将艾滋病服务纳入非洲初级卫生保健：莫桑比克卫生系统强化的经验教训——案例研究。

Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study.

机构信息

University of Washington Department of Global Health, Harborview Medical Center, Seattle, 98104, USA.

出版信息

J Int AIDS Soc. 2010 Jan 20;13:3. doi: 10.1186/1758-2652-13-3.

DOI:10.1186/1758-2652-13-3

PMID:20180975

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2828398/

Abstract

INTRODUCTION

In 2004, Mozambique, supported by large increases in international disease-specific funding, initiated a national rapid scale-up of antiretroviral treatment (ART) and HIV care through a vertical "Day Hospital" approach. Though this model showed substantial increases in people receiving treatment, it diverted scarce resources away from the primary health care (PHC) system. In 2005, the Ministry of Health (MOH) began an effort to use HIV/AIDS treatment and care resources as a means to strengthen their PHC system. The MOH worked closely with a number of NGOs to integrate HIV programs more effectively into existing public-sector PHC services.

CASE DESCRIPTION

In 2005, the Ministry of Health and Health Alliance International initiated an effort in two provinces to integrate ART into the existing primary health care system through health units distributed across 23 districts. Integration included: a) placing ART services in existing units; b) retraining existing workers; c) strengthening laboratories, testing, and referral linkages; e) expanding testing in TB wards; f) integrating HIV and antenatal services; and g) improving district-level management.

DISCUSSION

By 2008, treatment was available in nearly 67 health facilities in 23 districts. Nearly 30,000 adults were on ART. Over 80,000 enrolled in the HIV/AIDS program. Loss to follow-up from antenatal and TB testing to ART services has declined from 70% to less than 10% in many integrated sites. Average time from HIV testing to ART initiation is significantly faster and adherence to ART is better in smaller peripheral clinics than in vertical day hospitals. Integration has also improved other non-HIV aspects of primary health care.

CONCLUSION

The integration approach enables the public sector PHC system to test more patients for HIV, place more patients on ART more quickly and efficiently, reduce loss-to-follow-up, and achieve greater geographic HIV care coverage compared to the vertical model. Through the integration process, HIV resources have been used to rehabilitate PHC infrastructure (including laboratories and pharmacies), strengthen supervision, fill workforce gaps, and improve patient flow between services and facilities in ways that can benefit all programs. Using aid resources to integrate and better link HIV care with existing services can strengthen wider PHC systems.

摘要

简介

2004 年，在国际疾病专项资金大量增加的支持下，莫桑比克启动了国家快速扩大抗逆转录病毒治疗（ART）和艾滋病毒护理的计划，通过垂直的“日间医院”方法。尽管这种模式显示出接受治疗的人数大幅增加，但它将稀缺资源从初级卫生保健（PHC）系统中转移出来。2005 年，卫生部（MOH）开始努力利用艾滋病毒/艾滋病治疗和护理资源作为加强其 PHC 系统的手段。卫生部与一些非政府组织密切合作，以便更有效地将艾滋病毒方案纳入现有的公共部门 PHC 服务。

案例描述

2005 年，卫生部和健康联盟国际在两个省份开展了一项工作，通过分布在 23 个区的卫生单位，将 ART 纳入现有的初级卫生保健系统。整合包括：a）将 ART 服务放在现有单位；b）重新培训现有工作人员；c）加强实验室、检测和转诊联系；e）扩大结核病房的检测；f）整合艾滋病毒和产前服务；g）改善区级管理。

讨论

到 2008 年，在 23 个区的近 67 个卫生设施中提供了治疗。近 30000 名成年人接受了 ART。超过 80000 人参加了艾滋病毒/艾滋病方案。从产前和结核检测到 ART 服务的随访损失从许多整合点的 70%下降到不到 10%。从艾滋病毒检测到开始接受 ART 的平均时间明显更快，并且在较小的周边诊所中，对 ART 的依从性更好，垂直日间医院。整合也改善了初级卫生保健的其他非艾滋病毒方面。

结论

整合方法使公共部门 PHC 系统能够对更多的艾滋病毒患者进行检测，更快、更有效地为更多的患者提供 ART，减少随访损失，并与垂直模式相比，实现更大的地理艾滋病毒护理覆盖范围。通过整合过程，艾滋病毒资源被用于修复 PHC 基础设施（包括实验室和药房），加强监督，填补劳动力缺口，并改善服务和设施之间的患者流量，从而使所有方案受益。利用援助资源整合并更好地将艾滋病毒护理与现有服务联系起来，可以加强更广泛的 PHC 系统。