Page 30 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 26 Guideline

Palliative care guidelines for the management

of HIV-infected people in South Africa

Authors: Overview and summary
David C. Spencer 1 Introduction: What is palliative care and what are its
René Krause 2
Theresa Rossouw 3 essential elements?
Mahomed-Yunus S. Moosa 4
Selma Browde 5 Definition: Palliative care is:
Esnath Maramba 6
Lauren Jankelowitz 7 • Care that places the relief of suffering at its core, affirms life and does not hasten nor postpone
Muhangwi B. Mulaudzi 8 death, but regards dying as a normal process, according to World Health Organization
Mpho Ratishikana-Moloko 9
Oluwarotimi F. Modupe 10 (WHO).
Adam Mahomed • Care that is individualised: the person or patient is its core focus. The recipient is someone who
11
has been diagnosed with a chronic, life-threatening illness that is no longer responsive to
Affiliations:
1 Division of Infectious curative treatment, for example, cancer, irreversible end-stage end-organ failure, HIV infection
Diseases, Department of and related disorders unresponsive to available treatment, et cetera.
Medicine, Helen Joseph ß ‘End-of-life’ care is an aspect of palliative care that specifically refers to the care of persons
Hospital, University of the
Witwatersrand, estimated to have a life expectancy of ≤ 12 months, according to the National Council for
Johannesburg, South Africa Palliative Care, United Kingdom.
• Care that is directed towards the control of distressing symptoms including the relief
2 Department of Family
Medicine, University of Cape of pain:
Town, Cape Town, South Africa ß ‘Total Pain’ – this concept refers to pain that cannot be adequately controlled without
addressing its contributory factors, namely, physical, emotional, social and spiritual
3 Department of Immunology, factors.
University of Pretoria,
Pretoria, South Africa ß The opioid-use crisis – inappropriate opioid use is a major contributor to the opioid
addiction crisis currently reported from high- and middle-income countries. Under-use
4 Department of Infectious of and insufficient access to opioids however characterises opioid use in Africa and
Diseases, Nelson Mandela other low-income countries. Palliative care offers appropriate access to opioids without
School of Medicine,
University of KwaZulu-Natal, the risk of addiction and within the context of a professionally competent team. (Knaul
Durban, South Africa et al.).
42
• Care that is provided by a team. The team is multidisciplinary and comprises nurses, doctors,
5 Community Action NGO/ paramedical persons, for example, physiotherapists, counsellors and accredited members of
NPO, Johannesburg,
South Africa the religious community. The patient and their personal support network (e.g. family, partner
and friends) are advisors to the team and receive support from the team. The team has a leader
6 Clinical Unit, Council for who takes responsibility for the totality of care, plans specific therapy, prescribes medication,
Medical Schemes, Pretoria, completes medico-legal forms, et cetera. This is usually a medical doctor.
South Africa
ß Team care is intended to integrate the medical, practical, psychological and spiritual aspects
7 Southern African HIV of care in a system that promotes as active a lifestyle as possible until death. Team care
Clinicians Society, provides support for the patient’s family or partner, et cetera, during the illness and
Johannesburg, South Africa
through the time of bereavement.
8 Phomolong Medical Centre, • Care that is not restricted by the patient’s age and is not restricted to a particular access point,
Rustenburg, South Africa such as a local clinic, district hospital or tertiary level medical centre. The 2017 National Draft
Policy Framework and Strategy Paper on Palliative Care, Department of Health, South Africa
9 Chris Hani Baragwanath (SA), envisages access to palliative care for all South Africans who are in need. (Comment:
Academic Hospital, University
of the Witwatersrand, These remarks from the National Framework Paper are aspirational. Few public sector
Johannesburg, South Africa facilities offer access to palliative care at this time.)

10 Council for Medical Schemes, Pretoria, South Africa
Read online: 11 Department of Internal Medicine, Charlotte Maxake Johannesburg Academic Hospital, Johannesburg, South Africa
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Scan this QR Corresponding author: David Spencer, [email protected]
code with your Dates: Received: 15 July 2019|Accepted: 15 July 2019|Published: 13 Dec. 2019
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mobile device How to cite this article: Spencer DC, Krause R, Rossouw T, et al. Palliative care guidelines for the management of HIV-infected people in
to read online. South Africa. S Afr J HIV Med. 2019;20(1), a1013. https://doi.org/10.4102/sajhivmed.v20i1.1013
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Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 23 Open Access