AEGiS-15IAC: Determinants of hospice use among terminally ill patients in Lusaka Zambia: a high HIV prevalence and resource limited setting.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Determinants of hospice use among terminally ill patients in Lusaka Zambia: a high HIV prevalence and resource limited setting.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. D10121)

Nota A, Shalunga C
Zambart Project, Lusaka, Zambia

ISSUES: Hospice services have been available in Zambia for some years. The health system in Zambia is overburdened by the TB/HIV dual threat. Currently few terminally ill patients are able to access and benefit from these services. This observational study identifies determinants of hospice service uptake and factors leading to a lack of use of these services.

DESCRIPTION: A study done by Zambart project in 2001 at Jon Hospice in Lusaka, Zambia revealed that HBC centres refer patients who have no carers at home and also to relieve the families the burden of looking after patients in disadvantaged communities. Hospitals refer patients as a way of decongesting their wards. The role of the hospice as a place were terminally ill patients can choose as a place of end-of-life care has changed to that of diagnosing and caring for patients who do not want to be seen in public hospitals. Terminally ill patients who require intensive nursing care are disadvantaged. Providing nursing care to these patients is only possible at home through family care-givers.

CONCLUSIONS: Hospice services lack proper screening and diagnostic facilities like laboratory and x-ray. The difficulty faced by terminally ill patients in accessing care at public hospitals, means that they end up at the hospice before a diagnosis is made. The overwhelmed hospitals in a bid to reserve bed capacity refer terminally ill patients to the hospice. This has led to overloading and overstretching of hospice meagre resources. To improve hospice usage and deal with impediments, involve the community TB/HIV treatment advocates in the awareness campaigns for proper hospice usage through out-reach activities. Forming support networks for informal and family care-givers will help reduce the effects of emotional stress. Building and strengthening the human resource capacity will motivate staff as most of them work on voluntary basis.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Prevalence, Hospices, HIV Seropositivity, Health Resources, Caregivers, HIV Infections, Family, Health Services, Health Services Accessibility, Emotions, Zambia, Humans, utilization, epidemiology, nursing

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D10121