Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings-insights from South Africa
Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings-insights from South Africa
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DOI：
10.3945/ajcn.111.019075
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发表时间：
2011-12-01
影响因子：
7.1
通讯作者：
Bradshaw, Debbie
中科院分区：
文献类型：
--
作者：
Levitt, Naomi S.;Steyn, Krisela;Bradshaw, Debbie
撒哈拉以南非洲正在经历多重疾病负担。非传染性疾病正在出现，其风险因素随着生活方式的改变和城市化速度的提高而变得更加普遍。与此同时，传染病的流行持续存在，艾滋病毒/艾滋病已在该区域扎根，尽管最近的数据表明艾滋病毒新感染率有所下降。由于使用糖尿病作为非传染性疾病的标志，据估计，尽管艾滋病毒/艾滋病流行，但糖尿病患者的人数在2000年至2010年期间仍将增加，这主要是因为南非人口老龄化和糖尿病风险因素增加。鉴于艾滋病毒/艾滋病死亡率下降，抗逆转录病毒疗法的推广及其伴随的代谢并发症使预期寿命延长，这些数字可能会进一步增加。鉴于接受治疗的艾滋病毒/艾滋病已成为一种慢性病，接受抗逆转录病毒治疗的人的医疗保健需求与非传染性疾病患者的医疗保健需求相似，并鉴于当卫生系统资源不足和紧张时，垂直项目难以维持，因此有充分的理由整合慢性病患者的初级护理，无论是非传染性疾病还是传染病。需要进行试点研究，以检验根据世卫组织慢性病创新护理模式，以互惠方式从卫生设施向社区提供综合服务的可行性。这些将开始提供决策者需要改变卫生保健提供模式的证据。美国临床营养杂志2011;94（增刊）：1690 S-6S。
Sub-Saharan Africa is experiencing a multiple disease burden. Noncommunicable diseases (NCDs) are emerging, and their risk factors are becoming more common as lifestyles change and rates of urbanization increase. Simultaneously, epidemics of infectious diseases persist, and HIV/AIDS has taken hold in the region, although recent data indicate a decrease in new HIV infection rates. With the use of diabetes as a marker for NCDs, it was estimated that the number of people with diabetes would rise between 2000 and 2010 despite the HIV/AIDS epidemic, largely because of the aging of the population and the increase in risk factors for diabetes in South Africa. These numbers are likely to increase further, given the declining HIV/AIDS mortality rates and longer life expectancy due to the up-scaling of antiretroviral therapy (ART), with its concomitant metabolic complications. Given that treated HIV/AIDS has become a chronic disease, and the health care needs of people on ART resemble those of people with NCDs, and given that vertical programs are difficult to sustain when health systems are underresourced and strained, there is a powerful argument to integrate the primary level care for people with chronic diseases, whether they be NCDs or infectious diseases. Pilot studies are required to test the feasibility of an integrated service that extends from health facilities into the community in a reciprocal manner based on the WHO Innovative Care for Chronic Conditions model of care. These will begin to provide the evidence that policy makers need to change the mode of health care delivery. Am J Clin Nutr 2011;94(suppl):1690S-6S.