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Dr Richard Harding, Reader in Palliative Care, Director of Global Programmes and Partnerships, Cicely Saunders Institute, King's College London, UK, writes.
Building on the PEPFAR Care & Support Public Health Evaluation (PHE) that we led, we identified patient problems and went on to design an intervention trial. The data were published recently as a fast track in Lancet HIV. We found that our intervention improved quality of life, psychiatric morbidity, and psychosocial problems.
Current global policy is that by 2020, 90% of people with HIV will be tested; of these 90% will be on treatment, and of those on treatment 90% will have viral suppression. This poses a huge challenge to health services, especially as our prior evidence from East Africa showed a high burden of psychosocial problems among people with HIV, that this is evident from the point of diagnosis and our systematic review identified a high prevalence of depression, anxiety and perceived stigma globally for people on HIV treatment.
The TOPcare trial, published on 15 June in Lancet HIV, found that a simple training program in the principles and practice of palliative care, which was delivered to existing HIV outpatient nurses, significantly improved quality of life, psychosocial problems, and psychiatric morbidity. This offers a promising model for health services around the world that will face an increasing patient load with such problems. The paper is freely downloadable here.
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