美国艾滋病护理的未来。

The future of HIV care in the USA.

机构信息

Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 South Maryland Avenue MC5065, Chicago, IL 60612, USA.

出版信息

Sex Transm Infect. 2012 Mar;88(2):106-11. doi: 10.1136/sextrans-2011-050160. Epub 2011 Dec 8.

DOI:10.1136/sextrans-2011-050160

PMID:22158933

Abstract

BACKGROUND

The number of people living with HIV in the USA increased by 50% to 1.115 million persons from 1996 to 2006 and may exceed 1.5 million by 2015. The rising caseloads are straining the HIV care system, while recession and the unknown fate of health reforms are sources of uncertainty. HIV care in the USA evolved within a fragmented healthcare system. Unique community-based support and education linked to diverse multidisciplinary HIV care teams contributed to 'AIDS exceptionalism'.

OBJECTIVE

To describe HIV care in the USA in 2011 and to consider future trends.

METHODS

Literature review.

RESULTS

Though evidence for effectiveness of HIV care teams is increasing, HIV care in the USA in 2011 is severely challenged. Low reimbursements, rising caseloads and increasing care complexity are leading to clinician shortages. Access to antiretrovirals through Medicare and Medicaid is worsening, and deficiencies in AIDS Drug Assistance Programs are increasing. Durable health insurance will become available for most Americans in 2014 through new health reforms, but the likelihood of incomplete coverage, fierce political opposition and the uncertain details are reasons for concern. At the same time, recent trends in HIV epidemiology, pathogenesis and care services have reinforced the need for multidisciplinary teams with strong community linkages.

CONCLUSIONS

HIV advocates have their greatest challenge to date to ensure that the gains and lessons in HIV care learnt from the past are not lost in the transition to national health reform in the next turbulent 5 years in the USA.

摘要

背景

1996 年至 2006 年，美国的艾滋病毒感染者人数增加了 50%，达到 111.5 万人，到 2015 年可能超过 150 万人。不断增加的病例使艾滋病毒护理系统不堪重负，而经济衰退和卫生改革的前途未卜是不确定的根源。美国的艾滋病毒护理是在支离破碎的医疗保健系统中发展起来的。独特的以社区为基础的支持和教育与多样化的多学科艾滋病毒护理团队联系在一起，促成了“艾滋病的特殊性”。

目的

描述 2011 年美国的艾滋病毒护理情况，并考虑未来的趋势。

方法

文献回顾。

结果

尽管艾滋病毒护理团队有效性的证据不断增加，但 2011 年美国的艾滋病毒护理仍面临严峻挑战。低报销率、病例增加和护理复杂性增加导致临床医生短缺。通过医疗保险和医疗补助获得抗逆转录病毒药物的机会正在恶化，艾滋病药物援助计划的缺陷也在增加。2014 年，通过新的卫生改革，大多数美国人将获得持久的健康保险，但覆盖范围不完整、强烈的政治反对和不确定的细节是令人担忧的原因。与此同时，艾滋病毒流行病学、发病机制和护理服务的最新趋势加强了需要有强大社区联系的多学科团队。