Integrated HIV prevention and care strengthens primary health care:: Lessons from rural Haiti
Integrated HIV prevention and care strengthens primary health care:: Lessons from rural Haiti
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DOI：
10.1057/palgrave.jphp.3190013
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发表时间：
2004-01-01
影响因子：
3.8
通讯作者：
Mukherjee, JS
中科院分区：
文献类型：
--
作者：
Walton, DA;Farmer, PE;Mukherjee, JS
三十年前，世界各国卫生部宣布初级卫生保健--提供基本预防和治疗服务--为首要任务。然而，自那时以来，世界上最贫穷的国家没有达到大多数初级卫生保健目标。在《阿尔玛·阿拉宣言》发表26年后，据说我们生活在一个“资源有限”的时代，这个短语将各种卫生干预措施解释为相互竞争的优先事项。由于艾滋病毒已成为世界大部分地区成人死亡的主要传染病原因，很难辩称艾滋病预防和护理不是初级卫生保健的优先事项，但正是这种观点在国际卫生政策制定者中占据了主导地位。我们将介绍一项已建立的综合艾滋病预防和护理计划的规模所产生的新信息，该计划最初设在海地中部的一个棚户区，现已扩展到海地农村的第二个地点。该方案包括强有力的预防工作以及以社区为基础的晚期艾滋病治疗；三个相关部分--妇女健康和活动性病例发现以及结核病和性传播感染的治疗--是这项工作的核心。在海地中部的一家公立诊所推出这些服务后的14个月里，我们跟踪了关键指数的变化。我们发现，在资源匮乏的情况下，包括使用抗逆转录病毒药物在内的综合艾滋病预防和护理是可行的，这种努力可能会对一些初级卫生保健目标产生有利和容易衡量的影响，包括接种疫苗、计划生育、结核病病例发现和治疗以及健康促进。其他附带好处虽然不那么容易衡量，但包括提高了工作人员的士气，增强了对公共卫生和医药的信心。我们的结论是，改进艾滋病的预防和治疗有助于重振旨在促进普及初级卫生保健的日渐衰弱的努力。
Three decades ago, the world's ministries of health declared primary health care-the delivery of basic preventive and curative services-a top priority. Since then, however, the world's poorest countries have not met most primary health care goals. Twenty-six years after the Declaration of Alma Ara, we are said to be living in a time of "limited resources," a phrase that construes various health interventions as competing priorities. As HIV has become the leading infectious cause of adult death in much of the world, it is difficult to argue that AIDS prevention and care are not ranking priorities for primary health care, yet precisely such arguments have held sway among international health policy makers. We present new information emerging from the scale-up of an established and integrated AIDS prevention-and-care program, based initially in a squatter settlement in central Haiti, to a second site in rural Haiti. The program includes robust prevention efforts as well as community-based therapy for advanced AIDS; three related components-women's health and active case finding and therapy for tuberculosis and sexually transmitted infections-were central to this effort. We tracked changes in key indices over the 14 months following the introduction of these services to a public clinic in central Haiti. We found that integrated AIDS prevention and care, including the use of antiretroviral agents, to be feasible in resource-poor settings and that such efforts may have favorable and readily measured impact on a number of primary health care goals, including vaccination, family planning, tuberculosis case finding and cure, and health promotion. Other collateral benefits, though less readily measured, include improved staff morale and enhanced confidence in public health and medicine. We conclude that improving AIDS prevention and treatment can help to reinvigorate flagging efforts to promote universal primary health care.