HIV Care
Figure 2 Continuum of prevention and care13
many developing countries is ensuring that there is a consistent supply of the appropriate medicines. Usually services have basic symptom care medicines for nausea, diarrhoea, and pain. These include analgesics such as paracetamol and ibuprofen. However, HIV services are less likely to have access to mild or strong opioids (e.g. codeine and morphine) which are essential for pain management. Getting access to oral morphine may involve registering HIV physicians as narcotic prescrib- ers with the provincial health services and using specific forms to request anticipated amounts of oral morphine. HIV clinics in countries such as India, Kenya, South Africa, Tanzania, Uganda, Vietnam, and Zambia have successfully navigated narcotics regulations to ensure oral morphine was available for PLHIV in severe pain. It is usually relatively straightforward for HIV services
to integrate the management of physical symptoms into care. It can take more time for mental health care, psycho-social support, and spiritual support to be
incorporated. Addressing mental health and the wider psychosocial and spiritual concerns of patients and their families is not only critical for patients’ quality of life, it is also essential for promoting retention in care, better ART adherence, and physical wellbeing. An increasing number of HIV services are integrating mental health care into their provision, many providers have not had training in mental health.
Not all HIV services will be able to fully address mental health, social concerns, and spiritual wellbeing, but they should at a minimum screen for these issues, manage non-complex mental health cases, and refer clients with complex psychiatric disorders to appropri- ate health providers. Home-based care teams, with their strong community roots, are often better placed to meet the social and spiritual needs of clients and provide valuable lay emotional support. Phased integration (Step 4) is the way to prevent the incorporation of palliative care becoming just another
Integration into hospital inpatient and outpatient care The Hospital Palliative Care Team at Charlotte Maxeke Hospital in Johannesburg, South Africa provides an advisory service that integrates palliative care with the curative management of patients in the hospital. It also accepts referrals from other hospitals, health centres, and the community. The team is available for all departments: surgical, medical, the HIV/AIDS clinic, gynaecology, obstetrics, orthopedics and paediatrics. They provide palliative care training to staff and medical students. The team is led by a doctor and palliative care-trained nurses, and links patients and their families to Soweto Hospice and other community-based care providers.
28 Africa Health July 2012
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