The recently announced UNAIDS 90-90-90 targets have emphasised the need to identify strategies to address the complex psychosocial challenges affecting engagement with HIV care for the 13 million people with HIV taking antiretroviral therapy (ART).1 In The Lancet HIV, Keira Lowther and colleagues2 offer compelling evidence from the TOPCare trial, showing that integrating palliative care with HIV treatment and care might be one such strategy. In a randomised controlled trial, they studied the effects of a nurse-led palliative care intervention on patient-reported pain and physical and psychological quality of life for people with HIV taking ART. Implemented in a private HIV clinic in Kenya, the intervention was designed to be feasible and scalable in routine HIV care settings, and combined nurse training and mentorship with standardised assessment of, and holistic palliative care for, patients.2 Although pain did not differ between the intervention and standard of care groups, the intervention significantly improved patient psychiatric morbidity and psychological quality of life. Patients in the intervention group also had significant improvements in the ability to share feelings and receive help for their family to plan for the future, two factors previously identified as burdensome for people with HIV in sub-Saharan Africa.3 Although TOPCare was not designed to assess the effects of integrated palliative care on HIV clinical outcomes, it does show the feasibility of palliative care integration and its effect on psychosocial wellbeing for patients taking ART...
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