title: Palliative care and support for persons with HIV/AIDS in 7 African countries: implementation experience and future priorities.
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.
authors: University of Maryland School of Medicine, Institute of Human Virology, 29 S Greene Street, Baltimore, MD 21201, USA. calexand@medicine.umaryland.edu
authors: Carla S
authors: CS
authors: Alexander
authors: Peter
authors: P
authors: Memiah
authors: Yvonne B
authors: YB
authors: Henley
authors: Angela
authors: A
authors: Kaiza-Kangalawe
authors: Anna Joyce
authors: AJ
authors: Shumbusho
authors: Michael
authors: M
authors: Obiefune
authors: Victor
authors: V
authors: Enejoh
authors: Winifred
authors: W
authors: Stanis-Ezeobi
authors: Charity
authors: C
authors: Eze
authors: Ehekhaye
authors: E
authors: Odion
authors: Donald
authors: D
authors: Akpenna
authors: Amana
authors: A
authors: Effiong
authors: Kenneth
authors: K
authors: Miriti
authors: Samson
authors: S
authors: Aduda
authors: John
authors: J
authors: Oko
authors: Gebremedhin D
authors: GD
authors: Melaku
authors: Cyprien
authors: C
authors: Baribwira
authors: Hassina
authors: H
authors: Umutesi
authors: Mope
authors: M
authors: Shimabale
authors: Emmanuel
authors: E
authors: Mugisa
authors: Anthony
authors: A
authors: Amoroso
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control / Q000628:therapy; D000328:Adult; D000349:Africa / Q000453:epidemiology; D002648:Child; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000517:prevention & control / Q000628:therapy*; D006291:Health Policy / Q000191:economics; D006801:Humans; D007391:International Cooperation / Q000331:legislation & jurisprudence*; D008297:Male; D010166:Palliative Care / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration* / Q000639:trends; D012944:Social Support; D014481:United States