Kariuki et. al. Treatment and Outcomes in Palliative Care for HIV Patients: a Randomised Control Trial.

N. DRKARIUKIHELLEN. "Kariuki et. al. Treatment and Outcomes in Palliative Care for HIV Patients: a Randomised Control Trial.". In: Partnership for Advanced Clinical education Conference, HIV symposium. Kenya. International Association for the Study of Pain; 2012.


Introduction: Despite the epidemiological data demonstrating a high need for palliative care in sub-Saharan Africa, systematic appraisal of the outcome evidence found a wealth of experience yet a dearth of evidence. This paradox offers an opportunity for ethical outcome evidence. A number of barriers to access for HIV palliative care have been identified, particularly in the assessment and management of HIV pain and drug availability in Africa for management of palliative care for people with HIV.There evidence from several studies in Europe, Africa and Latin America identifying those on ART to have a physical and psychological symptom burden equal to those not on treatment (even when controlling for CD4 and viral load). Research showed that around half of HIV outpatients would benefit from palliative care irrespective of their treatment status. Longitudinal studies conducted in East Africa have identified the palliative care-related needs among patients accessing outpatient care in the presence of ART. Barriers and lack of evidence have been identified and there is need for appropriateness of palliative care throughout the HIV disease trajectory and alongside ART. The aim of this study is to evaluate the efficacy in terms of patient outcomes of training HIV nurses in palliative care including an assessment tool, for adults taking ART in Kenya, using randomised controlled trial (RCT) designs.Materials and Method: The study consists of two independent Phase III clinical randomised controlled trials, in a comprehensive care centre in Kenya.Patients are randomly allocated to standard HIV care (including ART) or standard HIV care plus palliative care. The palliative care is delivered through the HIV clinic using an integrated model. The APCA African POS questionnaire is used in this study.The design is longitudinal, using repeated measures. Patient-centred outcomes are measured using quantitative questionnaires. This study aims to reject the null hypothesis that receipt of palliative care in addition to standard care does not affect pain compared to those receiving standard care alone.APCA African POS seeks to address: pain, symptoms, anxiety information, spirituality, communication, planning, family information, family ability to care and family anxietyConclusion: With palliative care being introduced in government hospitals in Kenya, the study aims to provide evidence for efficacy of palliative care in HIV management and to achieve greater access to palliative care for those on ART by enabling existing ART clinic staff to assess and provide palliative care rather than use alternative (potentially more costly) approaches that refer all palliative care need out to external providers.




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