Igumbor Jude, Pascoe Sophie, Rajap Shuabe, Townsend Wendy, Sargent John, Darkoh Ernest
Research and Development Department, BroadReach Healthcare, Cape Town, South Africa.
Operations Department, BroadReach Healthcare, Cape Town, South Africa.
PLoS One. 2014 Oct 20;9(10):e110635. doi: 10.1371/journal.pone.0110635. eCollection 2014.
The increasing number of people requiring HIV treatment in South Africa calls for efficient use of its human resources for health in order to ensure optimum treatment coverage and outcomes. This paper describes an innovative public-private partnership model which uses private sector doctors to treat public sector patients and ascertains the model's ability to maintain treatment outcomes over time.
The study used a retrospective design based on the electronic records of patients who were down-referred from government hospitals to selected private general medical practitioners (GPs) between November 2005 and October 2012. In total, 2535 unique patient records from 40 GPs were reviewed. The survival functions for mortality and attrition were calculated. Cumulative incidence of mortality for different time cohorts (defined by year of treatment initiation) was also established.
The median number of patients per GP was 143 (IQR: 66-246). At the time of down-referral to private GPs, 13.8% of the patients had CD4 count <200 cell/mm(3), this proportion reduced to 6.6% at 12 months and 4.1% at 48 months. Similarly, 88.4% of the patients had suppressed viral load (defined as HIV-1 RNA <400 copies/ml) at 48 months. The patients' probability of survival at 12 and 48 months was 99.0% (95% CI: 98.4%-99.3%) and 89.0% (95% CI: 87.1%-90.0%) respectively. Patient retention at 48 months remained high at 94.3% (95% CI: 93.0%-95.7%).
The study findings demonstrate the ability of the GPs to effectively maintain patient treatment outcomes and potentially contribute to HIV treatment scale-up with the relevant support mechanism. The model demonstrates how an assisted private sector based programme can be effectively and efficiently used to either target specific health concerns, key populations or serve as a stop-gap measure to meet urgent health needs.
在南非，需要接受艾滋病治疗的人数不断增加，这就要求有效利用其卫生人力资源，以确保最佳的治疗覆盖率和治疗效果。本文介绍了一种创新的公私合作伙伴关系模式，该模式利用私立部门医生为公立部门患者提供治疗，并确定该模式随时间推移维持治疗效果的能力。
该研究采用回顾性设计，基于2005年11月至2012年10月期间从政府医院转诊至选定的私立普通医生（全科医生）的患者电子记录。总共审查了来自40名全科医生的2535份独特患者记录。计算了死亡率和失访率的生存函数。还确定了不同时间队列（由开始治疗年份定义）的累积死亡率。
每位全科医生的患者中位数为143名（四分位距：66 - 246）。转诊至私立全科医生时，13.8%的患者CD4细胞计数<200个/立方毫米，这一比例在12个月时降至6.6%，在48个月时降至4.1%。同样，48个月时88.4%的患者病毒载量得到抑制（定义为HIV - 1 RNA<400拷贝/毫升）。患者在12个月和48个月时的生存概率分别为99.0%（95%置信区间：98.4% - 99.3%）和89.0%（95%置信区间：87.1% - 90.0%）。48个月时患者留存率仍高达94.3%（95%置信区间：93.0% - 95.7%）。
研究结果表明，全科医生有能力有效维持患者的治疗效果，并在相关支持机制下可能有助于扩大艾滋病治疗规模。该模式展示了一个基于私立部门的辅助项目如何能够有效且高效地用于针对特定的健康问题、关键人群，或作为满足紧急健康需求的临时措施。
