Isicwangciso sijolise ekutshintshiseni amanani kwiindawo ezisemngciphekweni
Ukunyangwa kweNtsholongwane kaGawulayo njengoThintelo (iTraP) isicwangciso esisekelwe kubungqina abantu abanomthamo ongekhoyo ongabonakaliyo kwintsholongwane engaphantsi kwintsholongwane engatshatanga.
Nangona i-TasP yabonwa njengendlela yokunciphisa umngcipheko ngamnye xa ingqiqo yaqala ngo-2006, bekuphela ngo-2010 ukuba ubungqina obuvela kwi-HTPN 052 uphando lubonelelwe ukuba luzakusetyenziswa njengeziko lokukhusela abantu.
UkuPhuculo koPhando kuthathwa njengenguqu yomdlalo
Uvavanyo lwe-HTPN 052-oluye lwafunda impembelelo yonyango lwe-antiretroviral (ART) kwimilinganiselo yokudlulisela kwi-serodiscordant couples-sexual-sex stops-stopped stopped almost four years early when it was shown that people in treatment were 96% less likely to infect their partners than the participants. '.
Iziphumo zetyala zakhokelela abaninzi ukuba bacacise ukuba i-TasP inokuthi ityeke, nokuba ingazange iphele, ukusasazeka kwe-HIV ngokunciphisa oko kuthiwa "umthamo wentsholongwane yoluntu." Kwiingcamango, ngokunciphisa umlinganiselo wentsholongwane yentsholongwane kumntu osulelekileyo, ukutshatyalaliswa kwe-HIV ekugqibeleni kuya kuba mnqabile ukuyeka ulwahlulo kwiindlela zalo.
Ubungqina kwiNkxaso ye-TasP
Ngaphambi kokusungulwa kwezidakamizwa zokulwa nezidambisi ze-antiretroviral, i-TasP yayicatshangelwa ingenakwenzeka ngenxa yamanqanaba aphezulu okusetyenziswa kweziyobisi kunye namazinga okunciphisa iintsholongwane ezithintela iiprogram ezingama-80, kwanokuba abo banamathela ngokupheleleyo.
Umfanekiso ushintshile kakhulu kwiminyaka yakutshanje, ngokuqaliswa kweemveliso ezinonophelo, ezinokuthengisa. Kumazwe amaninzi afana noMzantsi Afrika, ukufumaneka kwezivelisi eziphantsi kwexabiso eliphantsi (njengama-dollar angama-10 ngenyanga) uye wabeka ingcamango ngakumbi ekufikeleleni.
Ngelixa zonke ezi zinto zibonisa ukuba i-TasP njengenxalenye ebalulekileyo yesicwangciso-nkqubo sokukhusela esisekelwe ngabanye, ngaba oko kuthetha ukuba kuya kubangelwa kwisilinganisi esisezantsi?
Iingxaki ekuphunyezweni
Ukususela ekuqaleni, kwacaca ukuba bekuya kubakho inani lezithintelo ezicwangcisiweyo zokunqoba ukuba i-TasP yayingenokwenzeka:
- Kuza kufuna ukuhlolwa okuphezulu kwe-HIV kunye nonyango, ngokukodwa kwiindawo ezingapheliyo, eziphakamileyo. E-US, abaninzi abantu abathathu abane-HIV abaqondi ngokupheleleyo isimo sabo. Ekuphenduleni, i-US Prevention Services Task Force ngoku ikhuthaza ukuvavanywa kwangaphambili kwabo bonke abemi baseMelika abaneminyaka eli-15 ukuya ku-65 njengenxalenye yokutyelela konyango rhoqo.
- Kuya kufuna ukuqinisa ukulandelwa kwezigulane ezikhoyo. Ngokutsho kwamaziko okuLawula nokuLawula (i-CDC), kuphela ama-44 ekhulwini aseMerika afunyaniswe ukuba ne-HIV anxulumene nokunakekelwa kwezonyango. Uphando lubonisa ukuba ukwesaba ukuchazwa kunye nokungabikho kokunyamekela kwe-HIV kungenxa yezizathu ezininzi zokulibazisa unyango de ukubonakala kwezifo ezibonakalisa izifo.
- Kuza kufuna iindlela zokuqinisekisa ukunamathela kwabantu, impumelelo yinto eguquguqukayo kwaye kunzima ukuqikelela. Ngokutsho kwe-CDC, abantu abane-HIV okwangoku kunyango, phantse enye kwizine ayinakukwazi ukugcina imfuneko yokubambelela ekufezekiseni ukunyanzeliswa kwe-viral.
- Ekugqibeleni, iindleko zokuphunyezwa kubonakala ukuba ngumqobo omkhulu kunokuba inkxaso-mali ye-HIV iyaqhubeka iyancipha.
Ubungqina kwiNkxaso ye-TasP
Isixeko saseSan Francisco sinokuba yinto esondeleyo kubungqina bombono we-TasP. Ngama- gay kunye namadoda angamaqabane angama -90 ekhulwini labantu abanesifo esiphelelekileyo, ukungenelela okujoliswe kuyo, kuye kwabangela izinga eliphantsi lemiba engafumanekiyo. Ukupapashwa ngokubanzi kwe-ART kuye kwabangela ukuba kukho iipesenti ezingama-33 ezithintela ukusulelwa kwintsholongwane ukususela ngo-2006 ukuya ku-2008. Ngo-2010, ukusungulwa kwonyango jikelele kwi-diagnostic kuqhube ngakumbi kubangele ukwanda kwetandathu kwinani labantu abanokugcina ukunyanzelisa .
Kodwa abaninzi bayavuma ukuba i-San Francisco inomsebenzi oyingqayizivele kwabanye abantu abane-HIV. Kukho ubungqina obaneleyo bokuxhasa ukuba ngaba i-TasP iya kunciphisa amazinga okusuleleka kwindlela efanayo nakwezinye indawo.
Enyanisweni, uphando luka-2015 oluvela kwiYunivesithi yaseNorth Carolina lucebise ukuba ukuphumelela kwelizwe langempela le-TasP lingafihla kwiindawo ezithile eziphambili. Isifundo, esakhangela izibini ezine-serodiscordant ezingama-4,916 kwiPhondo laseHenan laseChina ukususela ngo-2006 ukuya ku-2012, zafunda impembelelo ye-ART kwimilinganiselo yokudlulisela inani labantu ekusebenziseni ikhondom ephezulu (63 ekhulwini) kunye nesantya sosulelo lwezesondo kunye Ukulala ngokwesondo kwakuphantsi kakhulu (0.04 kunye ne-0.07 ekhulwini, ngokulandelanayo).
Ngokwolu cwaningo, ama-80 ekhulwini labalingani abane-HIV, bonke abo babesanda kuphulukiswa ekuqaleni kwetyala, bebekwe kwi-ART ngo-2012. Ngelo xesha, ukuhla kwesulelo olutsha luhambelana nokunciphisa jikelele umngcipheko wama-48 ekhulwini.
Ngaphezu koko, njengoko uphando luqhubela phambili kwaye amaqabane aphezulu abane-HIV afakwe kwi-ART, amaxabiso avela ukuba ahlawule ngakumbi. Ukususela ngo-2009 ukuya ku-2012, ukusetyenziswa okuqhubekayo kwe-ART kunciphisa umngcipheko we-HIV ngamaphesenti angama-67, phantse amaxesha amathathu okubonwayo ukususela ngo-2006 ukuya ku-2009 xa kwakungama-32 ekhulwini kuphela.
ILizwi
Njengoko kunyanzelekile njengalezi ziphumo, kubalulekile ukuqaphela ukuba, ngokwezizathu zomntu, i-TasP ayizange ithathwe njengeqhinga elizimeleyo, nokuba phakathi kwezenzo ezizibophezelekileyo, izibini zesistimiscordant. Kwakungazange kuthathelwe ukufaka iikhondom okanye ukubonelela ngelayisenisi yamahhala yokushiya izenzo zesondo ezikhuselekileyo.
Xa kuthethwa oko, iinjongo zesicwangciso sihlala sisomelele. Oku kuyinyaniso ngokukhethekileyo kubini abalingani abafuna ukuba nabantwana okanye ngabanye abasengozini enkulu yokusuleleka . Kwiimeko ezinjalo, ukuhlaselwa kwangaphambili kweprophylaxis (i-PrEP) inokumiselwa ukuba kuqhubele phambili ukukhusela umlingani ongenazo ii-HIV. Xa zisetyenzisene ndawonye, i-TasP kunye ne-PrEP inokunciphisa umngcipheko wokusuleleka kwi-close-negligible rate.
Njalo xubusha ezi zikhethwe ngogqirha wakho ngaphambi kokuba uqalise nasiphi na isicwangciso esinjalo.
> Imithombo:
> Cohen, M .; Chen, Y; McCauley, M .; okqhubekayo. "Ukuthintela usulelo lwe-HIV-1 ngonyango lokuqala lwe-antiretroviral." I-New England Journal of Medicine. Agasti 11, 2011; 365 (6): 493-505.
> Gill, V .; Lima, V .; Zhang, W; okqhubekayo. IziPhumo eziPhuculisiweyo ze-Virological eBrithani Columbia ezidibeneyo neNgcembelelo eyanciphayo yohlobo lwe-HIV 1 Ukuthotywa kweMithi yokuKhatya. Izifo ezithathelwanayo zonyango. NgoJanuwari 1, 2010; 50 (1): 98-110.
> Amasebe ase-US okuLawula nokuVikela (i-CDC) yezifo. "Izimpawu ezibalulekileyo: Ukukhusela i-HIV ngoNonophelo kunye noNyango - eMerika." Ukuxhatshazwa kunye nokufa kweeVeki ngeveki (MMWR). Disemba 2, 2011; 60 (47): 1618-1623.
> Charlebois, B .; Das, M .; Porco, T; kunye neHaullir, D. "Impembelelo yamanqwanqwa enyango ye-Antiretroviral Treatment kwi-HIV Epidemic phakathi kwabesilisa abalala ngesondo nabantu baseSan Francisco." Izifo ezithathelwanayo zonyango. Aprili 15, 2011; 52 (8): 1046-1049.
> Smith, K .; Westreich, D .; Liu, H .; okqhubekayo. "Unyango lokuthintela ukuhanjiswa kwe-HIV kuma-Serodiscordant Couples eHenan, eChina, ngo-2006 ukuya ku-2012." Izifo ezithathelwanayo zonyango. Matshi 13, 2015; pii: i-civ200. [Epub ngaphambi kokuprinta].