Kwaye Kutheni Kufanele Kuxhalabele Konke
Intsholongwane kaGawulayo ye-HIV iyimodeli yokumelwa esetyenziswa ngama-arhente, aseburhulumenteni kunye neendawo zendawo ukuze kuchaneke ngakumbi izikhala kwiinkathalo ezinikezelwa kubantu abaphila ne-HIV. Eyaziwa nangokuthi i- HIV / AIDS Care Continuum , umzekelo unikeza umfanekiso oqiqayo wenani labantu baseMerika ababandakanyekayo kwicandelo ngalinye lokunyamekela nge-HIV ekuhlaleni ukusuka:
- Inani eliqikelelwayo labantu abanentsholongwane kaGawulayo;
- Inani elithe lafunyaniswa ;
- Umlinganiselo odibaniswe nokunyamekela;
- Inani eligcinwe ngononophelo;
- Inani elifuna unyango lwe-antiretroviral;
- Inani elifumana ngokwenene unyango, kwaye;
- Inani elinakho ukugcina imithwalo engenakulinganiswa yentsholongwane (ithathwa njengesiphumo sempumelelo impumelelo).
Umzekelo waqale uchazwa nguDkt. Edward Gardner kunye noogxa lakhe kwiSebe lezeMpilo laseDenver ngoMatshi 2011. Uhlalutyo lufumene ukuba kukho ukuphahla okukhulu phakathi kweyonke inyathelo lokuqhubela phambili ukuya kwinqanaba apho lidale ipiramidi ekungeniswayo xa kufakwe umxholo wesiganeko ( jonga umzekeliso ).
Eyona nto inqabisayo, into yokuba i-HIV Treatment Cascade ibonisa ukuba yi-1.2 yezigidi zaseMerika eziqikelelwa ukuba ne-HIV, kuphela malunga nama-25% aye akwazi ukuhamba ngokukhawuleza ekunyamekeleni ukuxilongwa kwi-anti-HIV.
Okubi nakakhulu, kuma-66% abo baqhagamshelwe ekuqaleni ukuba banakekele, phantse isiqingatha sazo (malunga nabantu abayi-219,000) abalahlekile ukuba balandele okanye bangakwazi ukufumana unyango oluthile lwe-HIV.
Nangona kukho ukunyamekela kwizifo zesifo kunye nokudibanisa ukunyamekela ukususela ngo-2010 ukuya ku-2012 (ukwandisa i-2% kunye ne-4%, ngokulandelanayo), ilahleko eziphakathi kwe-3% kunye ne-4% zaphawulwa kuzo zonke iindidi.
Oko iNtsholongwane kaGawulayo i-Cascade iyasitshela
La manani acacisa imingeni ezayo phambi kwabaququzeleli njengemigaqo- nkqubo ye-US yangoku ayibiza nje kuphela ukuhlolwa kovavanyo lwe-HIV lwabantu baseMerika abaneminyaka eyi-15 ukuya ku-6, kodwa kwaye lifuna ukuba kuqaliswe unyango lwe-HIV ngexesha lokuxilongwa ngaphandle kwe-CD4 count.
Ekugqibeleni, injongo yalo mgaqo-nkqubo kukuba baphathe kakuhle abantu abaninzi ngangokunokwenzeka ukuba bahlawule oko kuthiwa "umthamo we-viral load" (CVL) ngaphakathi kwabantu abaphezulu. Ngokwenjenjalo, ukusasazeka kwe-HIV kunokunciphisa ngokukhawuleza njengoko ukunyuka kwezinga lolo manani lancipha.
Nangona kunjalo, iyancoma ukubuza ukuba ngaba ezi njongo zikwazi ukufezekiswa ngokuqinisekileyo ngenxa yezikhalazo ezibalulekileyo ekuqhubekeni kwenkathalo, ngokukodwa phakathi kwabase-Afrika baseMelika abangenakunxulumene nokunyamekela (62%) kwaye bancinci ukuphumeza ukunyanzelwa kwe-viral (21% ).
Abancinci baseMerika (abaneminyaka engama-25-34) bahamba ngakumbi, banama-56% kuphela anxulumene nokunyamekela kwaye kuphela i-15% ekufezekiseni imithwalo engabonakaliyo yentsholongwane.
Ukongezelela, abanye baye bathi, njengesixhobo, i-CVL isalathisi esichaphazelekayo malunga nokusuleleka kwimeko njengoko ibonisa ukuba igalelo labantu abanemithwalo ephezulu yentsholongwane xa bephantsi kobuninzi beengcambu zentsholongwane yabo abasalayo.
Olunye uphando oluqhutywe yiYunivesithi yaseChristian Hill, eNorth Carolina iphakamisa ukuba i-CVL inokuthi ibe kabini ekhoyo njengangoku iyenziwa xa kulungiswa i-epidemiological.
Ukuvalwa kweZithuba
Ukuze kuncitshiswe ezinye zezikhewu ekuqhubekeni kwenkathalo, iinkqubo zokunakekelwa kweenkonzo eziphuculweyo ziphononongwa ngabaninzi bamagosa empilo karhulumente kunye noomasipala. Phakathi kweenjongo eziphambili:
- Ukubonelela ngoncedo olubanzi kwiinkathalo ezithile ze-HIV, ngokukodwa kwimimandla ebekelwe phantsi. Ukufikeleleka kokufikelela kwiMicrosoft kunye ne-yinshorensi yezempilo yangasese phantsi kwe- Care Affordable Act kunganceda ukunciphisa ukungabikho kwempilo kubantu abachaphazelekayo.
- Ukuxhamla ukutya ngokuhlola, ukudibanisa nokunyamekela nokunyanga izigulane kwiziko elidibeneyo (inkqubo eyaziwa ngokuba yiTCL-Plus). I-San Francisco, eLos Angeles, iBirmingham, neWashington, DC ziphakathi kwezixeko zase-US zihlala zikhankanywe njengokuba zibonisa iindlela ezilungileyo zeTLC-Plus.
- Ukwandisa imizamo yokufumana izigulane "ezilahlekileyo" kwaye uzibuyisele kwakhona ukuzinakekela. Ngo-2013, iSebe lezeMpilo leNew York laseNew York likwazi ukufumana i-689 ye-797 izigulane ze-HIV ezilahlekelwe ukulandelelana, ekugqibeleni ziphinde zibuyisele kwakhona i-77% yazo ukuba zilungele unyango.
- Yabelana ngamarekhodi ezonyango zobugcisa phakathi kwee-arhente zempilo ezigunyazisiweyo ukuqinisekisa ukuba "ukufikelela kwikhompyutheni" kulabo abalahlekelwe ukulandela okanye abafuna unyango. Phakathi ko-2009 no-2011, iSebe lezeMpilo laseLouosana lakwazi ukuchonga nokulumkisa izigulane ezingama-345 ezine-HIV ngokusebenzisa i-Louisiana ye-Orlando Health Information Exchange (LaPHIE), isiseko seenkcukacha zezempilo ze-elektroniki.
- Hlola zombini iveli kunye nezindlela zamasiko ukuphucula ukubambelela phakathi kwabantu abakwi-antiretroviral therapy. Oku kubandakanya ukwandisa ukusebenzisana nodokotela kunye nesigulane. Uphando lubonisa ukuba izigulane ezinezobugqirha omnye uvakatye ngamnye ngonyaka zingama-94% amathuba okugula okanye ukufa kunomntu abane. Ukunyuka kwamagqirha kunye nesigulane kukunyanelana nokuphucula amazinga okunamathela kwezidakamizwa.
Imithombo:
Cohen, M .; Miller, W; Amandla, K. kunye no-Smith, M. "Imithwalo yeNtsholongwane yoLuntu njengeNqanaba loVavanyo lweNtsholongwane kaGawulayo njengoThintelo." Izifo ezithathelwanayo zeLancet. Meyi 2013; 13 (5): 459-464.
Gardner, E .; McLees, M .; Steiner, J; okqhubekayo. "I-Spectrum of Engagement kwi-HIV Care kunye nokuBheka kwayo kwi-Test-and-Treat Treat Strategies for Prevention of HIV Infection." Izifo ezithathelwanayo zonyango. Matshi 2011; 52 (6): 793-800.
Giordano, T; Gifford, A .; White, A .; okqhubekayo. "Ukugcinwa kwiNkathalo: Umngeni wokuPhepha ngeNtsholongwane kaGawulayo." Izifo ezithathelwanayo zonyango. Julayi 4, 2007; 44 (11): 1493-1499.
Herwehe, J .; UWilbright, W. Abrams, A .; okqhubekayo. "Ukuphunyezwa kweRekhodi yeNgcaciso yezoNyango (i-EMR) kunye noHlelo lwezoLuntu lweeNkcukacha zezeMpilo kwi-HIV / AIDS." Umbhalo we-American Medical Information Association. NgoMeyi-Juni 2012; 19 (3): 448-452.
Project Inform. "I-TLC +: Iinkqubo eziPhambili zokuPhucula ukuPhucula uVavanyo lweNTSholongwane kaGawulayo, ukuQinisekisa ukuNyamekela, ukuPhathwa kweNtengiso (iTLC-Plus) kwiinkalo ezine kwizixeko ezine." ESan Francisco, eCalifornia; Agasti 2011.
Udeagu, C .; Webster, T; I-Bocour, A .; okqhubekayo. "Ulahlekile okanye Ungalandeli: Uphulo lwezeMpilo yoluntu ukuphinda lubandakanye abantu abachaphazelekayo abaneNTSHOLONGWANE-NTSHOLONGWANE KAGAWULAYO. AIDS. NgoSeptemba 10, 2013; 27 (14): 2271-2279.
Amaziko e-US for Control and Prevention (CDC) yeZifo. "I-CDC Fact Sheet | I-HIV e-United States: Amanyathelo okuNakekela." Atlanta, Georgia; epapashwe ngoJulayi 2012.