A mixed methods evaluation of the effectiveness of a nurse-led palliative care intervention for HIV positive patients on ART in Mombasa, Kenya

    Student thesis: Doctoral ThesisDoctor of Philosophy


    People living with HIV (PLWH) accessing antiretroviral therapy (ART) report worse mental well-being than general populations and those with other chronic conditions.
    To evaluate the effectiveness of a nurse-led palliative care intervention on the mental well-being of PLWH on ART in Kenya compared with standard care.
    A randomised controlled trial (RCT) with longitudinal monthly follow-up over five time points and qualitative exit interviews was conducted. The primary outcome was psychological quality of life (Medical Outcome Study-HIV), with secondary outcomes being psychiatric morbidity, worry and ability to share feelings. Eligible participants were adults on ART reporting moderate to severe pain or other symptoms. Analyses included ordered logistic regression at monthly time points and multilevel modeling to identify intervention benefit. A purposive subsample of 30 participants across both study arms were selected for qualitative interviewing. Thematic analysis explored active ingredients of the intervention and experiences of study participation.
    16% of all patients screened were eligible; 56% refused to participate. 120 patients were recruited (mean age 39, SD 8.9, 81% female) and equally randomised to each study arm. Quantitative data analysis found significant benefit of the intervention in psychological quality of life (coefficient 0.59 (CI 0.12-1.07), p=0.015), psychiatric morbidity (coefficient -0.50 (CI-0.96 to -0.03), p=0.035) and ability to share feelings (coefficient 0.92 (CI 0.28-1.56), p=0.005). Qualitative analysis identified three active ingredients of the intervention: insight and understanding, medication and time. Unresolved physical, social and financial problems were identified as barriers to improvement. Aspects of study participation found to improve mental health and well-being were compassionate care, social support, communication, and material support.
    The intervention was effective in improving mental well-being through health information, symptom relief and enabling participants to articulate problems. Aspects of study participation benefited participants in both study arms, highlighting unmet needs of PLWH.
    Date of Award2014
    Original languageEnglish
    Awarding Institution
    • King's College London
    SupervisorRichard Harding (Supervisor), Lucy Selman (Supervisor) & Irene Higginson (Supervisor)

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