Alexander Carla S, Memiah Peter, Henley Yvonne B, Kaiza-Kangalawe Angela, Shumbusho Anna Joyce, Obiefune Michael, Enejoh Victor, Stanis-Ezeobi Winifred, Eze Charity, Odion Ehekhaye, Akpenna Donald, Effiong Amana, Miriti Kenneth, Aduda Samson, Oko John, Melaku Gebremedhin D, Baribwira Cyprien, Umutesi Hassina, Shimabale Mope, Mugisa Emmanuel, Amoroso Anthony
University of Maryland School of Medicine, Institute of Human Virology, 29 S Greene Street, Baltimore, MD 21201, USA.
Am J Hosp Palliat Care. 2012 Jun;29(4):279-85. doi: 10.1177/1049909111419292. Epub 2011 Oct 13.
To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of life for individuals. Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.
为应对全球人类免疫缺陷病毒（HIV）疫情导致的发病和死亡情况，美国国会在30个资源有限的国家实施了总统艾滋病紧急救援计划（PEPFAR），以整合用于预防和治疗的联合抗逆转录病毒疗法（ART）。超过35%符合条件的人已得到成功治疗。最初的立法将姑息治疗列为该计划的一个重要方面，但总体健康强化对于项目的可持续性变得至关重要，资金优先事项发生转移，以确保护理提供场所的人员配备；实验室和制药基础设施；数据收集和报告；以及财务管理，因为鼓励各个国家承担国内资金的控制权。鉴于基础设施的要求，仅超出ART管理的个体护理提供所获得的资金极少，但护理对于持久的病毒抑制和个人的整体生活质量仍然是必要的。代表七个非洲国家的一个实施伙伴的技术援助人员开会，以澄清姑息治疗领域与替代术语“护理与支持”相比的情况，以了解正在进行的HIV护理中的潜在差距。他们将护理需求列为：1）心理健康（抑郁症和其他情绪障碍）；2）沟通技巧（根据年龄适当披露HIV状况）；3）对护理提供者的支持（为熟练的HIV工作队伍的可持续性进行压力管理）；4）相关优先事项：机会性感染中的症状管理；临终护理；精神病史采集；以及5）相关优先事项：关注患者、其家人和工作人员与悲伤相关的需求；以及HIV合并症的管理。随着资金向新的优先事项过渡，这一过程可为卫生政策提供参考。
