Page 0094

access to ART through these facilities is increasing through

the efforts of the Ministry of Health to decentralize ART in

Zimbabwe, AIDS-KS treatment is centralized at tertiary

referral centres such as the Parirenyatwa Hospital in Harare

where laboratory facilities and chemotherapy drugs are

available; patients with AIDS-KS are often diagnosed late in

the course of their illness, resulting in a high tumour burden

on presentation. In a study conducted in Harare, after 96

weeks of ART, despite suppression of plasma HIV-1 RNA

below the limits of detection only 19% of Zimbabweans had

complete or partial resolution of AIDS-KS disease and 16%

died; in addition, 34% of participants had no improvement in

their quality of life after 24 weeks of treatment, indicating

that more effective treatment of symptoms related to AIDSKS and associated co-morbidities is needed for a large

portion of AIDS-KS patients after beginning ART.30

Palliative care for AIDS-KS in Zimbabwe

Patients with AIDS-KS experience a high burden of pain and

other chronic symptoms, over a long period of time, and have

a disease course marked by cumulative exacerbations and

remissions, making palliative care highly relevant to this

population.27 The World Health Organization (WHO) has

recognized that development of palliative care for HIV/AIDS

has been relatively neglected in Africa and made

enhancement of palliative care for HIV/AIDS in Africa a

priority in 2002.28 Although much progress has been made in

enhancing access to palliative care in Zimbabwe, little is

known about the role of palliative care to improve outcomes

specifically in the treatment of patients with AIDS-KS in

resource-poor areas. (For this study, we are using the WHO

definition of palliative care: "An approach that improves the

quality of life of patients and their families facing problems

associated with life-threatening illness, through the

prevention and relief of suffering by means of early

identification and impeccable assessment and treatment of

pain and other problems, physical, psychosocial and spiritual".)

Essential elements of palliative care relevant to AIDS-KS are

the focus of palliative care on providing relief from pain and

other distressing symptoms and enhancing quality of life, and

DISEASE-SPECIFIC CANCER CONTROL

CANCER CONTROL 2014 93

Table 1: Summary of recommendations for AIDS-KS management in recent international guidelines

Source Kaposi sarcoma-related recommendations

Screening Diagnosis Staging Treatment

Integrated management of adolescent and adult illness, None None None None

chronic HIV care module (WHO 2006)

http://www.who.int/3by5/publications/documents/imai/en

Primary care guidelines for the management of persons Examine skin None None None

infected with HIV (IDSA 2009) Aberg et al., and mouth

Clin Infect Dis 2009; 49:651-81 for KS lesions

Guidelines for prevention and treatment of opportunistic None None None ART for all

infections in HIV-infected adults and adolescents KS; ART with

(NIH/CDC/IDSA, 2013) http://aidsinfo.nih.gov/guidelines chemotherapy

for visceral

and

disseminated

disease

Guidelines for the use of antiretroviral agents in None None None None

HIV-1-infected adults and adolescents (US DHHS 2013)

http://aidsinfo.nih.gov/guidelines

Consolidated guidelines on the use of antiretroviral None Criteria for None None

drugs for treating and preventing HIV infection clinical and

(WHO, 2013) http://www.who.int/hiv/pub/guidelines/ definitive

arv2013/download/en/ diagnoses

Integrated management of childhood illness, Manual None None None None

on Paediatric HIV Care and Treatment for District

Hospitals (WHO 2011)

Guidelines for the prevention and treatment of opportunistic None None None None

infections among HIV-exposed and HIV-infected

children (US DHHS, 2009)

http://aidsinfo.nih.gov/guidelines

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