Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review
Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review
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DOI：
10.1080/09540121.2017.1344350
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发表时间：
2018-01-01
影响因子：
1.7
通讯作者：
Perel, Pablo
中科院分区：
文献类型：
--
作者：
Haldane, Victoria;Legido-Quigley, Helena;Perel, Pablo
非传染性疾病，包括心血管疾病、高血压和糖尿病以及艾滋病毒感染，是全世界主要的公共卫生问题。针对艾滋病毒和非传染性疾病的卫生服务需要能够满足人们长期护理需求的卫生系统，这为协调努力和在造福艾滋病毒和/或艾滋病感染者和非传染性疾病感染者的方案之间创造协同增效提供了机会。这项审查包括报告艾滋病毒和/或艾滋病与冠心病，慢性心血管疾病，脑血管疾病（中风），高血压或糖尿病的服务整合的研究。我们检索了从成立到2015年10月的多个数据库。文章由两名评审员独立筛选，并评估偏倚风险。11，057条记录被识别，重复删除后有7，616条。在筛选标题和摘要后，14篇涉及17种不同干预措施的论文符合纳入标准。我们按疾病对整合模式进行了分类（艾滋病毒与糖尿病、艾滋病毒与高血压和糖尿病、艾滋病毒与心血管疾病，最后是艾滋病毒与高血压、心血管疾病和糖尿病）。模型还着眼于从微观（以患者为中心的集成）到宏观（系统级集成）的集成。大多数报告说，高血压和糖尿病与艾滋病毒和艾滋病服务相结合，并介绍了多学科合作，共享协议，并将筛查活动纳入社区运动。整合只发生在中间一级，没有描述微观或宏观一级的整合。大多数是描述性研究，其中一项队列研究报告了评价性结局。确定了几项创新举措，研究表明，心血管疾病和艾滋病毒服务一体化是可行的。一体化应建立在现有协议的基础上，并利用社区作为宣传和保健服务的场所，同时促进多学科团队，包括药剂师的更多参与。有必要在各级开展强有力和精心设计的研究-特别是宏观层面的研究、着眼于一体化长期成果的研究以及在更多样化的国家开展的研究。
Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), hypertension and diabetes together with HIV infection are among the major public health concerns worldwide. Health services for HIV and NCDs require health systems that provide for people's chronic care needs, which present an opportunity to coordinate efforts and create synergies between programs to benefit people living with HIV and/or AIDS and NCDs. This review included studies that reported service integration for HIV and/or AIDS with coronary heart diseases, chronic CVD, cerebrovascular diseases (stroke), hypertension or diabetes. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias. 11,057 records were identified with 7,616 after duplicate removal. After screening titles and abstracts, 14 papers addressing 17 distinct interventions met the inclusion criteria. We categorized integration models by diseases (HIV with diabetes, HIV with hypertension and diabetes, HIV with CVD and finally HIV with hypertension and CVD and diabetes). Models also looked at integration from micro (patient focused integration) to macro (system level integrations). Most reported integration of hypertension and diabetes with HIV and AIDS services and described multidisciplinary collaboration, shared protocols, and incorporating screening activities into community campaigns. Integration took place exclusively at the meso-level, with no micro- or macro-level integrations described. Most were descriptive studies, with one cohort study reporting evaluative outcomes. Several innovative initiatives were identified and studies showed that CVD and HIV service integration is feasible. Integration should build on existing protocols and use the community as a locus for advocacy and health services, while promoting multidisciplinary teams, including greater involvement of pharmacists. There is a need for robust and well-designed studies at all levels - particularly macro-level studies, research looking at long-term outcomes of integration, and research in a more diverse range of countries.