The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 19: Palliative Care in Resource-Poor Settingspalliative care, and increase drug availability for the appropriate treatment of patients withcancer and AIDS. The Pain and Policy Studies Group at the University of Wisconsin is providingtechnical support to this project through its resource center to help facilitate drug availabilityfor opioids.26 picas52The United StatesThe Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is a national policyof the US government funding healthcare and support services—including counseling, homeand hospice care—for underserved and resource-poor populations affected by HIV/AIDS. 53 In1999, the Health Resources and Services Administration (HRSA) awarded five grants specificallyfor palliative care through the Special Projects of National Significance (SPNS) portion ofthis legislation. 54As part of its development assistance, the U.S. government advocates palliative care through itsLeadership and Investment for Fighting an Epidemic (LIFE) Initiative by supporting the expansionof palliative care in community-based treatment of HIV/AIDS and opportunistic infectionsalong with the innovative use of ART and TB prevention and care. USAID, the Department ofHealth and Human Services (HHS), and the Department of Defense collaborate in this $100million initiative by funding care and treatment improvements, primary prevention, and capacityand infrastructure development in 13 target countries in Africa and India. 55The United KingdomThe National Health Service (NHS) of the UK supports hospice and specialist palliative careservices, including professional educational programs. This is an evolving national policy that isworking to provide better access to care and the development of care pathways for patients withvarious diseases who can benefit from palliative care. Patients with AIDS, cancer and a widerange of other chronic illnesses are currently included in government-supported palliative careprograms. The program provides a seamless continuum of care from in-patient palliative care56, 57services to community- and home-based hospice programs.RECOMMENDATIONS■ Based on experience to date, the following recommendations may be made regarding palliativecare in resource-poor settings. 61. Governments should establish national policies and programs for HIV/AIDS palliativecare.2. Governments should ensure that HIV/AIDS-related pain relief and palliative care programsare incorporated into their existing healthcare systems; separate systems ofcare are neither necessary nor desirable.3. Governments should ensure that healthcare workers (physicians, nurses, pharmacists,or other professional groups appropriate to local needs) are adequately trained inpalliative care and pain relief.4. Governments should review their national health policies to ensure that equitablesupport is provided for programs of palliative care in the home.XIXU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 403