Galvin Michael, Evans Denise, Moolla Aneesa, Coetzee Lezanie, Maluleke Vongani, Leshabana Patricia, Miot Jacqui
Department of Psychiatry, Boston Medical Center (BMC), Boston, Massachusetts, United States of America.
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
PLOS Glob Public Health. 2024 Oct 16;4(10):e0003792. doi: 10.1371/journal.pgph.0003792. eCollection 2024.
For the last decade, South Africa has made substantial progress to control the dual HIV and TB epidemics. However, disruptions in TB and HIV treatment during the COVID-19 pandemic threatened to reverse this. This study aimed to identify adaptations in HIV and TB service delivery models in response to COVID-19 and government restrictions. This information informed the development of an online survey, which was utilized as part of a consultation exercise to further capture adaptations made to HIV/TB service delivery within the South African context. The literature review involved screening 380 titles and abstracts, identifying 30 HIV and TB studies across 19 countries, and categorizing 90 individual interventions into ten thematic areas. Common themes included interventions addressing screening, testing, diagnosis, medication collection and delivery support, and virtual models. Digital health interventions and adaptations to medication collection/delivery were reported in 38% of studies. Analysis of survey responses from 33 stakeholders in South Africa revealed that 47% of interventions targeted HIV, 11% TB, and 23% HIV/TB integrated service delivery. Most interventions (81%) were integrated into the national HIV or TB program, with implementation occurring at various levels: 39% at facility level, 35% at sub-district or district level, and 18% at provincial level. Programmatic data was available for 86% of interventions, with 50% being funded. This study demonstrated that services can be delivered in locations other than in health facilities (e.g., community-based or home-based) and that integrated services can also free up additional resources. Although studies varied, COVID-19 accelerated the adoption of differentiated service delivery (DSD) models for TB care, including multi-month dispensing (MMD) for TB preventative therapy (TPT) and TB treatment, home-based or mobile outreach screening and testing, and community pickup points (PuP) for TB medications. These initiatives had previously lagged behind HIV-focused DSD models, and it is crucial to sustain these services beyond the pandemic. To achieve universal health coverage, it will also be important to capitalize on these experiences and learn from HIV-focused DSD models so programs can deliver integrated person-centered chronic care services for TB, HIV, and non-communicable diseases.
在过去十年中，南非在控制艾滋病毒和结核病双重流行方面取得了重大进展。然而，新冠疫情期间结核病和艾滋病毒治疗的中断有可能使这一进展发生逆转。本研究旨在确定针对新冠疫情和政府限制措施，艾滋病毒和结核病服务提供模式所做的调整。这些信息为一项在线调查的开展提供了依据，该调查被用作咨询工作的一部分，以进一步了解南非境内艾滋病毒/结核病服务提供方面所做的调整。文献综述包括筛选380篇标题和摘要，确定来自19个国家的30项艾滋病毒和结核病研究，并将90项个体干预措施归类为十个主题领域。常见主题包括涉及筛查、检测、诊断、药物收集与配送支持以及虚拟模式的干预措施。38%的研究报告了数字健康干预措施以及对药物收集/配送的调整。对来自南非33名利益相关者的调查回复进行分析后发现，47%的干预措施针对艾滋病毒，11%针对结核病，23%针对艾滋病毒/结核病综合服务提供。大多数干预措施（81%）被纳入国家艾滋病毒或结核病项目，实施发生在各个层面：39%在机构层面，35%在分区或地区层面，18%在省级层面。86%的干预措施有项目数据，其中50%获得了资金支持。这项研究表明，可以在医疗机构以外的地点提供服务（例如，基于社区或居家），而且综合服务还可以释放更多资源。尽管各项研究存在差异，但新冠疫情加速了结核病护理差异化服务提供（DSD）模式的采用，包括针对结核病预防治疗（TPT）和结核病治疗的多月份配药（MMD）、居家或流动外展筛查与检测，以及结核病药物社区取药点（PuP）。这些举措此前落后于以艾滋病毒为重点的DSD模式，在疫情过后维持这些服务至关重要。为实现全民健康覆盖，利用这些经验并借鉴以艾滋病毒为重点的DSD模式也很重要，这样项目才能提供以患者为中心的结核病、艾滋病毒和非传染性疾病综合慢性病护理服务。
