Intensity and correlates of multidimensional problems in HIV patients receiving integrated palliative care in sub-Saharan Africa.
BACKGROUND
Despite global clinical guidance that HIV patients should have multidimensional care integrated into their management, there has been very limited data to guide practice since the advent of treatment. This study aimed to determine the three-day period intensity of problems (physical, psychological, social and spiritual) among HIV patients receiving integrated palliative care in sub-Saharan Africa, and to identify associations with problem severity.


METHODS
A sample of 230 consecutive adult patients attending five sites in South Africa and Uganda gave self-report data using a well-validated outcome scale. Multivariable regression models determine the association of patient characteristics with intensity of three scale factors.


RESULTS
The most burdensome problems were (in descending order) pain, worry, symptoms, and adequate information to plan for the future. Interestingly, CD4 counts were available on file for only 59.1% of patients. In multivariate analyses, being cared for at home was associated with poorer physical/psychological factor score (B=-0.192, 95% CI -2.566 -0.464, p=0.005), while being on ART was associated with better factor score (B=0.187, 95% CI=0.424 23.80, p=0.005). For the existential/spiritual factor, being cared for at home was associated with a worse factor score (B=-0.306, 95% CI -2.776 -1.128, p<0.001). ART use was not associated with either the interpersonal or spiritual/existential factors.


CONCLUSIONS
These self-report data reveal a high burden of both physical and psychological problems, and that communication from professionals is insufficient. Patients receiving home care may require additional support to enhance wellbeing, and treatment may not affect interpersonal and existential/spiritual wellbeing.
King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK. richard.harding@kcl.ac.uk
Richard
R
Harding
Lucy
L
Selman
Godfrey
G
Agupio
Natalya
N
Dinat
Julia
J
Downing
Wei
W
Gao
Liz
L
Gwyther
Thandi
T
Mashao
Keletso
K
Mmoledi
Anthony
A
Moll
Lydia
L
Mpanga Sebuyira
Barbara
B
Ikin
Irene J
IJ
Higginson
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000473:pathology* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012924:Social Conditions / Q000706:statistics & numerical data*; D013019:South Africa; D014454:Uganda; D055815:Young Adult