Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Antirretrovirais/uso terapêutico , Antivirais/uso terapêutico , Cegueira/prevenção & controle , Retinite por Citomegalovirus/tratamento farmacológico , Surtos de Doenças , Ganciclovir/análogos & derivados , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/imunologia , África Subsaariana/epidemiologia , Antirretrovirais/economia , Antivirais/economia , Sudeste Asiático/epidemiologia , Cegueira/epidemiologia , Cegueira/imunologia , Cegueira/virologia , Contagem de Linfócito CD4 , Retinite por Citomegalovirus/complicações , Retinite por Citomegalovirus/diagnóstico , Retinite por Citomegalovirus/epidemiologia , Retinite por Citomegalovirus/imunologia , Países em Desenvolvimento , Custos de Medicamentos , Ganciclovir/economia , Ganciclovir/uso terapêutico , Acessibilidade aos Serviços de Saúde , Humanos , Programas de Rastreamento , Oftalmoscopia , Desenvolvimento de Programas , Resultado do Tratamento , ValganciclovirRESUMO
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 1 hospital and 12 clinics, Médecins Sans Frontières 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.