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

2. 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)

3. 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

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

5. 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.

6. 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
     

7. 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

8. 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

9. 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.

10. 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

11. 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.

12. 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.