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PEPFAR Implementation: Progress and Promise
PEPFAR’s Definition of Palliative Care
PEPFAR defines palliative care as:
… patient and family-centered care [which] optimizes the quality of life of adults and children living with HIV though the active anticipation, prevention, and treatment of pain, symptoms and suffering from the onset of HIV diagnosis through death. It also provides the routine monitoring that is essential to determine the optimal time to initiate ART, but continues during and after the initiation of treatment. [It] includes and goes beyond medical management of infections, neurological, or oncological complications of HIV/AIDS to comprehensively address symptoms and suffering throughout the continuum of HIV disease. Routine, confidential counseling and testing is an essential component of palliative care to identify those who need or will need palliative care, family members who could also be infected and in need of care, and family members and partners not infected and in need of prevention.
SOURCE: OGAC, 2006d, p. 3.
is consistent with the WHO standard with several exceptions, the most significant of which are in the domain of clinical care. WHO includes both antiretroviral therapy (ART) and services to prevent mother-to-child transmission of HIV in the clinical care domain. By contrast, OGAC includes in that domain only routine follow-up to determine the best timing for initiation of ART, placing ART itself in PEPFAR’s treatment category, and includes services to prevent mother-to-child transmission in the prevention category. In addition, pain management and prevention/management of opportunistic infections are funded under PEPFAR’s care category, but are placed operationally under the treatment category. The Committee was unable to determine whether this creates challenges to ensuring that these services are a consistent part of home-based care and programs. OGAC also supports voluntary counseling and testing activities with funds from the care category, but the Leadership Act places these activities in the prevention category (OGAC, 2004). One last difference is what WHO describes as the domains of “socioeconomic care” and “human rights and legal support.” It appears that PEPFAR combines these activities into one domain that it calls “social care.” Table 6-1 shows a comparison of the WHO and PEPFAR definitions of comprehensive care; the types of providers for the services listed are shown in parentheses if they are identified.
PEPFAR divides care services into three budgeting and reporting subcategories: (1) routine care for HIV/AIDS and care for tuberculosis (TB),