Combining prevention, treatment and care: lessons from South Africa
Combining prevention, treatment and care: lessons from South Africa
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DOI：
10.1097/01.aids.0000279702.71062.52
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发表时间：
2007-07-01
期刊：
影响因子：
3.8
通讯作者：
Simcock, Julian
中科院分区：
文献类型：
--
作者：
Achmat, Zackie;Simcock, Julian
撒哈拉以南非洲现在有100多万人接受艾滋病毒治疗，随着抗逆转录病毒疗法(ART)预期寿命的预后改善，政府、公民社会和私营部门面临的中心问题肯定是：我们将如何支付医疗费用？这篇论文对长期提供有效的艾滋病毒治疗、预防和护理的必要性进行了批判性评估。令人信服的证据和道德论据表明，在基层动员和有效的治疗扫盲运动的支持下，正确结合治疗和预防政策，可以预防新的感染、挽救生命和减轻艾滋病毒/艾滋病的影响。南非艾滋病毒的流行及其抗逆转录病毒的推出提供了具有启发性的全球模板。疫情的规模、政治反应、流行病学证据和结果数据为目前仅有低水平疫情的国家提供了经验教训。在南非提供普世艺术品所需的投资将是巨大的，但现在采取行动的经济理由是令人信服的。巴西以及泰国(程度较小)的反应更加紧迫和有远见。与南非相比，它们的成功进一步证明了通过广泛获得治疗和护理来加强艾滋病毒预防工作的重要性。尽管存在这些障碍，南非还是取得了重大进展，社区一级的卫生设施记录了值得注意的治疗和坚持结果。我们的例子表明，即使在犯了悲惨的错误之后，集体行动、循证方案和持续投资仍然可以拯救生命和缓解疫情。(C)2007年，Lippincott Williams&Wilkins。
Over one million people in sub-Saharan Africa now access HIV treatment, and as the prognosis of life expectancy on antiretroviral therapy (ART) improves, the central question that arises for governments, civil society and the private sector must be: how will we pay for the healthcare costs?This paper critically evaluates the need to provide effective treatment, prevention and care for HIV over the long term. Compelling evidence and moral argument suggest that the right combination of treatment and prevention policies, bolstered by grassroots mobilization and effective treatment literacy campaigns, can prevent new infections, save lives and mitigate the impact of HIV/AIDS.South Africa's HIV epidemic and its antiretroviral roll-out provide instructive global templates. The scale of the epidemic, the political responses, the epidemiological evidence and the outcomes data are lessons for countries where there is only a low-level epidemic at present. The investment needed to provide universal ART in South Africa will be substantial, but the economic rationale to act now is compelling.Brazil and to a lesser extent Thailand have responded with increased urgency and foresight. When compared with South Africa, their successes lend further credence to the importance of augmenting HIV prevention efforts with widespread access to treatment and care. Despite the obstacles, important gains have been made in South Africa, with community level health facilities documenting noteworthy treatment and adherence results. Our example suggests that even after tragic mistakes have been made, collective action, evidence-informed programmes, and sustained investment can still save lives and mitigate the epidemic. (c) 2007 Lippincott Williams & Wilkins.