HIV, Tuberculosis, and Noncommunicable Diseases: What Is Known About the Costs, Effects, and Cost-effectiveness of Integrated Care?
HIV, Tuberculosis, and Noncommunicable Diseases: What Is Known About the Costs, Effects, and Cost-effectiveness of Integrated Care?
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DOI：
10.1097/qai.0000000000000254
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发表时间：
2014-09-01
影响因子：
3.6
通讯作者：
Freedberg, Kenneth A.
中科院分区：
文献类型：
--
作者：
Hyle, Emily P.;Naidoo, Kogieleum;Freedberg, Kenneth A.
对低收入和中等收入国家卫生系统的空前投资使800多万人接受了抗逆转录病毒治疗。这些人的生存率大大提高，但患上常见非传染性疾病的风险也越来越大。整合艾滋病毒、其他传染病和非传染性疾病的临床护理可以使卫生服务更有效，并提供更大的价值。成本效益分析是一种评估与不同医疗保健干预措施相关的临床效益和成本的方法，并为投资和扩大规模的优先次序提供指导，特别是在资源日益受限的情况下。我们首先研究结核病和艾滋病毒作为综合护理的一个例子，已经成功地在几个低收入国家实施;然后我们审查了有关宫颈癌和抑郁症的2个非传染性疾病的例子，其中综合护理与艾滋病毒服务可以提供很好的价值发表的文献。综合服务的好处的直接证据一般仍然很少;然而，数据表明，通过将额外的服务与现有的艾滋病毒临床护理相结合，可以提高效率和降低成本。进一步调查低收入国家艾滋病毒感染者的非传染性疾病的临床结果和护理费用，将有助于了解负担能力和实施综合办法，从而有助于确定具体保健服务的优先次序。
Unprecedented investments in health systems in low-and middle-income countries (LMICs) have resulted in more than 8 million individuals on antiretroviral therapy. Such individuals experience dramatically increased survival but are increasingly at risk of developing common noncommunicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different health care interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as 1 example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as 2 examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV in LMICs will help to prioritize specific health care services by contributing to an understanding of the affordability and implementation of an integrated approach.