The prevalence and burden of pain and other symptoms among South Africans attending highly active antiretroviral therapy (HAART) clinics

Farrant, Lindsay; Gwyther, Liz; Dinat, Natalya; Mmoledi, Keletso; Hatta, Ntombi; Harding, Richard

doi:10.7196/samj.5481

Cited by 17 publications

(14 citation statements)

References 5 publications

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“…Increasing numbers of patients are living with HIV with multidimensional problems that include physical symptoms, psychological and spiritual distress as well as social problems such as isolation and stigma [7–11]. A shift in the focus of care is required to address patients’ multidimensional needs while continuing to ensure access to ART, particularly in light of evidence that unaddressed psychological distress and depression are associated with non-adherence to ART and treatment failure [12–14].…”

Section: Resultsmentioning

confidence: 99%

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A randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy: recruitment, refusal, randomisation and missing data

et al. 2014

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BackgroundDespite the life threatening nature of an HIV diagnosis and the multidimensional problems experienced by this patient population during antiretroviral therapy, the effectiveness of a palliative care approach for HIV positive patients on ART is as yet unknown.FindingsA randomised controlled trial (RCT) was conducted in a sample of 120 HIV positive patients on ART in an urban clinic in Mombasa, Kenya. The intervention was a minimum of seven sessions of multidimensional, person-centred care, given by HIV nurses trained in the palliative care approach over a period of 5 months. Rates of recruitment and refusal, the effectiveness of the randomisation procedure, trial follow-up and attrition and extent of missing data are reported.120 patients (60 randomised to control arm, 60 randomised to intervention arm) were recruited over 5.5 months, with a refusal rate of 55.7%. During the study period, three participants died from cancer, three withdrew (two moved away and one withdrew due to time constraints). All of these patients were in the intervention arm: details are reported. There were five additional missing monthly interviews in both the control and intervention study arm, bringing the total of missing data to 26 data points (4.3%).DiscussionThe quality and implications of these data are discussed extensively and openly, including the effect of full and ethical consent procedures, respondent burden, HIV stigma, accurate randomisation, patient safety and the impact of the intervention. Data on recruitment randomisation, attrition and missing data in clinical trials should be routinely reported, in conjunction with the now established practice of publishing study protocols to enhance research integrity, transparency and quality. Transparency is especially important in cross cultural settings, in which the sources of funding and trial design are often not based in the country of data collection. Findings reported can be used to inform future RCTs in this area.Trial registrationClinicaltrials.gov NCT01608802.

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Section: Resultsmentioning

confidence: 99%

“…However, these methodological difficulties should not preclude high quality research, as evidence on the prevalence of pain, symptoms and psychological distress in this population, indicate that multidimensional problems in the participants group continue in the presence of ART, and should be addressed [7, 14, 41]. …”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy: recruitment, refusal, randomisation and missing data

et al. 2014

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“…21 A survey of HIV end-of-life programs in sub-Saharan Africa found that 94% of programs reported problems with pain relief, including drug availability and government restrictions. 22 Patient self-reports [23][24][25] and analyses of pain medication prescribed 26 have also found that pain in patients with HIV is inadequately managed. Moreover, in a system of limited resources, priority is often given to curative treatment.…”

Section: Discussionmentioning

confidence: 99%

“What is Killing Me Most”: Chronic Pain and the Need for Palliative Care in the Eastern Cape, South Africa

Dekker

Amon

Roux

et al. 2012

Journal of Pain & Palliative Care Pharmacotherapy

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Palliative care and the provision of pain relief medicine are essential components of health care, yet little research has been conducted on access to pain medicine in rural areas of sub-Saharan Africa. The objective of this study was to examine patient experiences and health care provider attitudes towards chronic pain and palliative care in Eastern Cape Province, South Africa. The study used a mixed-methods approach to evaluate experience of chronic pain in a district hospital and associated clinics. Questionnaires and in-depth interviews were conducted with 45 current and former patients receiving care and 26 health care providers. Forty-six percent (n = 19) of patients rated their pain in the last month as severe. Thirty-nine percent (n = 17) of individuals stated that they had never been provided with an explanation for the cause of their pain. Multiple regression analysis found that being female, not having received a social welfare grant, and not having received an explanation for the cause of pain were associated with higher ratings of pain (P < .10 for each variable). Factors inhibiting the provision of palliative care included insufficient access and availability of pain medication and providers' association of palliative care with end-of-life care. Adequate pain relief is often deprioritized in a busy health care setting. Ensuring patients receive sufficient relief for their pain requires interventions at clinical and policy levels, including the provision of needed pain medication and training in palliative care for all providers.

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“…[9][10][11][12][13][14][15][16][17]37 It is clear from prior data that pain is a considerable burden on HIV-positive, cancer, and end-stage patients. This study now establishes that hospitalized patients also carry a significant amount of pain.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

Huang

Owino

Gramelspacher

et al. 2013

Journal of Palliative Medicine

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Background: Pain is often inadequately evaluated and treated in sub-Saharan Africa (SSA). Objective: We sought to assess pain levels and pain treatment in 400 hospitalized patients at a national referral hospital in western Kenya, and to identify factors associated with pain and pain treatment. Design: Using face-validated Kiswahili versions of two single-item pain assessment tools, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), we determined patients' pain levels. Additional data collected included patient demographics, prescribed analgesics, and administered analgesics. We calculated mean pain ratings and pain management index (PMI) scores. Results: Averaged between the NRS and FPS-R, 80.5% of patients endorsed a nonzero level of pain and 30% of patients reported moderate to severe pain. Older patients, patients with HIV, and cancer patients had higher pain ratings. Sixty-six percent of patients had been prescribed analgesics at some point during their hospitalization, the majority of which were nonopioids. A majority of patients (66%) had undertreated pain (negative scores on the PMI). Conclusion: This study shows that hospitalized patients in Kenya are experiencing pain and that this pain is often undertreated.

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The prevalence and burden of pain and other symptoms among South Africans attending highly active antiretroviral therapy (HAART) clinics

Cited by 17 publications

References 5 publications

A randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy: recruitment, refusal, randomisation and missing data

A randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy: recruitment, refusal, randomisation and missing data

“What is Killing Me Most”: Chronic Pain and the Need for Palliative Care in the Eastern Cape, South Africa

Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

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