Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
Confl Health. 2013 Dec 1;7(1):25. doi: 10.1186/1752-1505-7-25.
BACKGROUND: Widespread violence followed the 2007 presidential elections in Kenya resulting in the deaths of a reported 1,133 people and the displacement of approximately 660,000 others. At the time of the crisis the United States Agency for International Development-Academic Model Providing Access to Healthcare (USAID-AMPATH) Partnership was operating 17 primary HIV clinics in western Kenya and treating 59,437 HIV positive patients (23,437 on antiretroviral therapy (ART)). METHODS: This case study examines AMPATH's provision of care and maintenance of patients on ART throughout the period of disruption. This was accomplished by implementing immediate interventions including rapid information dissemination through the media, emergency hotlines and community liaisons; organization of a Crisis Response leadership team; the prompt assembly of multidisciplinary teams to address patient care, including psychological support staff (in clinics and in camps for internally displaced persons (IDP)); and the use of the AMPATH Medical Records System to identify patients on ART who had missed clinic appointments. RESULTS: These interventions resulted in the opening of all AMPATH clinics within five days of their scheduled post-holiday opening dates, 23,949 patient visits in January 2008 (23,259 previously scheduled), uninterrupted availability of antiretrovirals at all clinics, treatment of 1,420 HIV patients in IDP camps, distribution of basic provisions, mobilization of outreach services to locate missing AMPATH patients and delivery of psychosocial support to 300 staff members and 632 patients in IDP camps. CONCLUSION: Key lessons learned in maintaining the delivery of HIV care in a crisis situation include the importance of advance planning to develop programs that can function during a crisis, an emphasis on a rapid programmatic response, the ability of clinics to function autonomously, patient knowledge of their disease, the use of community and patient networks, addressing staff needs and developing effective patient tracking systems.
背景：2007 年肯尼亚总统选举后，暴力事件蔓延，据报道造成 1133 人死亡，约 66 万人流离失所。在这场危机发生之时，美国国际开发署学术模式提供医疗保健（USAID-AMPATH）合作伙伴在肯尼亚西部运营着 17 个初级艾滋病毒诊所，治疗着 59437 名艾滋病毒阳性患者（23437 名接受抗逆转录病毒治疗（ART））。
方法：本案例研究考察了 AMPATH 在整个混乱期间提供护理和维持接受抗逆转录病毒治疗的患者的情况。这是通过实施即时干预措施来实现的，包括通过媒体、紧急热线和社区联络人迅速传播信息；组建危机应对领导小组；迅速召集多学科小组解决患者护理问题，包括心理支持人员（在诊所和境内流离失所者（IDP）营地）；并利用 AMPATH 医疗记录系统确定错过诊所预约的接受抗逆转录病毒治疗的患者。
结果：这些干预措施使得所有 AMPATH 诊所都在预定节后开放日期后的五天内开放，2008 年 1 月有 23949 名患者就诊（之前计划就诊 23259 名），所有诊所均不间断提供抗逆转录病毒药物，在 IDP 营地治疗了 1420 名艾滋病毒患者，分发了基本生活用品，动员外展服务寻找失踪的 AMPATH 患者，并向 300 名工作人员和 632 名 IDP 营地患者提供心理社会支持。
结论：在危机情况下维持艾滋病毒护理提供方面吸取的主要经验教训包括：提前规划制定在危机期间能够运作的方案的重要性，强调快速的方案应对，诊所自主运作的能力，患者对自身疾病的了解，利用社区和患者网络，满足员工需求和开发有效的患者跟踪系统。
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