Nurse-led palliative care for HIV-positive patients taking antiretroviral therapy in Kenya: A randomised controlled trial

Keira Lowther, Lucy Selman, Victoria Simms, Nancy Gikaara, Aabid Ahmed, Zipporah Ali, Hellen Kariuki, Lorraine Sherr, Irene J. Higginson, Richard Harding*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)

Abstract

Background

People with HIV accessing antiretroviral therapy (ART) have persistent physical, psychological, social, and spiritual problems, which are associated with poor quality of life and treatment outcomes. We assessed the effectiveness of a nurse-led palliative care intervention on patient-reported outcomes. 

Methods

We did this randomised controlled trial at a clinic in Kenya for adults with HIV, established on ART, and reporting moderate-to-severe pain or symptoms. We randomly assigned participants (1:1) either to a palliative care intervention (including assessments of physical, emotional, and spiritual wellbeing and quality of life) given six times over 4 months, or to usual care. Participants and investigators were not masked to allocation. The primary outcome was pain (scored on the African Palliative Care Association's African Palliative Outcome Scale). This trial is registered with ClinicalTrials.gov, number NCT01608802. 

Findings 

We screened 2070 patients, of whom we enrolled 120: 60 allocated to each group. In the control group, median pain score improved from 1·0 (IQR 0·0-2·0) at baseline to 5·0 (3·0-5·0) at 4 months; in the intervention group, it improved from 1·0 (0·0-2·0) at baseline to 4·5 (3·0-5·0) at 4 months. Compared with standard care, the intervention had no significant effect on pain (coefficient -0·01, 95% CI -0·36 to 0·34, p=0·95). 

Interpretation

A nurse-led palliative care intervention was not effective in reducing pain. However, person-centred assessment and care delivered by staff who have received additional training had positive effects on self-reported mental health related quality of life and psychosocial wellbeing. 

Funding

Diana Princess of Wales Memorial Fund.

Original languageEnglish
Pages (from-to)e328-e334
Number of pages7
JournalLancet HIV
Volume2
Issue number8
Early online date15 Jun 2015
DOIs
Publication statusPublished - 1 Aug 2015

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