs and the need and role of harm reduction in geriatric care is necessary for the provision of appropriate and effective care. Gap 3: Greater knowledge around the adoption of harm reduction and case manager approaches in various care facilities is essential to ensure equitable access to care for OALHIV who use drugs. Gap 4: Improved understanding of barriers to high‐quality palliative care among OALHIV who use drugs is important to enhance quality of life across their life course. Conclusions Addressing the identified gaps in literature will lead to a more fulsome understanding of the issues encountered by OALHIV who use drugs and inform the development and implementation of strategies that address disparities at the intersection of HIV, substance use and ageing.

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Section: Gap 4: Palliative Care Needs Of Oalhiv Who Use Drugsmentioning

confidence: 99%

Section: Gap 4: Palliative Care Needs Of Oalhiv Who Use Drugsmentioning

confidence: 99%

Addressing treatment and care needs of older adults living with HIV who use drugs

Chayama

McNeil

2020

J Intern AIDS Soc

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“…Outside of India, however, palliative care is a recognised and essential component of the HIV care continuum. [24][25][26] Other illnesses are better represented in the Indian palliative care literature: for example, Lloyd et al recently conducted a qualitative study assessing the palliative needs of patients who had a stroke in a tertiary care setting in south India. 21 Despite only including clinicians in the study, the authors found that physical disabilities had the most significant impact on quality of life, and that palliative medicine played a major role in counselling and alleviating caregivers' burden in terms of stroke management and care.…”

Section: Introductionmentioning

confidence: 99%

Lived experiences of palliative care among people living with HIV/AIDS: a qualitative study from Bihar, India

Nair¹,

Kumar

Mahajan³

et al. 2020

BMJ Open

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ObjectivesThis study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand the broader palliative care context in Bihar.DesignThis was an exploratory, qualitative study which used thematic analysis of semistructured, in-depth interviews as well as a focus group discussion.SettingAll interviews took place in a secondary care hospital in Patna, Bihar which provides holistic care to critically unwell PLHA.ParticipantsWe purposively selected 29 participants: 10 critically unwell PLHA, 5 caregivers of hospitalised patients, 7 relatives of deceased patients who were treated in the secondary care hospital and 7 key informants from community-based organisations.ResultsCritically ill PLHA emphasised the need for psychosocial counselling and opportunities for social interaction in the ward, as well as a preference for components of home-based palliative care, even though they were unfamiliar with actual terms such as ‘palliative care’ and ‘end-of-life care’. Critically unwell PLHA generally expressed preference for separate, private inpatient areas for end-of-life care. Relatives of deceased patients stated that witnessing patients’ deaths caused trauma for other PLHA. Caregivers and relatives of deceased patients felt there was inadequate time and space for grieving in the hospital. While both critically ill PLHA and relatives wished that poor prognosis be transparently disclosed to family members, many felt it should not be disclosed to the dying patients themselves.ConclusionsDespite expected high inpatient fatality rates, PLHA in Bihar lack access to palliative care services. PLHA receiving end-of-life care in hospitals should have a separate dedicated area, with adequate psychosocial counselling and activities to prevent social isolation. Healthcare providers should make concerted efforts to inquire, understand and adapt their messaging on prognosis and end-of-life care based on patients’ preferences.

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“…In addition, palliative medicine principles are essential to sustaining quality of life during aging. Providers and people aging with HIV need to consider how best to approach treatment preferences . For PLWH in resource‐poor areas, physical symptom burden may be similar to that experienced by patients living with cancer and requires careful symptom assessment and management.…”

mentioning

confidence: 99%

“…Providers and people aging with HIV need to consider how best to approach treatment preferences. 17 For PLWH in resource-poor areas, physical symptom burden may be similar to that experienced by patients living with cancer and requires careful symptom assessment and management. In all settings, person-centered care should address spiritual needs and psychological suffering.…”

mentioning

confidence: 99%