CARE BEYOND ARVS

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CARE BEYOND ARVS

• By
• Dr. W MUSOKE
• MILDMAY CENTRE
• 5TH DEC 2006

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Over view of presentation

• Brief history of ART
• Current ART situation
• Beyond ART

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History of ART

• 1987- first drug AZT coming on market
• 1996-

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Current ART Situation

• 6.8 million pple in developing countries are in
  need of ARVS today.
• Only 1.65 million are currently receiving them.
• In Uganda, 200000 pple are in need and
  only75000-80000 are currently receiving them.

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As people take ARVS-

• Many have improved quality of life.
• Some have developed serious side effects and have
  had to stop the drugs.
• Some have developed resistance to the drugs (
  disease progression)
• Some do not want to continue with this aggressive
  treatment.

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Therefore

• Although, ART is the most effective palliation
  for HIV/AIDS, not every body will benefit from
  it- but, there should be no end to caring.
• Support the patient,family caregivers and
  professional caregivers

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Beyond ART

• Implement the principles of palliative care
• In the event that some one cant receive ARVS for
  whatever reason, we should ensure the following-

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Beyond ART( contd)

• Ensure physical comfort as far as possible
• Optimum symptom control
• Emotional support to patient and family
• Non-abandonment
• Prognostication is inexact

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Ensuring physical comfort.

• Appropriate assessment to identify cause and
  severity of symptoms
• Correct reversible factors
• Consider disease-specific palliative therapy
• Explanation to patient and family
• Institute non-pharmacological interventions

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Comfort (contd)

• Prescribe appropriate first-line treatment
• Consider adjuvant/second-line treatment
• Review assessment and management
• At all stages of management consider
• Involvement of interdisciplinary team
• Referral to appropriate service/more experienced
  clinician.

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As the disease progresses

• Explain the to patient and family what is being
  done, what we hope to achieve
• Rationalise medication and discontinue
  non-essential medicines
• Psychosocial support
• Spiritual support

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Family support

• Face prognostic uncertainty- need info about the
  illness,impending death and what to expect
• Distress of watching deteriorating condition of
  the patient
• Require reassurance that they are doing a good
  job of caring for loved one
• Adjust to alteration of role e.g husband to nurse

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Psychosocial support

• Pre-bereavement grief counseling
• Emotional and practical support of the family
• Respect of confidentiality
• Assisting the patient and family to come to terms
  with changing abilities, body image, roles

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Spirituality

• Man is not destroyed by suffering but by
  suffering without meaning
• Frankl
• Search for meaning
• Some patients are well supported within their own
  religious framework

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Discuss

• Explore patients/family members understanding
• Fears
• Advance directives
• Resuscitation
• Unfinished business

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Importance of care

• To the patient
• Physical comfort in the face of challenging
  symptoms
• Dignity in death
• Emotional and spiritual support
• Non abandonment, journeying with the patient

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Importance (contd)

• To family members
• Impact on bereavement
• To the HCP
• Change from attitude of there is nothing more I
  can do
• Active care, management of symptoms
• Being present, making a difference

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Conclusion

• Commitment to care beyond ART
• Quality of life is the goal
• Dignity in death for the patients
• Support of family members.

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• THANKYOU.