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HIV Care


The characteristics measured We are measuring demographics plus time since di- agnosis, CD4/VL (where available), regimen, and time since beginning ART. We are using the African Palliative Care Association Palliative Outcome Scale (APCA Afri- can POS) to measure multidimensional palliative care outcomes in line with the WHO definition of palliative care.18,19


We are also using the MOS-HIV20


health-related quality of life, with physical and mental health subscales, the most widely used tool in Africa), the CSRI – Client Services Receipt Inventory21


(adapted from existing measure of behaviour22 (measure


of interventions received), adherence – adapted from multi-level measure of adherence that is shown to pre- dict virological outcomes,7


GHQ (12 item) – a widely used measure of psycho- logical morbidity that has been cited in many African populations.23


sexual risk-taking behaviour and the


Participants are invited to complete data


collection at months 0, 1, 2, 3 and 4. A sub-sample of intervention patients are invited to complete a qualita- tive interview in order to identify the effective compo- nents of the intervention, thus informing subsequent replication.


Partnerships TOPCare is bringing together a wide range of clinical academic expertise. It is led from the Cicely Saunders Institute at King’s College London, with academic part- nership with University College London, the University of Nairobi, and the University of Cape Town. Our HIV clinical partnerships span BOMU Hospital in Mombasa and the Cape Metro Department of Health, with pallia- tive care expertise from Coast Hospice (Mombasa) and Helderberg Hospice (South Africa). We have represen- tation from the Hospice Palliative Care Association of South Africa, the African Palliative Care Association and the Kenyan Hospice Palliative Care Association.


Pictured below: the research team 19.


References 1. Harding R, Lampe FC, Norwood S, Date HL, Clucas C, Fisher M, et al. Symp- toms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse. Sex Transm Infect 2010; 86: 520–4. sti.2009.038505 pii ;10.1136/sti.2009.038505 doi.


2. Wakeham K, Harding R, Bamukama-Namakoola D, et al. Symptom burden in HIV-infected adults at time of HIV diagnosis in rural Uganda. J Palliat Med 2010; 13: 375–80. 10.1089/jpm.2009.0259 doi.


(a measure of


3. Harding R, Molloy T. Positive futures? The impact of HIV infection on achieving health, wealth and future planning. AIDS Care 2008; 20: 565–70. 793150780 pii ;10.1080/09540120701867222 doi.


4. Harding R, Molloy T, Easterbrook P, Frame K, Higginson IJ. Is antiretroviral therapy associated with symptom prevalence and burden? Int J STD & AIDS 2006; 17: 400–5.


5. Lampe FC, Harding R, Smith CJ, Phillips AN, Johnson M, Sherr L. Physical and Psychological Symptoms and Risk of Virologic Rebound Among Patients With Virologic Suppression on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2010; 54: 500–50. 10.1097/QAI.0b013e3181ce6afe doi.


6. Simms VM, Higginson IJ, Harding R. What palliative care-related problems do patients experience at hiv diagnosis? a systematic review of the evidence. J Pain Symptom Manage 2011; 42: 734–53.


7. Sherr L, Lampe F, Norwood S, et al. Adherence to antiretroviral treatment in patients with HIV in the UK: a study of complexity. AIDS Care 2008; 20: 442–8.


8. Sherr L, Lampe F, Norwood S, et al. Successive switching of antiretroviral therapy is associated with high psychological and physical burden. Int J STD & AIDS 2007; 18: 700–4.


9. Harding R, Karus D, Easterbrook P, Raveis VH, Higginson IJ, Marconi K. Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence. Sex Transm Infect 2005; 81: 5–14. 81/1/5 pii ;10.1136/ sti.2004.010132 doi.


10. Harding R, Higginson IJ. Palliative care in sub-Saharan Africa. The Lancet. 2005; 365: 1971–7.


11. Collins K, Harding R. Improving HIV management in sub-Saharan Africa: How much palliative care is needed? AIDS Care 2007; 19: 1304–6.


12. Harding R, Selman L, Agupio G, et al. Prevalence, burden and correlates of physical and psychological symptoms among HIV palliative care patients in sub- Saharan Africa: an international multicentred study. J Pain Symptom Manage 2012. In Press.


13. Harding R, Gwyther L, Mwangi-Powell F, Powell RA, Dinat N. How can we improve palliative care patient outcomes in low- and middle-income countries? Successful outcomes research in sub-Saharan Africa. J Pain Symptom Manage 2010; 40: 23–6.


14. Harding R, Easterbrook P, Dinat N, Higginson IJ. Pain and symptom control in HIV disease: under-researched and poorly managed. Clin Infect Dis 2005; 40: 491–2. CID34949 pii ;10.1086/427037 doi.


15. Harding R, Gwyther L, Powell FM. Treating HIV/AIDS patients until the end of life. J Acquir Immune Defic Syndr 2007; 44: 364. 10.1097/ QAI.0b013e31802e1eac doi ;00126334-200703010-00019 pii. .


16. Harding R, Krakauer EL, Sithole Z, De LL, Selman L. The ‘lost’ HIV popula- tion: time to refocus our clinical and research efforts. AIDS 2009; 23: 145–6. 10.1097/QAD.0b013e32831de90b doi ;00002030-200901020-00024 pii.


17. Harding R, Simms V, Krakauer E, et al. Quality HIV Care to the End of life. Clin Infect Dis 2011; 52: 553–4.


18


Harding R, Selman L, Agupio G, et al. Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale. Health Qual Life Outcomes 2010; 8: 10. 1477-7525-8-10 pii;10.1186/1477-7525-8-10 doi.


Powell RA, Downing J, Harding R, Mwangi-Powell F, Connor S. Development of the APCA African Palliative Outcome Scale. J Pain Symp Manage 2007; 33: 229–32.


20. Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, va- lidity and usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Qual Life Res 1997; 6: 481–93.


21.


Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van WB. Client Socio-Demographic and Service Receipt Inventory--European Version: development of an instru- ment for international research. EPSI- LON Study 5. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl 2000; 39: s28–s33.


22.


Harding R, Clucas C, Lampe FC, et al. Behavioral Surveillance Study: Sexual risk taking behaviour in UK HIV outpatient attendees. AIDS Behav 2011.


23.


Goldberg D, Williams P. A user’s guide to the General Health Ques- tionnaire. Goldberg D, Williams P, editors. Windsor: NFER Nelson, 1991.


32 Africa Health


July 2012


© Nadia Bettega


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