The Role of Palliative Care in HIV/AIDS Management in Botswana Dr. Miriam Sebego Ms. Esther Ntsayagae

Palliative care defined Palliative care is an approach which improves the quality of life of patients and their families facing life-threatening illness, through the prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems (WHO, 2003)

Principles of Palliative Care Affirms life and regards dying as a normal process Neither hastens nor postpones death Provides relief from pain and other distressing symptoms Integrates the psychological and spiritual aspects of care Offers a support system to help patients live as actively as possible until death Offers a support system to help the family cope during the patients illness and in their own bereavement. WHO 1990

Components of Palliative Care Relief of symptoms Psychosocial support End-of-life care Caring for caregivers

Why Palliative Care for People Living with HIV/AIDS (PLWHA) Changes in HIV care Increasing body of knowledge and expanded definition of palliative care Shift in the trajectory of dying from HIV/ AIDS Patient with HIV/AIDS have palliative care needs at each stage of the illness.

Caring for (PLWHA) in Botswana Community Home Based Care (CHBC)  Established in 1996 Goals of CHBC Ensure optimum level of care for all terminally ill patients in order to avoid the “dumping syndrome”. To avoid unnecessary hospital admissions To provide clinical care in the home including giving medications Provide nursing care in the home setting Provide on-going counseling service to both PLWHA and their families      

Strengths of CHBC Commitment and structure in place to support families: Social support including provision of food basket and clinical supplies such gloves Community mobilization The established referral system between hospitals and clinics

Weaknesses of CHBC Quality of care provided was found to be inadequate Failure to address palliation Insufficient knowledge and skills regarding palliative care by service providers Lack of country specific guidelines on palliative care in Botswana Inadequate capacity to train for palliative care Issues concerning death and dying not adequately addressed

Challenges of CHBC in the HAART Era The shift in illness trajectory Adverse reactions requiring palliation Psychosocial support Patients in transition - HIV/AIDS stigma result in some infected persons entering care later in the disease progression. -Some lack the support to adhere to a complicated medication regimen.

Efforts towards Addressing the Identified Challenges Incorporating palliative care into CHBC -Palliative care strategy launched by the Minister of Health in June, 2005 Development of palliative care guidelines Efforts towards training of Health care workers

Importance of Palliative Care in HIV/AIDS HIV/AIDS is still a leading cause of morbidity and mortality particularly in sub-Saharan Africa HAART is still not a cure and has many side effects Many symptoms throughout the disease impact quality of life Complex psychosocial issues such as psychiatric illness and substance abuse HIV/AIDS stigma- some infected person enter care later in the disease progression.

The Way Forward Strengthening of palliative care services Need to design and test innovate models of care Development and dissemination of palliative care guidelines Improvement of Palliative care in the acute care setting.