Ensuring HIV care to undocumented migrants in Israel: a public-private partnership case study
Ensuring HIV care to undocumented migrants in Israel: a public-private partnership case study
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DOI：
10.1186/s13584-019-0350-4
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发表时间：
2019-11-13
影响因子：
4.5
通讯作者：
Gamzu, Ronni
中科院分区：
文献类型：
--
作者：
Chemtob, Daniel;Rich, Rivka;Gamzu, Ronni
背景以色列的无证移民大多来自艾滋病毒流行国家，不属于以色列全民医疗保险的覆盖范围。我们启动了公私伙伴关系（PPP），以应对这一公共卫生和人道主义挑战。公私伙伴关系企业包括卫生部、制药公司、药房和专门的艾滋病毒诊所、以色列艾滋病毒医学会（来自以色列医学协会）和非政府组织。本研究介绍了国家政策过程中的概念化和实施无证移民通过PPP获得艾滋病毒服务，并分析了初步结果。方法本案例研究介绍了建立一个临时的公私合作伙伴关系，提供艾滋病毒护理的无证移民的基础上，结核病和艾滋病（DTA）和记忆和合作伙伴的反思的机构记录的过程。根据经合组织-发援会的发展援助标准（相关性、有效性、效率、可持续性和影响）对这一案例进行了分析。收集了2014年至2018年期间转诊患者的人口统计学和血清学数据，以监测进展。并分析初步的医学和生物学结果获得了卫生部的伦理批准。制定一项将艾滋病毒护理扩大到无证移民的政策是一个15年的过程，在以色列和国际话语中面临着一些挑战，特别是关于政府对移民危机的反应。使用涉及众多利益攸关方的公私伙伴关系模式提供了一个坚实的地方可行性证明，将艾滋病毒护理作为一项政策扩大将对以色列的公共卫生产生积极影响。在该方案的头两年（2014-2015年），卫生部资助了医疗后续行动，制药公司在任何时候都只为100名患者免费提供抗逆转录病毒治疗，此外，卫生部还为孕妇提供抗逆转录病毒治疗。自2016年以来，卫生部已全面覆盖这项服务，并将其纳入以色列卫生系统;这是PPP计划的主要成功之处。截至2018年12月，该国家项目已监测了350名患者，治疗了316名（90.3%）。转诊时最常见的疾病是结核病。结论据我们所知，这项研究记录了第一个成功的公私伙伴关系的例子，在一个高收入国家的政府伙伴关系，以解决无证移民缺乏获得卫生服务，特别是艾滋病毒护理。鉴于北南移徙加剧，以色列的这一案例研究对面临类似挑战的其他国家可能有用。它在以色列也有教训，因为该国正在努力解决未保险社区的其他健康问题。
Background Undocumented migrants in Israel, mostly originating from HIV endemic countries, are not covered by Israel's universal healthcare coverage. We initiated a Public-Private Partnership (PPP) to handle this public health and humanitarian challenge. The PPP venture included the Ministry of Health (MoH), pharmaceutical companies, pharmacies, and specialized HIV clinics, the Israeli HIV Medical Society (from the Israel Medical Association), and non-governmental organizations. This study describes the national policy process in conceptualizing and implementing access to HIV services for undocumented migrants through a PPP, and analyzes the preliminary results. Methods This case study describes the process of creating a temporary Public-Private Partnership to provide HIV care for undocumented migrants based on institutional records of the Department of Tuberculosis and AIDS (DTA) and memories and reflections from partners. This case was analyzed according to the OECD-DAC criteria for development assistance (relevance, effectiveness, efficiency, sustainability and impact). Demographic and serological data of patients referred between 2014 to 2018 were collected to monitor progress. and analyze preliminary medical and biological outcomes. Ethical approval was obtained from the Ministry of Health. Results Creating a policy to extend HIV care to undocumented migrants was a 15 year process that confronted several challenges within Israeli and international discourse, particularly concerning governmental response to the migration crisis. The use of a PPP model involving numerous stakeholders provided a solid, local feasibility demonstration that extending HIV care as a matter of policy would have positive implications for public health in Israel. During the first 2 years of the program (2014-2015), the MoH funded medical follow-up and the pharmaceutical companies provided antiretroviral treatment (ART) free of charge for only 100 patients at any given time, in addition to ART provided by the MoH for pregnant women. Since 2016, the MoH has fully covered this service and integrated it within the Israeli health system; this constitutes the major success of the PPP program. As of December 2018, the national program has monitored 350 patients and treated 316 (90.3%). The most prevalent disease present upon referral was Tuberculosis. Conclusions To our knowledge, this study documents the first example of a successful PPP with government partnership in a high-income country to address undocumented migrants' lack of access to health services in general and HIV care in particular. In light of the intensification of North-South migration, this Israeli case study could be useful for other countries facing similar challenges. It also has lessons within Israel, as the country grapples with other health problems among uninsured communities.