Integrating HIV, hypertension, and diabetes primary care in Africa.
Integrating HIV, hypertension, and diabetes primary care in Africa.
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整合非洲的艾滋病毒、高血压和糖尿病初级保健。
DOI：
10.1016/s0140-6736(23)01884-6
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Peck,RobertN
中科院分区：
文献类型：
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作者：
Kisigo,GodfreyA;Peck,RobertN
然而，非洲非传染性疾病的激增有可能使防治艾滋病毒所取得的健康成果付之一篑。根据世卫组织全球卫生估计，2019年，非传染性疾病导致1700万人过早死亡，其中86%发生在低收入国家。预计到2030年，非传染性疾病将成为非洲过早死亡的最常见原因。3非洲的问题似乎再次与初级保健卫生系统有关，该系统目前在非传染性疾病方面的能力远远弱于艾滋病毒，4导致非传染性疾病的诊断、治疗和控制率低得令人不安。悲观主义者再次认为，非传染性疾病的治疗将过于复杂和昂贵。显而易见的问题是，我们可以从非洲非常成功的艾滋病毒规划中学到什么，以解决日益严重的非传染性疾病问题，我们能否在不损害艾滋病毒规划的情况下，在现有的艾滋病毒基础设施基础上解决非传染性疾病？这些问题一直在回响，但直到现在，我们还没有临床试验证据来回答这些问题。在《柳叶刀》杂志上，Sokoine Kivuyo和他的同事们报道了inter - africa的结果，8这是一项实用的针对艾滋病、糖尿病和高血压综合管理的随机分组试验。坦桑尼亚和乌干达的32个初级保健诊所被随机分配，提供综合护理或加强的标准垂直护理。在综合护理组中，
However, a dramatic wave of non-communicable diseases (NCDs) in Africa threatens to reverse the health gains made by combating HIV. According to WHO global health estimates, NCDs accounted for 17 million premature deaths in 2019, and 86% of these premature deaths occurred in lower-income countries. NCDs are projected to be the most common cause of premature death in Africa by 2030. 3 Once again, the problem in Africa appears to be related to primary care health systems, which are currently much weaker for NCDs than for HIV, 4 resulting in disturbingly low rates of diagnosis, treatment, and control for NCDs. 5 Once again, pessimists believe that NCD care will be too complicated and too costly.The obvious questions are what can be learned from the highly successful HIV programmes in Africa to address the growing problem of NCDs, and can we build on existing HIV infrastructure to address NCDs without compromising HIV programmes? These questions have been reverberating but, until now, we did not have the clinical trial evidence to answer them. 6, 7 In The Lancet, Sokoine Kivuyo and colleagues report the results of INTE-AFRICA, 8 a pragmatic cluster randomised trial of integrated management of HIV, diabetes, and hypertension. 32 primary care clinics in Tanzania and Uganda were randomly allocated to provide either integrated care or an enhanced standard vertical care. In the integrated care group,