A call for differentiated approaches to delivering HIV services to key populations.
A call for differentiated approaches to delivering HIV services to key populations.
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呼吁差异化方法向关键人群提供艾滋病毒服务。
DOI：
10.7448/ias.20.5.21658
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发表时间：
2017-07-21
影响因子：
6
通讯作者：
Baggaley R
中科院分区：
文献类型：
--
作者：
Macdonald V;Verster A;Baggaley R
简介：重点人群（KPs）受到艾滋病毒的严重影响，与更广泛的人群相比，他们获得艾滋病毒检测和治疗服务的比例较低。世卫组织提倡使用差别化方法，以接触金伯利进程并将其纳入艾滋病毒服务连续体。这些方法可能有助于增加接触往往被定罪或受到侮辱的金伯利进程的机会。通过满足金伯利进程每一个人的具体需要，有区别的做法可以提高服务的可接受性、质量和覆盖面，降低成本，并支持金伯利进程成员领导其社区的艾滋病毒防治工作。讨论：世卫组织建议实施以社区为基础和由非专业提供者管理的艾滋病毒检测服务。这些办法合在一起，减少了与其他检测战略有关的障碍和费用，使金伯利进程成员在艾滋病毒方案中拥有更大的自主权，并比基于设施的服务覆盖更多的人。尽管有这些证据，但对它们的可用性和支持是有限的。同行驱动的干预措施已被证明能有效地吸引、征聘和支持客户。一些方案雇用艾滋病毒抗体阳性或未感染艾滋病毒的“同伴领航员”和其他工作人员，提供病例管理、登记和/或重新登记护理和治疗服务。然而，需要更好地了解对同伴志愿人员的影响、成本效益和潜在负担。世卫组织的艾滋病毒综合治疗和金伯利进程指导方针都建议，在抗逆转录病毒疗法的开始和维持以及抗逆转录病毒药物的分发方面，应采用任务转移和非设施服务地点。这些方法在普遍流行病中被接受，并为存在成功模式的一般人群所接受;然而，很少有组织在KP社区服务中提供或启动抗逆转录病毒疗法。结论：对金伯利进程采用差别化服务办法，可使更多的人了解自己的状况，并获得有效和持续的艾滋病毒预防和治疗。然而，虽然基于社区和非专业提供者的测试是有效和负担得起的，但它们没有大规模实施。此外，在许多情况下，需要克服使非专业和同行提供者合法化的监管障碍，使其成为保健服务系统的一部分。世卫组织关于抗逆转录病毒疗法治疗和护理的任务转移和权力下放的建议往往不适用于金伯利进程。
Introduction: Key populations (KPs) are disproportionally affected by HIV and have low rates of access to HIV testing and treatment services compared to the broader population. WHO promotes the use of differentiated approaches for reaching and recruiting KP into the HIV services continuum. These approaches may help increase access to KPs who are often criminalized or stigmatized. By catering to the specific needs of each KP individual, differentiated approaches may increase service acceptability, quality and coverage, reduce costs and support KP members in leading the HIV response among their communities. Discussion: WHO recommends the implementation of community-based and lay provider administered HIV testing services. Together, these approaches reduce barriers and costs associated with other testing strategies, allow greater ownership in HIV programmes for KP members and reach more people than do facility-based services. Despite this evidence availability and support for them is limited. Peer-driven interventions have been shown to be effective in engaging, recruiting and supporting clients. Some programmes employ HIV-positive or non-PLHIV “peer navigators” and other staff to provide case management, enrolment and/or re-enrolment in care and treatment services. However, a better understanding of the impact, cost effectiveness and potential burden on peer volunteers is required. Task shifting and non-facility-based service locations for antiretroviral therapy (ART) initiation and maintenance and antiretroviral (ARV) distribution are recommended in both the consolidated HIV treatment and KP guidelines of WHO. These approaches are accepted in generalized epidemics and for the general population where successful models exist; however, few organizations provide or initiate ART at KP community-based services. Conclusions: The application of a differentiated service approach for KP could increase the number of people who know their status and receive effective and sustained prevention and treatment for HIV. However, while community-based and lay provider testing are effective and affordable, they are not implemented to scale. Furthermore regulatory barriers to legitimizing lay and peer providers as part of healthcare delivery systems need to be overcome in many settings. WHO recommendations on task shifting and decentralization of ART treatment and care are often not applied to KP settings.