**13. Establishing palliative care programme**

The World Health Organization recommends three important programmes for effective national palliative care programme such as policies, education, and availability of drugs. Government policies must be placed to support palliative care. For the healthcare providers and other concerned palliative care, education must be available. Finally, for the management of pain and other symptoms, appropriate medications must be available. These three programmes are essential for establishing palliative care programmes [9, 15].

## **14. Palliative care policies**

The World Health Organization recommends that all countries should adopt a national palliative care policy, ensure the training and education of health professionals, ensure the availability of morphine in all healthcare settings, and ensure standards for pain relief and palliative care are progressively adopted at all levels of care [6, 7]. Therefore, palliative care programme should be an integral part of the national healthcare system [HIV care and treatment]. The presence of appropriate policy helps to solve existing obstacle, access drugs, and facilitate for resource and funding. Public health approach is a key approach of national plan that can be established through home care and community support [3, 9].

Policies can be generated from various levels of government and public and private institutions, such as medical and nursing schools, public and private healthcare facilities, and community-based organisations [6, 7]. Key actions for policy development include:


#### **15. Palliative care training and education**

Palliative care training and education should be an integral part of nursing and medical schools. Educated healthcare providers can provide better palliative care. There should be also continuous professional development on the area of palliative care for caregivers. Its effectiveness for people living with HIV depends on the providers' skills and is only as good as the skills of its providers. Therefore, palliative care training and education helps its implementation in an effective way [9, 14]. The training programme of palliative care should address three areas: [1] attitudes, beliefs, and values, [2] knowledge base, and [3] skills [15].

The best training includes hands-on clinical experience under the supervision of a skilled professional who serves as a mentor and guides colleagues in every aspect of palliative care ranging from symptom management, especially pain control, to the art of listening. Healthcare professionals should get interdisciplinary training which also provides them an opportunity for establishing a team that helps them understand and respect each other. Training and education will avoid misconception about palliative care especially regarding pain management [9].

#### **16. Presence of drugs for palliative care**

Drugs used for HIV pain and other symptom managements should be available and regulated by government policies. The drug list for palliative care in HIV is

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**Author details**

pessaries [20].

**17. Conclusion**

Habtamu Abera Areri

University, Ethiopia

provided the original work is properly cited.

palliative care for people living with HIV.

*Palliative Care in HIV/AIDS*

*DOI: http://dx.doi.org/10.5772/intechopen.85847*

all the time to patients suffering from pain [9, 14].

basic and short, and it can be found on any country's essential drug list. However, availability of these drugs for palliative care may be hindered by government policies regulating controlled substances such as opioids for distributing and dispensing the drugs. Palliative care professional should also advocate for legislative or regulatory changes at all level to make appropriate drugs because some of the drugs may not be legal in some countries, for instance, opioids. Procedural barriers may also need to be overcome for drugs to people living with HIV. However, drug availability is not only dependent on appropriate policy and efficient procedures, but also there should be policy for efficient way of utilisation, and the drugs should be available

Symptom control medications in palliative care that include essential medications for opportunistic infections in each health facility are as follows: [1] for pain management paracetamol, aspirin, ibuprofen, tramadol, morphine liquid, and dexamethasone and [2] for other symptom managements amitriptyline, diazepam, phenobarbitone, metoclopramide, chlorpromazine, ORS, co-trimoxazole, flucloxacillin, fluconazole, acyclovir, clotrimazole 1% cream, and nystatin suspension and

Palliative care is critically important for people living with HIV to lead better quality of life. It helps them manage pain and other symptoms, the complex drug treatments, and psychosocial impacts and helps the patients self-manage. Therefore, care providers need to be educated on palliative care and have favouring attitude to implement it. HIV is becoming a long-term health effect with many concerns. Therefore, people living with this condition need compressive palliative care to address psychosocial and spiritual concerns and improve quality of life. The courses designed for healthcare providers should consist of palliative care related to HIV, and training should be given for families and friends of people living with HIV for better support. There should be in place policy to enforce the implementation of

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

School of Nursing and Midwifery, College of Health Sciences, Addis Ababa

\*Address all correspondence to: habtamu.abera64@gmail.com

#### *Palliative Care in HIV/AIDS DOI: http://dx.doi.org/10.5772/intechopen.85847*

basic and short, and it can be found on any country's essential drug list. However, availability of these drugs for palliative care may be hindered by government policies regulating controlled substances such as opioids for distributing and dispensing the drugs. Palliative care professional should also advocate for legislative or regulatory changes at all level to make appropriate drugs because some of the drugs may not be legal in some countries, for instance, opioids. Procedural barriers may also need to be overcome for drugs to people living with HIV. However, drug availability is not only dependent on appropriate policy and efficient procedures, but also there should be policy for efficient way of utilisation, and the drugs should be available all the time to patients suffering from pain [9, 14].

Symptom control medications in palliative care that include essential medications for opportunistic infections in each health facility are as follows: [1] for pain management paracetamol, aspirin, ibuprofen, tramadol, morphine liquid, and dexamethasone and [2] for other symptom managements amitriptyline, diazepam, phenobarbitone, metoclopramide, chlorpromazine, ORS, co-trimoxazole, flucloxacillin, fluconazole, acyclovir, clotrimazole 1% cream, and nystatin suspension and pessaries [20].
