Title: The Role of Palliative care in the era of Anti Retroviral treatment
1The Role of Palliative care in the era of Anti-
Retroviral treatment
- Dr. Siobhan Kennelly
- Hospice Africa Uganda
2Introduction
- What Is Palliative Care ?
- What is the general role of palliative care?
- What is the role of palliative care in HIV/AIDS
care in the setting of ART ? - Integration of Palliative care and ART services
3Exploding the Myths about Palliative Care
- Not an active treatment
- Only of use when all other curative options
have been exhausted - Terminal care
- Morphine
4WHO Definition 2002
- Palliative care is an approach that improves the
quality of life of patients and their families
facing the problems associated with
life-threatening illness through - Prevention and relief of suffering by means of
early identification and effective assessment and
treatment of pain and other problems, physical,
psychosocial and spiritual. - A multi-disciplinary team approach to address the
needs of patients and their families, including
dignity in dying and bereavement support.
5Physical
Spiritual
Social / Cultural
Family
Psychological
6Palliative care involves
- Relief of pain and distressing symptoms
- Freedom from pain is a Human Right WHO 1990
- Psychological and spiritual care
- Continued support of the patient through
different phases of their illness - Support of family /- carer through the illness
and bereavement
7Total Pain
8General Role of Palliative Care
9Role of Palliative care in patients on ART
10Exploring the role of PC in the setting of ART
- Availability of Antiretroviral treatment changing
the Palliative care environment - Still not curative
- Patients still have pain-control needs
11General role of Palliative Care in HIV/AIDS
- Clinical Care involves-
- Patient-centred care- multiple models of delivery
- Provision of pain relieving medicines
- Chemoprophylaxis
- Diagnosis and treatment of opportunistic
infections - Referral to/provision of ART programs
12Clinical Care
- Treatment of HIV-Associated cancers (including
those that occur in children) - ART treatment failure
- End-of-life care
13Psychosocial Care
- Emotional Support
- For the patient
- For the caregivers
- Social
- Nutritional assistance
- Financial assistance
- Networking with other support organisations
- Spiritual Support
- - Non-denominational
- - Given as per patients wishes
14HIV and Malignancies
- CDC AIDS Defining cancers
- KS
- Non-Hodgkins Lymphoma
- Invasive cervical cancer
- (SCC Conjunctiva)
- Aggressive clinical behaviour, more advanced
stage, shortened survival.
15Kaposis Sarcoma
- 1st described by Moritz Kaposi in 1872
- Several epidemiological types classic, African
KS (endemic), immunosuppressive
treatment-related, epidemic, non-epidemic gay
related KS - In Uganda Before HIV/AIDS 9 of tumors in men
were KS, very rare in females after AIDS 50KS
in men, 2nd commonest(20) females
16Effect of ART on Cancer Incidence in Western
Studies
- HAART has led to decreased incidence of OI, KS
primary CNS lymphoma. In one European study
incidence of AIDS-defining illnesses decreased
from 30.7/100 pt-yrs in 1994 to 2.5/100 pt-yrs in
1998 but NHL increased. (Mocroft et al .Lancet
356291-6, 2000). - Surveys yet to be carried out in patients from
developing countries - Longer follow-ups and epidemiological studies
needed to characterize risk of lymphoma in HIV
infected people.
17Issues for HIV-related Cancer in Uganda
- Issues of actual HIV-related cancer incidence and
prevalence still to be addressed. - Routine testing for HIV in cancer patients not
yet available - Access to basic cancer treatment remains a
problem for most Ugandans - Issues of affordability and infrastructure
18HIV-related Cervical Cancer
19Disseminated KS
20Opportunistic Infections
- Pain incidence in those with Opportunistic
Infections - Implications of severe / under-treated pain or
symptom control in patients who need to take ART - General Access of Patients to ART at district
level
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23Reasons For Referral for HIV Patients attending
HAU,Makindye
24Reasons for Referral while on ART
25Who can provide palliative care?
- Informal Health Sector
- Families and Caregivers
- Community Volunteers
- Traditional Healers
- Formal Health Sector
- Health professionals
- Allied Health Professionals
26Way Forward
- Education of Formal and Informal Healthcare
Sector in PC - Development of Palliative Care Standards
- Drug Availability
- PCAU
- Development of strong networks between agencies
providing ART, support care and palliative care - Sensitization and advocacy at community level and
above
27Summary
- HIV patients receiving and not receiving ART have
palliative care needs - Need to integrate ART provision and palliative
care, particularly for those with HIV related
cancer, pain and symptom problems and those who
fail available treatment.
28Thank You