Santa Fe 2011 Santa Fe, USA 2011
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Abstract #333  -  Multidimensional outcomes for HIV outpatients receiving integrated palliative care: a prospective longitudinal natural experiment
  Presenting Author:   Dr George Loy - AIDSRelief Tanzania
  Additional Authors:  Dr. Richard  Harding, Dr. Karilyn Collins, Dr. Peter  Memiah, Mrs. Genevieve Patrick, Mr. Erick Kombo, Dr. Carla Alexander, Dr. Geoffrey Sigalla, Ms. Vicky Simms,  
To evaluate effectiveness of HIV/AIDS palliative care for outpatients attending HIV/AIDS Care and Treatment Clinics in two hospitals in Tanzania
  Method / Issue:
This was a prospective, longitudinal natural experiment design, comparing patient outcomes at an outpatient facility that introduced palliative care training to clinicians and stocked essential palliative care drugs, to outcomes of a cohort of patients at a similar HIV care facility with no palliative care. Inclusion criteria were pain or symptoms. Patients were followed from baseline fortnightly until week 10 using validated self-report outcome measures (APCA African POS and MOS-HIV).
  Results / Comments:
For primary pain outcome, odds of reporting pain reduced significantly more at intervention site (OR= 0.60, 95% CI 0.50-0.72) than at control (OR=0.85, 95% CI 0.80-0.90), p=0.001. For secondary outcomes, longitudinal analysis revealed significant difference in slope between intervention and control respectively: MOS-HIV physical score 1.46 vs 0.54, p=0.002; MOS-HIV mental health 1.13 vs 0.26, p=0.006; and POS total score 0.84 vs 0.18, p=0.001. Neither baseline CD4 or ART use were associated with outcome scores.
These data are the first to report outcomes evaluating integrated HIV outpatient palliative care in the presence of ART. Findings demonstrate clinical and statistically significantly benefits for HIV outpatient care with integrated palliative care involving clinical training, multiprofessional teamwork and essential drug availability. The data offer a substantive response to underpin WHO and UNAIDS clinical guidance stating an essential role for palliative care alongside treatment, regardless of prognosis.
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