HIV Care
Types of integration2 Cooperation
Coordination Examples of services HIV and palliative care service twinning or partnership
In Uganda, Reach-Out Mbuya Parish HIV/AIDS Initiative partners with Hospice Africa Uganda to provide their patients with pain treatment and other palliative care services.
A system of formal referrals between HIV and palliative care services and intermural meetings The South Africa Integrated Community and Home Care Programme is an example of this.8
Palliative care consultative team
A specialist team based in a hospital or hospice provides palliative care to those under the care of a variety of services. It includes inpatient, outpatient and home-based care consults. This model is applied in the US by Montifore Hospital.9
Co-location Amalgamation
HIV and palliative care service offered by separate providers in the same location An example of this is the inpatient palliative care unit that was added to a hospital in Grahamstown, South Africa, also offering HIV outpatient care.10
Integrating palliative care into home-based care services This involves training, equipping, and supervising traditional home-based care services to offer pain and other symptom assessment and management, skilled emotional support, bereavement care, and spiritual care.11
HIV outpatient clinics offering palliative care as part of routine HIV care and
treatment. In Uganda, HIV services such as Reach-Out Mbuya Parish has nurses certified in palliative care and opioid prescription working in the outpatient clinic and supervising home-based care. They store oral morphine and a range of other palliative medicines. The Parish has a referral relationship with specialty palliative care through Hospice Africa Uganda (Green K, Site visit, May 2008).
Assimilation
Full incorporation of palliative care for HIV, cancer, and other diseases in the public healthcare system One of few places in resource-poor contexts where this has occurred is the state of Kerala, India, where the state government has officially incorporated palliative care into all levels of the healthcare system, including provision for provider training, standards, and medicines. These generalist palliative care services are linked to specialty palliative care providers who provide training, quality assurance support, and care for complex cases.12
Table 1 Types of HIV palliative care integration
important to include subjective information from PLHIV and their families. What they see as critical to their quality of life may differ from what service providers consider important. The team will also assess the service capacity and training needs of staff, medicine avail- ability, resources, and referral agencies. It will decide what actions will be needed to incorporate services to address these needs and to guide and monitor the implementation of services. An integration plan (step 2), with clear activities a
time-frame, and allocated responsibilities, should be developed collaboratively and validated with key stake- holders. Key tasks will be: • integrating palliative care into the staffing structure; • training clinician and other care providers; • ensuring that administration and management also receive some training;
• securing key medicines; • adapting and using clinical tools to assess symptoms and other palliative care needs;
• developing referral systems and integrating palliative care data into existing patient information monitor- ing systems. Building effective systems and skills (step 3) will
Figure 1 The HIV palliative care integration process: five key steps
July 2012
involve training of all staff within the institution, from 1-day briefing for administrative staff to 5-day courses with clinical placement for healthcare staff providing services. One of the challenges of implementation for
Africa Health 27
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