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Intensity and correlates of multidimensional problems in HIV patients receiving integrated palliative care in sub-Saharan Africa
  1. Richard Harding1,
  2. Lucy Selman1,
  3. Godfrey Agupio2,
  4. Natalya Dinat3,
  5. Julia Downing4,
  6. Wei Gao1,
  7. Liz Gwyther5,
  8. Thandi Mashao6,
  9. Keletso Mmoledi3,
  10. Anthony Moll7,
  11. Lydia Mpanga Sebuyira8,
  12. Barbara Ikin5,
  13. Irene J Higginson1
  1. 1King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
  2. 2Hospice Africa Uganda, Kampala, Uganda
  3. 3Division of Palliative care, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
  4. 4African Palliative Care Association, Kampala, Uganda
  5. 5Hospice Palliative Care Association of South Africa, Cape Town, South Africa
  6. 6Palliative Medicine Unit, University of Cape Town, Cape Town, South Africa
  7. 7Philanjalo Hospice, KwaZulu Natal, South Africa
  8. 8Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
  1. Correspondence to Dr Richard Harding, King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK richard.harding{at}


Background Despite global clinical guidance that HIV patients should have multidimensional care integrated into their management, there has been very limited data to guide practice since the advent of treatment. This study aimed to determine the three-day period intensity of problems (physical, psychological, social and spiritual) among HIV patients receiving integrated palliative care in sub-Saharan Africa, and to identify associations with problem severity.

Methods A sample of 230 consecutive adult patients attending five sites in South Africa and Uganda gave self-report data using a well-validated outcome scale. Multivariable regression models determine the association of patient characteristics with intensity of three scale factors.

Results The most burdensome problems were (in descending order) pain, worry, symptoms, and adequate information to plan for the future. Interestingly, CD4 counts were available on file for only 59.1% of patients. In multivariate analyses, being cared for at home was associated with poorer physical/psychological factor score (B=−0.192, 95% CI −2.566 -0.464, p=0.005), while being on ART was associated with better factor score (B=0.187, 95% CI=0.424 23.80, p=0.005). For the existential/spiritual factor, being cared for at home was associated with a worse factor score (B=−0.306, 95% CI −2.776 −1.128, p<0.001). ART use was not associated with either the interpersonal or spiritual/existential factors.

Discussion These self-report data reveal a high burden of both physical and psychological problems, and that communication from professionals is insufficient. Patients receiving home care may require additional support to enhance wellbeing, and treatment may not affect interpersonal and existential/spiritual wellbeing.

  • HIV

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  • Funding This study was funded by a grant from the BIG Lottery Fund UK under grant number IG/1/010141040.

  • Competing interest None.

  • Ethical approval The Ethical Review Boards of the Universities of Cape Town, KwaZulu Natal and Witwatersrand, the Ugandan National Council for Science and Technology, Hospice Africa Uganda and the Hospice Palliative Care Association of South Africa approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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