Implementing antiretroviral therapy in rural communities: The Lusikisiki model of decentralized HIV/AIDS care
Implementing antiretroviral therapy in rural communities: The Lusikisiki model of decentralized HIV/AIDS care
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DOI：
10.1086/521114
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发表时间：
2007-12-01
影响因子：
6.4
通讯作者：
Reuter, Hermann
中科院分区：
文献类型：
--
作者：
Bedelu, Martha;Ford, Nathan;Reuter, Hermann
卫生工作者短缺是扩大抗逆转录病毒疗法(ART)的主要瓶颈，特别是在农村地区。在南非农村地区Lusikisiki，拥有150,000人口，由I医院和12家诊所提供服务，Sarecins Saris Frontieres一直在支持一项计划，通过下放到初级保健诊所、任务转移(包括护士发起的治疗，而不是医生发起的治疗)和社区支持来提供人类免疫缺陷病毒(HIV)服务。这一方法使治疗得以迅速扩大，取得了令人满意的结果。虽然南非的一般方法是通过医院提供抗逆转录病毒治疗--这严重限制了许多人(如果不是大多数人)获得抗逆转录病毒治疗的机会--但卢西基西基的1年结果在诊所和医院是相当的。诊所一级的服务更接近和更容易接受，导致患者更快地登记参加治疗，并更好地保留了治疗中的患者(2%对19%的患者失去了随访)。2006年，卢西基西基总共有2200人接受了抗逆转录病毒治疗，覆盖率为95%。要保持质量和覆盖面，将需要公共部门增加资源投入，并充分接受创造性的执行方法，包括任务转移和社区参与。
Health worker shortages are a major bottleneck to scaling up antiretroviral therapy (ART), particularly in rural areas. In Lusikisiki, a rural area of South Africa with a population of 150,000 serviced by I hospital and 12 clinics, Medecins Saris Frontieres has been supporting a program to deliver human immunodeficiency virus (HIV) services through decentralization to primary health care clinics, task shifting (including nurse-initiated as opposed to physician-initiated treatment), and community support. This approach has allowed for a rapid scale-up of treatment with satisfactory outcomes. Although the general approach in South Africa is to provide ART through hospitals-which seriously limits access for many people, if not the majority of people-1-year outcomes in Lusikisiki are comparable in the clinics and hospital. The greater proximity and acceptability of services at the clinic level has led to a faster enrollment of people into treatment and better retention of patients in treatment (2% vs. 19% lost to follow-up). In all, 2200 people were receiving ART in Lusikisiki in 2006, which represents 95% coverage. Maintaining quality and coverage will require increased resource input from the public sector and full acceptance of creative approaches to implementation, including task shifting and community involvement.