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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
'My dreams are shuttered down and it hurts lots'-a qualitative study of palliative care needs and their management by HIV outpatient services in Kenya and Uganda
BMC Palliative Care, Volume 12, No. 1, Article 35, Year 2013
Notification
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Description
Background: Despite the huge burden of HIV in sub-Saharan Africa, there is little evidence of the multidimensional needs of patients with HIV infection to inform the person-centred care across physical, psychological, social and spiritual domains stipulated in policy guidance. We aimed to describe the problems experienced by people with HIV in Kenya and Uganda and the management of these problems by HIV outpatient services. Methods. Local researchers conducted in depth qualitative interviews with HIV patients, caregivers and service staff at 12 HIV outpatient facilities (6 in Kenya, 6 in Uganda). Interview data were analysed thematically. Results: 189 people were interviewed (83 patients, 47 caregivers, 59 staff). The impact of pain and symptoms and their causes (HIV, comorbidities, treatment side-effects) were described. Staff reported that effective pain relief was not always available, particularly in Kenya. Psychosocial distress (isolation, loneliness, worry) was exacerbated by stigma and poverty, and detrimentally affected adherence. Illness led to despair and hopelessness. Provision of counselling was reported, but spiritual support appeared to be less common. Neither pain nor psychosocial problems were routinely reported to service staff. Collaboration with local hospices and income-generation activities for patients were highlighted as useful. Conclusions: The findings demonstrate the multiple and interrelated problems associated with living with HIV and how psychosocial and spiritual distress can contribute to 'total pain' in this population. In line with the palliative care approach, HIV care requires holistic care and assessment that take into account psychological, socioeconomic and spiritual distress alongside improved access to pain-relieving drugs, including opioids. © 2013 Selman et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Ellen Selman, Lucy Ellen
United Kingdom, London
King's College London
Simms, Victoria M.
United Kingdom, London
King's College London
Penfold, Suzanne C.
United Kingdom, London
King's College London
Powell, Richard Antony
United States, New York
Healthcare Chaplaincy
Uganda, Kampala
African Palliative Care Association
Mwangi-Powell, Faith N.
United States, New York
Open Society Foundations
Downing, Julia D.
Uganda, Kampala
African Palliative Care Association
Gikaara, Nancy
Kenya, Nairobi
Kenya Hospices and Palliative Care Association
Munene, Grace
Uganda, Kampala
African Palliative Care Association
Higginson, Irene J.
United Kingdom, London
King's College London
Harding, Richard
United Kingdom, London
King's College London
Statistics
Citations: 40
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1186/1472-684X-12-35
e-ISSN:
1472684X
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Approach
Qualitative
Study Locations
Kenya
Uganda