Palliative care guidelines for the management of HIV-infected people in South Africa

Abstract

Overview and summary Introduction: What is palliative care and what are its essential elements? Definition: Palliative care is:• Care that places the relief of suffering at its core, affirms life and does not hasten nor postpone death, but regards dying as a normal process, according to World Health Organization (WHO). • Care that is individualised: the person or patient is its core focus. The recipient is someone who has been diagnosed with a chronic, life-threatening illness that is no longer responsive to curative treatment, for example, cancer, irreversible end-stage end-organ failure, HIV infection and related disorders unresponsive to available treatment, et cetera. ß 'End-of-life' care is an aspect of palliative care that specifically refers to the care of persons estimated to have a life expectancy of ≤ 12 months, according to the National Council for Palliative Care, United Kingdom. • Care that is directed towards the control of distressing symptoms including the relief of pain: ß 'Total Pain' -this concept refers to pain that cannot be adequately controlled without addressing its contributory factors, namely, physical, emotional, social and spiritual factors. ß The opioid-use crisisinappropriate opioid use is a major contributor to the opioid addiction crisis currently reported from high-and middle-income countries. Under-use of and insufficient access to opioids however characterises opioid use in Africa and other low-income countries. Palliative care offers appropriate access to opioids without the risk of addiction and within the context of a professionally competent team. (Knaul et al.). 42 • Care that is provided by a team. The team is multidisciplinary and comprises nurses, doctors, paramedical persons, for example, physiotherapists, counsellors and accredited members of the religious community. The patient and their personal support network (e.g. family, partner and friends) are advisors to the team and receive support from the team. The team has a leader who takes responsibility for the totality of care, plans specific therapy, prescribes medication, completes medico-legal forms, et cetera. This is usually a medical doctor. ß Team care is intended to integrate the medical, practical, psychological and spiritual aspects of care in a system that promotes as active a lifestyle as possible until death. Team care provides support for the patient's family or partner, et cetera, during the illness and through the time of bereavement.

Palliative Care in HIV/AIDS

“…Spiritual and emotional support and counselling should always include the medical management of pain of people living with HIV. Deep breathing techniques, relaxation, and distracting attention of patients will also help as relieving methods for pain symptoms [8,16].…”

“…To prevent and control diarrhoeal symptoms, it is advisable to avoid eating raw foods. In general, for diarrhoeal disease management, it is recommended to increase frequency of food intake, such as rice soup, porridge, ORS, bananas, and other soups [16].…”

“…For fluconazole 50 mg daily for 5 days, use higher doses (200 mg daily for 2 weeks) if patient has difficulty swallowing and you suspect oesophageal candidiasis. Rinsing the mouth with diluted salt water after eating and at bedtime is the recommended care for patients with mouth sore [16,17].…”

“…At all stages of HIV, TB must be diagnosed, treated, and controlled. If fever is persisting, palliative care team must agree to do all that could minimise suffering [16].…”

“…There are different related factors with weight loss in people living with HIV. These include mouth sore, disease of the upper gastrointestinal tract, anorexia, side effects of drugs, food insecurity, malabsorption due to diarrhoeal disease, and poorly controlled infections [16,17].…”