Scaling-up HIV treatment programmes in resource-limited settings:: the rural Haiti experience
Scaling-up HIV treatment programmes in resource-limited settings:: the rural Haiti experience
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DOI：
10.1097/00002030-200406003-00005
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发表时间：
2004-06-01
期刊：
影响因子：
3.8
通讯作者：
Farmer, PE
中科院分区：
文献类型：
--
作者：
Koenig, SP;Léandre, F;Farmer, PE
目的：扩大一个成功的艾滋病毒/艾滋病治疗项目，并为整个中心提供全面护理在海地农村地区（人口550000）开展了一项项目，从而表明在资源有限的情况下，以社区为基础的艾滋病毒治疗是可行和非常有效的，并成为其他国家效仿的成功模式。在海地农村地区的Departement du Centre，为任何前来寻求护理的人免费提供全面的艾滋病毒和结核病治疗。干预措施：第一年，在项目的艾滋病毒、结核病、性传播疾病、治疗和预防以及妇女保健服务综合方案的框架内，在四个地点提供高效抗逆转录病毒疗法。每个地点的医疗设施都进行了翻修，并根据需要雇用了更多的工作人员，（社区卫生工作者）在周围村庄建立，作为与社区的联系，并提供直接观察治疗（DOT）。在方案扩大的第一年，对8 000多名患者进行了艾滋病毒跟踪，1 050多名患者接受了DOT HAART治疗。对HAART的依从性非常高，临床结果非常好：所有患者的体重增加和功能能力改善，只有不到5%的患者因副作用而需要改变药物。病毒载量进行了测试，显示86%的患者的子集检测不到的病毒loads.Conclusion：艾滋病的社区护理已经非常有效，在农村海地。在资源有限的情况下，随着国际社会为艾滋病毒/艾滋病治疗提供更多的财政支助，对于最需要的人来说，获得拯救生命的高效抗逆转录病毒疗法应该没有任何障碍。(C)2004年利平科特威廉姆斯威尔金斯。
Objective: To scale-up a successful HIV/AIDS treatment project and provide comprehensive care to an entire Departement du Centre (population 550000) in rural Haiti, thereby demonstrating that community-based treatment of HIV is feasible and highly effective in resource-limited settings, and serving as a successful model for others to replicate.Participants: In the Departement du Centre of rural Haiti comprehensive HIV and tuberculosis treatment is provided free of charge to anyone who presents for care. All those who meet clinical enrolment criteria are treated with highly active antiretroviral therapy (HAART).Intervention: HAART was provided in the context of a comprehensive programme of HIV, tuberculosis (TB), sexually transmitted disease (STD) of the project, treatment and prevention, and women's health services at four sites in the first year. At each site, the medical facility was renovated, additional staff were hired as needed, and a network of accompagnateurs (community health workers) was established throughout the surrounding villages to serve as a link with the community, and to provide directly observed treatment (DOT).Results: In the first year of programme scale-up, over 8000 patients were followed for HIV, and over 1050 were treated with DOT HAART. Adherence to HAART was very high, and clinical outcomes were excellent: all patients responded with weight gain and improved functional capacity, and fewer than 5% required medication changes due to side effects. Viral load was tested among a subset of patients showing that 86% had undetectable viral loads.Conclusion: Community-based care of AIDS has been highly effective in rural Haiti. With more international financial support for HIV/AIDS treatment in resource-limited settings, there should be no barriers to access to life-saving HAART for those who need it most. (C) 2004 Lippincott Williams Wilkins.