An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era
An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era
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DOI：
10.1007/s11524-011-9552-y
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发表时间：
2011-06-01
影响因子：
6.6
通讯作者：
Selwyn, Peter A.
中科院分区：
文献类型：
--
作者：
Chu, Carolyn;Selwyn, Peter A.
自艾滋病开始流行以来，艾滋病毒护理模式需要随着患者和社区需求的变化而发明或修改。在这一流行病初期，初级保健和姑息治疗占主导地位;随后，艾滋病毒感染的有效治疗方法的出现导致进一步专业化，并将重点放在日益复杂的抗逆转录病毒治疗上，以此作为艾滋病毒有效护理的基石。在过去的十年里，包括（1）老龄化、长寿人口在内的因素;（2）多种合并症;（3）多药治疗;（4）慢性病管理的需要导致需要进一步发展艾滋病毒护理模式。此外，地理扩散;在及时的艾滋病毒诊断、治疗获得和结果方面持续存在的差距，以及艾滋病毒提供者队伍的老龄化，也表明了在当今时代将初级保健提供者重新纳入艾滋病毒护理范围的重要性。虽然一些专门的艾滋病毒治疗中心提供全面的医疗服务，其他模式的艾滋病毒护理可能存在，并应开发和评估。特别是，初级保健和社区为基础的合作实践，其中艾滋病毒专家或专家被纳入现有的卫生中心，是一种方法，结合了艾滋病毒的具体专业知识和综合初级保健的好处，使用一个综合的，以病人为中心的方法。
Since the beginning of the AIDS epidemic, models of HIV care have needed to be invented or modified as the needs of patients and communities evolved. Early in the epidemic, primary care and palliative care predominated; subsequently, the emergence of effective therapy for HIV infection led to further specialization and a focus on increasingly complex antiretroviral therapy as the cornerstone of effective HIV care. Over the past decade, factors including (1) an aging, long-surviving population; (2) multiple co-morbidities; (3) polypharmacy; and (4) the need for chronic disease management have led to a need for further evolution of HIV care models. Moreover, geographic diffusion; persistent disparities in timely HIV diagnosis, treatment access, and outcomes; and the aging of the HIV provider workforce also suggest the importance of reincorporating primary care providers into the spectrum of HIV care in the current era. Although some HIV-dedicated treatment centers offer comprehensive medical services, other models of HIV care potentially exist and should be developed and evaluated. In particular, primary care- and community-based collaborative practices-where HIV experts or specialists are incorporated into existing health centers-are one approach that combines the benefits of HIV-specific expertise and comprehensive primary care using an integrated, patient-centered approach.