ABSTRACT
This article describes a pilot project, run over a two-year period in the Eastern Cape province of South Africa. It was aimed at assessing the impact of a model of introducing a palliative care component and professional supervision of community caregivers on the quality of care given to people living with HIV/AIDS and their families. The use of the African Palliative Care Association African Palliative Outcome Scale as an assessment tool is outlined, and the challenges and outcomes encountered by the various role players are listed. The overall conclusion is that this model is a cost-effective way of increasing access to palliative care in resource poor settings.
Subject(s)
Community Health Services/organization & administration , Community Health Services/trends , Home Care Services/organization & administration , Home Care Services/trends , Palliative Care/organization & administration , Palliative Care/trends , Acquired Immunodeficiency Syndrome , Adult , Ambulatory Care , Female , Health Plan Implementation , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , South Africa , Young AdultABSTRACT
This article provides a brief outline of the HIV/AIDS situation in South Africa and the development of the Hospice Palliative Care Association (HPCA) as the background to an exploration of the changing face of palliative care in light of the demands of HIV/AIDS. It describes the South African Palliative Care Mentorship Program, including a description of the Integrated Community-Based Home Care (ICHC) model and its promotion of collaboration with the formal health care sector and other networking partners. The role mentorship played in its application to HPCA member hospices in response to the increasing demands of HIV/AIDS is outlined. The article also focuses on the development of provincial and regional mentorship capacity, the establishment of provincial palliative care development teams, the development of comprehensive palliative care standards, and the link between mentorship and accreditation. The key results of the promotion of the ICHC model and the effects of the mentorship program are highlighted, including possibilities for the expansion of the model beyond its original context in South Africa. The difficult issue of sustainability within an African context is also mentioned. In conclusion, there is a challenge to readers to explore the use of mentorship within their own palliative care settings.
Subject(s)
Mentors , Palliative Care/organization & administration , Quality Assurance, Health Care , Acquired Immunodeficiency Syndrome/complications , HIV Infections/complications , Humans , Models, Organizational , Palliative Care/standards , South AfricaABSTRACT
The vast majority of people infected with HIV in South Africa have no access to antiretroviral therapy, making palliative care the only treatment available. An important element of palliative care is symptom management. However, little is known about the range of symptoms and the distress associated with them among rural South Africans living with HIV/AIDS. A cross-sectional study was conducted to describe the spectrum of symptoms experienced by 64 HIV-positive patients who received palliative care from a rural home-based palliative care program. Data were determined using a questionnaire adapted from an HIV symptom list and HIV symptom profile. The physical symptoms of most immediate importance identified by the respondents were localized pain, skin problems, cough, vaginal discharge/infection, and fatigue. The psychological symptoms of the most immediate and overall importance were feelings of anger, loneliness, decreased support from family and friends, and a decreased sense of satisfaction. This study provides insight into the spectrum of HIV-associated symptoms in a rural South African HIV-positive population. Through improved symptom assessment and management, nurses can improve palliative care services to those suffering from the distressful symptoms associated with HIV infection.
