Improving HIV management in sub-Saharan Africa: how much palliative care is needed?

The WHO advocates palliative care as an essential component of HIV care from the point of diagnosis (when the burden of pain and symptoms may be first experienced) to the end of life and into bereavement (World Health Organisation, 2006). However, in the field of African HIV care where mortality is high, palliative care has been shown to be largely lacking. This study aimed to measure the prevalence of multidimensional palliative care needs of patients with HIV disease in Muheza, Tanzania. A prospective census measured presenting problems for all patients during a one-month period: professional contact; physical symptoms; psychosocial problems; prescribing; and care planning. During the four-week period of the study, 731 patients attended for HIV care. The total number of professional contacts was 1,512, with 736 nurse, 733 doctor and 43 social worker contacts. Patients were identified as being appropriate for palliative care if they needed pain relief other than simple paracetamol or if they or their family had complex pain or physical, psychosocial or spiritual needs. The mean patient age was 35.4 years (SD=13.7) and 82 patients were under the age of 16. The majority were female (70.9%). Morphine was being prescribed to 21 patients (2.8%) and ART was being prescribed to 434 (59.4%). The mean CD4 count was 178.3 cells mm(3) (Median=131.1; SD=179.9). Palliative care intervention was indicated for 378 (51.7%) patients. Among those 434 patients using ART, 230 (52.9%) were indicated as having palliative care needs. Palliative care continues to be an important part of HIV programmes even in the presence of ARV treatment.