Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71of the patients' medical charts that were reviewed; however; only 34were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIV positive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83 experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71 of the patients' medical charts that were reviewed; however; only 34 were considered to be adequately managed for their pain.Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIV positive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83 experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71 of the patients' medical charts that were reviewed; however; only 34 were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

The Social and Clinical Characteristics of Patients on Antiretroviral Therapy who are 'Lost to Follow-up' in KwaZulu-Natal; South Africa: a Prospective Study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms; quality of life; depression; herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naive patients recruited from three (one urban; one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months' follow-up. At 12-months follow-up 557 (75.9) individuals continued active ART; 177 (24.1) were all cause attrition; there were 82 deaths (13.8); 58 (7.9) transfers; 7 (1.0) refused participation; 8 (1.1) were not yet on ART and 22 (3.0) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio; RR=2.05; confidence intervals; CI=1.20 - 3.49) and higher depression levels (RR=1.05; CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme; such as delays in health care access (delayed health care seeking); health system delays; or inappropriate treatment criteria; need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome

Social Support and Health Behaviour in Women Living with HIV in KwaZulu-Natal

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV. The sample size was 262 women; 165 from urban area and 97 from rural area. Data were collected using 3 instruments; namely a demographic questionnaire; the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71 of women had disclosed their HIV status to someone; while in the rural area 49 had done so.A total of 77 of the women indicated that they were sexually active - 21 had 2 partners and 20 indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16 said that they currently received counselling; which was significantly more frequent in the rural sample (27) than the urban (11).The membership of support groups is at 12 among the participating women; and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use; support group attendance and taking vitamins. However; receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own. The higher social support was not associated with increased disclosure