Integrating tuberculosis and HIV care in the primary care setting in South Africa
Integrating tuberculosis and HIV care in the primary care setting in South Africa
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DOI：
10.1111/j.1365-3156.2004.01259.x
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发表时间：
2004-06-01
影响因子：
3.3
通讯作者：
Boelaert, M
中科院分区：
文献类型：
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作者：
Coetzee, D;Hilderbrand, K;Boelaert, M
背景在包括南非在内的许多国家，日益严重的人类免疫缺陷病毒(HIV)和结核病(TB)疫情对本已薄弱的公共卫生服务产生了重大影响。本文回顾了南非凯耶利沙提供抗逆转录病毒治疗的初级保健环境中艾滋病毒和结核病服务的范围、流程和绩效，以评估是否需要某种形式的整合。方法通过对服务的观察以及对关键人物的个人和团体访谈来评估这两项服务的范围和流程。结果结核病服务的目标是在涂阳患者中达到85%的治愈率，而HIV服务对HIV患者有更全面的方法。结核病服务是高度标准化的既定方案的一部分。艾滋病毒服务正处于试点阶段。这两个服务的负荷都很大，而且两个服务之间有很大程度的交叉转介。我们可以从每项服务中吸取教训。存在活动重叠、服务重复和工作人员利用不足的情况。在结核病和艾滋病毒的预防、诊断和管理方面错失了机会。结论这项研究表明，整合艾滋病毒和结核病服务可能是有好处的。对这一过程的制约因素进行了讨论。
BACKGROUND In many countries including South Africa, the increasing human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have impacted significantly on already weakened public health services. This paper reviews the scope, process and performance of the HIV and TB services in a primary care setting where antiretroviral therapy is provided, in Khayelitsha, South Africa, in order to assess whether there is a need for some form of integration.METHODS The scope and process of both services were assessed through observations of the service and individual and group interviews with key persons. The performance was assessed by examining the 2001-2002 reports from the health information system and clinical data.RESULTS The TB service is programme oriented to the attainment of an 85% cure rate amongst smear-positive patients while the HIV service has a more holistic approach to the patient with HIV. The TB service is part of a well-established programme that is highly standardized. The HIV service is in the pilot phase. There is a heavy load at both services and there is large degree of cross-referral between the two services. There are lessons that can be learnt from each service. There is an overlap of activities, duplication of services and under-utilization of staff. There are missed opportunities for TB and HIV prevention, diagnosis and management.CONCLUSIONS The study suggests that there may be benefits to integrating HIV and TB services. Constraints to this process are discussed.