喀麦隆曼菲卫生区的以医疗机构为基础的社区方法：复杂人道主义环境下的差异化服务提供选择。

Facility-led community based approach in Mamfe health district, Cameroon: a differentiated service delivery option in complex humanitarian settings.

机构信息

Family Health International 360, Bafoussam, Cameroon.

Cameroon Baptist Convention Health Services, Bamenda, Cameroon.

出版信息

BMC Health Serv Res. 2023 Apr 3;23(1):334. doi: 10.1186/s12913-023-09323-9.

DOI:10.1186/s12913-023-09323-9

PMID:37013576

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10069350/

Abstract

BACKGROUND

The government of Cameroon's 2017 operational guidelines for the implementation of the "test and treat" strategy expressly incorporates and prescribes the differentiated service delivery (DSD) model with testing and treatment services being decentralized and task shifted at community level. However, express guidance on DSD approach in conflict situations, characterized by pressure on existing health systems remains a limitation. The outbreak of COVID-19 further confounded humanitarian responses for fear of spread. Facility-led community-based approach (FLCBA) was employed as a model of care in addressing DSD for HIV in conflict-affected settings within the COVID-19 context.

METHODS

A retrospective quantitative cross-sectional study was conducted in Mamfe District Hospital. Descriptive statistics was used to evaluate the implementation of FLCBA as a DSD model from April 2021 to June 2022 along the clinical cascades. Data were collected using a chart abstraction template from the respective registers. Analyses were done using Microsoft excel 2010.

RESULTS

In 15 months, a total number of 4707 (2142 males, 2565 females) people were screened for HIV and 3795 (1661 males, 2134 females) eligible individuals were tested. Out of the 11 targeted health areas, 208 (5.5%) new positive cases were identified, all (100%) of whom were linked to care and treatment. During this period, 61% (34/55) targeted missing clients were tracked through this means among which 31 were defaulters and 3 LTFU. Of the 196 target clients for FLCBA, eligible for viral load sample collection, 142 (72%) samples were collected.

CONCLUSIONS

The FLCBA as an integral primary health care delivery package is an efficient and effective variant of DSD for conflict settings; however it requires bravery of health care providers.

摘要

背景

2017 年，喀麦隆政府实施“检测即治疗”策略的业务准则明确纳入并规定了差异化服务交付（DSD）模式，将检测和治疗服务下放到社区一级。然而，在以现有卫生系统压力为特征的冲突情况下，有关 DSD 方法的明确指导仍然存在局限。由于担心传播，新冠疫情的爆发使人道主义应对措施更加复杂。在新冠疫情背景下，在受冲突影响的环境中，针对艾滋病毒，采用以设施为基础的社区方法（FLCBA）作为一种护理模式来解决 DSD 问题。

方法

在曼菲地区医院进行了一项回顾性定量横断面研究。使用描述性统计方法评估了 2021 年 4 月至 2022 年 6 月期间，沿着临床流程实施 FLCBA 作为 DSD 模型的情况。使用从相应登记册中提取的图表模板收集数据。使用 Microsoft excel 2010 进行分析。

结果

在 15 个月中，共有 4707 人（2142 名男性，2565 名女性）接受了艾滋病毒筛查，3795 名（1661 名男性，2134 名女性）符合条件的人接受了检测。在所涉及的 11 个目标卫生地区中，发现了 208 例（5.5%）新的阳性病例，所有（100%）新阳性病例均已转介至护理和治疗。在此期间，通过这种方式追踪到 61%（34/55）目标失踪客户，其中 31 人是逃兵，3 人是失访。在 196 名符合病毒载量样本采集条件的 FLCBA 目标客户中，采集了 142 份（72%）样本。