The Aurum Institute, Johannesburg, South Africa.
Sex Transm Infect. 2012 Mar;88(2):136-40. doi: 10.1136/sextrans-2011-050194.
The extent of the HIV epidemic in South Africa may render the public sector capacity inadequate to manage all patients requiring antiretroviral treatment (ART). Private practitioners are an underutilised resource.
The authors developed a model of care using 72 private practitioners in five provinces in urban and rural areas of South Africa with centralised clinical support, training, pharmacy control and data management. The authors describe the programme, its quality control measures and patient outcomes using a cohort analysis.
Between January 2005 and December 2008, 9102 individuals were started on ART, 62% female, median age 34 years, median viral load 50,655 copies/ml and median baseline CD4 count 123 cells/μl. Retention (alive and in care) after 12 months was 63% in the 2005 cohort (646 of 1026) and remained similar in the other calendar years, 58%, 68% and 64% in 2006, 2007 and 2008, respectively. After 36 months, retention was 50% and 41% for those enrolled in 2005 and 2006, respectively. The percentage virally suppressed remained similar at 6 months, 82% vs 84%, 84% and 85% from 2005, 2006, 2007 to 2008, respectively, p=0.66; but improved slightly at 12 months, 78% vs 83%, 83% and 84% from 2005 to 2008, p=0.05. At 36 months, it was 84% and 82% for the 2005 and 2006 cohorts, respectively.
The results show that a well-managed private practitioner model can achieve comparable results to public services, although long-term retention needs further evaluation. This model of ART delivery can be used to expand access to ART in areas where the public sector is unable to meet the demand.
南非的艾滋病毒流行程度可能使公共部门的能力不足以管理所有需要接受抗逆转录病毒治疗（ART）的患者。私人医生是一种未充分利用的资源。
作者在南非五个省份的城市和农村地区使用 72 名私人医生开发了一种护理模式，这些医生提供集中的临床支持、培训、药房控制和数据管理。作者使用队列分析描述了该方案、其质量控制措施和患者结果。
2005 年 1 月至 2008 年 12 月期间，共有 9102 人开始接受 ART 治疗，其中 62%为女性，中位年龄为 34 岁，中位病毒载量为 50655 拷贝/ml，中位基线 CD4 计数为 123 个/μl。2005 年队列中，12 个月时的保留率（存活且在治疗中）为 63%（646 例中有 626 例），在其他历年保持相似，分别为 2006 年的 58%、2007 年的 68%和 2008 年的 64%。36 个月时，2005 年和 2006 年入组患者的保留率分别为 50%和 41%。6 个月时病毒抑制率分别为 82%和 84%，从 2005 年到 2008 年分别为 84%和 85%，p=0.66；但在 12 个月时略有改善，分别为 78%和 83%，从 2005 年到 2008 年分别为 83%和 84%，p=0.05。36 个月时，2005 年和 2006 年队列的病毒抑制率分别为 84%和 82%。
结果表明，管理良好的私人医生模式可以取得与公共服务相当的结果，尽管长期保留率需要进一步评估。这种 ART 提供模式可用于扩大公共部门无法满足需求的地区获得 ART 的机会。
