Includes bibliography. / The aim of this study was to identify the ten most prevalent symptoms and five of the most common sites of pain in a patient with advanced AIDS. The setting was a Hospice In-Patient and Home Care program in Soweto, Johannesburg, South Africa. Soweto has a population of approximately 3.5 million. The design was a descriptive quantitative analysis using a nurse-led questionnaire to collect data and was completed in 3 different languages. The patients included 103 adult patients with WHO Stage 4 AIDS who were alert enough and willing to participate. Patients with impaired cognitive function were excluded from the study. The main outcome measures included a list of 30 symptoms, 13 site-specific pains, age, gender, worst overall pain and/or symptom and access to antiretroviral therapy. The results were based on the review of data collected from 103 patients between May 2002 and February, 2003. The results showed the mean age of patients to be 35.4 years, females being an average of 4.4 years younger than males. There was a higher number of female respondents (62.63%) compared to males (37.37%). The ten most common symptoms in order of prevalence were pain (98%), loss of weight (81%), loss of appetite (70.87%), low mood (69.9%) weakness (66%), dry skin (56.3%), diarrhoea (53.4%), nausea and vomiting (44.7%), cough (44.7%) and fatigue (42.7%). 34.38% of respondents mentioned pain as being their worst overall symptom. The average number of pains experienced was 2.91. Female respondents reported significantly more anxiety and genital sores and pain. 3.88% of patients had had access to ART. Lower limb pain was the most prevalent pain (66%) followed by mouth pain (50.5%), headache (42.3%), throat pain (39.8%) and chest pain (17.5%). Conclusions drawn were that patients with advanced AIDS suffer significantly from pain and a number of distressing symptoms. In the light of the HIV/AIDS pandemic in SA, and the lack of access to ART, reforms are needed to increase knowledge and education in Palliative Care. There is a need for the development of standard protocols for the palliative management of AIDS-related pain and symptoms and more research into end-of-life care for these patients.

Background: Cancer of the cervix is a common malignancy among women and is one of the leading causes of cancer morbidity and mortality in Malawi. The majority of women with cervical cancer present with advanced disease where cure is not possible. These women face many challenges that affect their lives holistically. In particular, the psycho-social impact is common for women living with cervical cancer and psychosocial care does not have sufficient attention as the focus is management of the disease and physical symptoms. However, research shows that support groups are associated with improvements in intimacy, emotional support and becoming better informed for women living with cancer of the cervix. Methodology: This was a qualitative research study. Semi structured interviews were used to collect data and were audio-taped. A purposive sampling technique was used in selection of participants. One to one interviews were conducted with eight (8) women diagnosed with cervical cancer because data saturation was reached at that number. Thematic analysis was undertaken where four phases of organisation, familiarization, reduction and analysis were used. Results: The following themes were identified: intimacy, emotional support, becoming informed and drawbacks of support group. Conclusion: A support group intervention is found to reduce psychosocial and intimacy distress associated with cervical cancer diagnosis. This leads to improved quality of life of these women and their families. Thus, a support group intervention has a potential to enhance appropriate holistic management plans for women with cervical cancer.

Includes bibliographical references. / This study was carried out between March and November 2002 at Port Shepstone Regional Hospital, KwaZulu Natal (KZN), South Africa. In early 2002, the KZN Provincial Department of Health (DOH) requested that physicians at state hospitals complete an AIDS Anonymous Report Form (AARF) for all patients testing HIV postive. This form aimed to allow monitoring of the demographic profile and AIDS-indicator diseases of patients throughout the province.

Includes bibliographical references. / Although curable, tuberculosis (TB) remains a serious health care problem. During 2011 there were almost 9 million new cases and 1.4 million TB deaths worldwide. The World Health Organisation (WHO) lists South Africa as a country with a high TB, HIV and MDR-TB burden. In this country the dual TB/HIV epidemic which has reached critical proportions is fuelled by the high TB/HIV co-infection rate. By definition the focus of palliative care is on the alleviation of suffering associated with lifelimiting illnesses. TB clearly falls into this category. The palliative care-related outcomes of a cohort of hospitalized TB patients were determined during this prospective longitudinal study and a quality improvement strategy was then generated from the audit data. The APCA POS, a validated outcome measurement tool was used to conduct weekly interviews. The audit sample comprised 57 patients with MDR-TB and 57 with drug responsive TB (n=114). The intensity of the multi-dimensional palliative care-related problems experienced by TB and MDR-TB patients on admission as well as the differences that occurred over time were measured over four consecutive weeks. In order to get staff perspectives on using the audit data to develop a quality improvement strategy, a report on the analyzed audit data formed the basis of a focus group discussion (FGD). The purposive sample of FGD participants included key members of staff from the TB and MDR TB wards. Audit findings indicated that on admission to hospital the predominant problems were pain, symptoms and worry. On a Lickert scale of 0-5 with 0 indicating best and 5 worst, the median score for both pain and other symptoms was 3.0, with an inter-quartile range of 2.00-4.25. Participants' worry about their illness attained the worst median baseline score of 4.0. Neither pain nor symptoms showed any sustained improvement over the four weeks of data collection. A statistically significant improvement in worry which moved from 4.0 to 2.0 occurred after week 1 but then remained static. An unexpected crucial finding was that the collective score for participants with drug responsive TB was worse than for those with MDR-TB for both the physical and psycho-social components, and at each time point. Using the APCA POS audit data as the basis of a FGD with key staff members resulted in the development of an appropriate palliative care-focused quality improvement strategy which they considered to be realistic and achievable within their busy hospital setting. Findings from this study support the recent WHO Declaration on the provision of palliative care for people with drug-resistant TB. Furthermore they clearly show that patients with drug responsive TB should not be excluded from a comprehensive palliative care person-centred approach. Palliative care within the context of TB is still an emerging concept. This study makes a meaningful contribution to the scarce information currently available. The topic is important in that the suffering experienced by vast numbers of TB patients and their families could and should be substantially relieved. It is suggested that it would be valuable to explore the impact of a palliative care approach on TB treatment outcomes.

This study was designed to measure the symptom prevalence and symptom burden amongst patients attending three HIV treatment clinics in greater Johannesburg, and to assess the relationship of these to CD4 count, viral load, WHO stage, functional status and HAART. Patients at the three clinics were invited, using convenience sampling, to participate in completing the interviewer administered Memorial Symptom Assessment Scale-Short Form (MSAS-SF) which assesses the 7 day prevalence and distress for 28 physical symptoms and prevalence and frequency of four psychological symptoms. Demographic and clinical data, including initial and latest CD4 counts, initial and latest viral loads and information on HAART use, were collected from the participants and from their clinic files.

Includes bibliographical references. / The research aimed to assess the availability of palliative care drugs to patients served by the public sector in the Knysna Health district. The population of approximately 50 000 is served by a Hospice organisation which offers home-based care (it has no residential component), 4 Municipal clinics, the 96 bed Knysna Provincial District Hospital and a regional referral centre 65km away, viz., the George Provincial Hospital. Tertiary referral is to Cape Town 600km away. The need for palliative care services has increased with the HIV/AIDS epidemic. Drugs on the hospital level EDLs are collected from the Knysna PRovincial Hospital by the Hospice staff and given to their patients.

Background: HIV infection and AIDS are characterized by a multitude of symptoms which has not changed since the advent of HAART. Based on this reality the World Health Organisation (WHO) recommends palliative care to be provided alongside disease specific treatment for all PLWHIV. There are many barriers to patients reporting their symptoms and physicians often fail to recognise the symptom burden. Palliative medicine improves quality of life, relieves suffering, provides good end of life care and helps patients and loved ones to come to terms with a chronic progressive disease. Namibia is one of the hardest hit countries globally with respect to the HIV epidemic. No palliative care services are available in that country yet. No research has been done to assess the prevalence and burden of symptoms amongst PLWHIV. The study serves as a pilot project to address these shortcomings. Aim: The aim of this study is to assess the prevalence and associated burden of symptoms in patients attending an HIV clinic in Swakopmund and local general practitioners' awareness of the symptom burden and assessment in HIV patients. Methods: This was a cross-sectional descriptive study conducted at the HIV clinic at the State Hospital in Swakopmund, Namibia, and amongst general practitioners working in the Erongo region. The study was conducted in two parts: 1) Assessment of symptom prevalence and severity in HIV patients on HAART attending the HIV clinic at the Swakopmund State Hospital. A total of 104 adult patients were recruited using simple random sampling was used to recruit 104 adult patients who were interviewed using the MSAS-SF. Demographic data and symptoms recorded by the health care professionals during follow-up visits were extracted from the patients' records. 2) The evaluation of general practitioners' perception regarding the symptom burden and importance of symptom assessment in HIV patients receiving HAART. Based on the outcome of the above findings a questionnaire was designed to assess the awareness of general practitioners of the burden of disease in PLWHIV. Ethical Approval was obtained from the Human Research Ethics Committee of the University of Cape Town as well as from the Ethical Committee of the Ministry of Health, Namibia. Results: The median of the sample was 40 years, the median CD4 count 417, and the median number of years on HAART was 4. The majority were females (61.5 %) and 66.3% were employed. The mean number of symptoms was 5.99 (median 5, SD 4.912). The most common symptoms were of psychological nature and pain, cough and peripheral neuropathy were common physical symptoms. Median values of TMSAS, GDI and PSYCH were higher in the unemployed and in females. PHYS was significantly higher in females. There was no association with the CD4 count. Time on treatment is not significantly related to any of TMSAS, GDI, PH YS or PSYCH scores, but younger age was related to higher GDI. Patient self - report of symptoms was significantly higher than symptoms recorded by the health practitioners during follow-up. Many general practitioners (44%) assume patients on HAART to be relatively symptom free, that low CD4 counts are related to symptom burden (84%) and that patients will report symptoms if present(76%). Conclusion: Symptom prevalence and burden is high in this study population despite HAART and there seem to be barriers to the reporting of symptoms by the patients. There is evidence of poor symptom assessment and symptom control. This highlights the need for palliative care for ambulatory HIV patients.

Includes bibliographical references (leaves 87-102). / Palliative care developed as a response to the specific needs experienced by terminally ill cancer patients and their families. The modern palliative care movement began in London in 1967 and African palliative care developed against this backdrop. The HIV pandemic has confronted African palliative care workers with new challenges to provide accessible, affordable, culturally sensitive care in resource limited settings. The domains of palliative care are well recognised and the provision of holistic patient centered care requires that the individual context of each person requiring palliative care is considered as these influenced the experience of life-threatening illness. The HIV burden in South Africa is complicated by other health care issues, poverty, and the implications of a multi-cultural, multi-racial society which add to the complexities of palliative care service provision. This study considered the individual context and palliative care needs of a group of HIV positive patients who access palliative care from Grahamstown Hospice.

Includes bibliographical references (leaves 49-56). / Neuropathic pain, of which a distal sensory polyneuropathy (DSP) is the most frequent cause, is a common problem in patients with HIV infection and AIDS. The researcher is concerned that neuropathic pain in patients with AIDS tends to be underdiagnosed and under-treated. There are several reasons for this, one of which may be a lack of awareness of the extent of the problem, as well as the impact it has on patients' lives. Several studies around the world have noted the problem of under-diagnosis and undertreatment of pain and more specifically, neuropathic pain, in patients with AIDS. A review of the literature reveals a wide variation in the prevalence of neuropathic pain and peripheral neuropathy in AIDS patients. To determine the prevalence, characteristics, severity and morbidity of neuropathic pain in AIDS patients, attending the Kalafong HIV Clinic, prior to the initiation of HAART.A prospective, cross sectional and descriptive study was done at the Kalafong Hospital HIV Clinic. Data was collected from a systematic sample of 354 AIDS patients, who were referred to this HIV clinic to be initiated on HAART. An interviewer-administered questionnaire and focused neurological examination were used. This included a recently validated instrument, the DN4, for identifying pain which is neuropathic in origin. Selected sections of the Brief Pain Inventory (BPI) were used to determine the severity of the neuropathic pain, as well as pain-related interference on aspects of daily living.

Includes abstract. / Includes bibliographical references (leaves 43-47). / People living with HIV/AIDS experience many losses, one of which may be loss of sexual expression. Sexuality has a broader meaning than mere sexual intercourse; it encompasses intimacy and impacts on psychosocial and spiritual realms. Despite the broader meaning of sexuality and that HIV is mainly a sexually transmitted disease; carers generally avoid real issues of sexuality. This study explored issues of sexuality in people living with AIDS who are given an optimistic outlook to life by the availability of HAART.