Palliative care for HIV in the era of antiretroviral therapy availability: perspectives of nurses in Lesotho.
BACKGROUND
Southern Africa is disproportionately affected by the HIV/AIDS epidemic. In Lesotho 23% of adults are HIV-positive, and only 26% of those in need are accessing antiretroviral treatment (ART). Consequently, about 18,000 people die from AIDS each year. In this situation, palliative care is needed towards the end of life, but is also recommended throughout the HIV disease trajectory. The World Health Organisation (WHO) has produced the Integrated Management of Adolescent and Adult Illness (IMAI) guidelines, which includes a palliative care guidebook (as well as acute and chronic ART guidebooks). IMAI aims to facilitate the implementation of integrated HIV/AIDS care in resource-poor areas. The opinions of health workers towards this integrated approach to care and the use of IMAI has not been considered in previous research studies. This paper therefore aims to address some of these issues.


METHODS
Semi-structured interviews were conducted with six key informants and ten nurses in Lesotho. The interviews were transcribed verbatim and analysed using content thematic analysis.


RESULTS
Many nurses described palliative care as synonymous with chronic care and felt that palliative care is necessary for HIV-positive patients despite the introduction of ART. It was thought that the approach taken should be holistic and integrated throughout the disease trajectory. Pain management was noted to be a particular area of need for palliative care, and it was suggested that this could be improved in Lesotho. The IMAI guidelines were thought to be useful, but knowledge of the palliative care booklet was limited.


CONCLUSIONS
Palliative care remains necessary for HIV despite the increasing availability of ART. However, it is currently significantly lacking in Lesotho and many other sub-Saharan African countries. Greater understanding of palliative care amongst health workers is required, as well as strong political will from the Ministry of Health. The IMAI guidelines are a useful tool for holistic HIV care, including palliative care, but they need to be used more effectively. As ART is becoming increasingly available worldwide, the complex chronic care issues for patients with HIV/AIDS should not be neglected.
Kell
Megan E
ME
Nuffield Centre of International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK. meg.e.kell@gmail.com
Walley
John D
JD
BMJ. 2007 Oct 6;335(7622):685
17916825
AIDS. 2002;16 Suppl 4:S61-8
12699001
PLoS Med. 2004 Oct;1(1):e5
15526053
AIDS. 2008 Mar 12;22(5):601-10
18317001
J Public Health Policy. 2007;28(1):40-1
17363934
J Public Health Policy. 2007;28(1):28-39
17363933
Lancet. 2005 Sep 17-23;366(9490):1026-35
16168785
J Pain Symptom Manage. 2002 Aug;24(2):91-6
12231124
BMJ. 2005 Oct 1;331(7519):750-4
16195293
J R Soc Med. 2001 Sep;94(9):449-51
11535746
Lancet. 2005 Jun 4-10;365(9475):1971-7
15936427
J Pain Symptom Manage. 2006 Jan;31(1):58-69
16442483
J Pain Symptom Manage. 2007 May;33(5):547-51
17482045
Sex Transm Infect. 2005 Feb;81(1):5-14
15681714
N Engl J Med. 1980 Jan 10;302(2):123
7350425
Lancet. 2004 Jul 31-Aug 6;364(9432):392-3
15288718
Sex Transm Infect. 2005 Feb;81(1):2-3
15681712
AIDS Care. 2007 Nov;19(10):1304-6
18071975
Clin Infect Dis. 2005 Feb 1;40(3):491-2
15668879
J Pain Symptom Manage. 2005 Nov;30(5):408-17
16310615