HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.
HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.
复制标题
DOI：
10.1016/s0140-6736(09)60916-8
复制
发表时间：
2009-09-12
期刊：
影响因子：
168.9
通讯作者：
Lawn, Stephen D.
中科院分区：
文献类型：
--
作者：
Karim, Salim S. Abdool;Churchyard, Gavin J.;Karim, Quarraisha Abdool;Lawn, Stephen D.
种族隔离后的南非面临的最大挑战之一是控制随之而来的艾滋病毒和结核病流行病。艾滋病毒继续无情地蔓延，结核病已被宣布为全国紧急状态。2007年，南非人口占世界人口的0.7%，但艾滋病毒感染负担占全球的17%，是世界上结核病流行最严重的国家之一，加上耐药性和艾滋病毒合并感染的加剧。直到最近，南非政府对这些疾病的反应一直以否认、缺乏政治意愿以及政策和规划执行不力为特点。尽管如此，在疾病管理方面取得了显著成就，包括大大改善了获得避孕套的机会，扩大了结核病控制工作，扩大了免费抗逆转录病毒治疗。对急性艾滋病患者的护理和长期提供抗逆转录病毒治疗是主导医疗实践和卫生保健系统的两个问题。需要采取果断行动，落实控制艾滋病毒和结核病流行的循证优先事项。通过利用南非结核病和艾滋病毒/艾滋病战略计划框架，我们为结核病控制、艾滋病毒预防和艾滋病毒治疗提供了优先的四步方法。成功实施这些办法需要强有力的领导、政治意愿、社会动员、充足的人力和财政资源以及保健服务的可持续发展。
One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0·7% of the world’s population, had 17% of the global burden of HIV infection, and one of the world’s worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government’s response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.