Ukulinganisa ubudlelwane phakathi kweendleko kunye noKhathalelo lweMpilo
Inani elithile zophando lwakutshanje alukhange libheke kwiindleko zonyango lwe-HIV kodwa iindleko zalo ngempumelelo kwiimeko ezahlukeneyo zentsholongwane.
Olunye uphando oluthile oluvela kwi-Centres of Diseases Control and Prevention (i-CDC) yase-United States enenjongo yokuqikelela iindleko zokuphila zentsholongwane kaGawulayo-kokubili kubantu abaqala unyango lwe-antiretroviral (ART) ekuqaleni (i- CD4 count of 500 cell / mL okanye ngaphantsi) kunye nabaqala (200 amaseli / mL okanye ngaphantsi).
Iziphumo ziqinisekisile ukuba zeziphi iincinci ezincinci eziye zacetyiswa ukuba: ukuqaliswa kwangaphambili kwe-ART kunye neendleko zokuphila eziphantsi.
Ngokutsho kophando, kulabo baqala unyango kumaxabiso angaphezulu kwe-CD4, ixabiso elilinganiselwayo lokuphila elilinganiselwa kuma-250,000. Ngokwahlukileyo, abo baqala kuma-cell cell / mL angaphantsi kwama-200 okanye ubuncinci bachithe kabini loo mali-ukusuka naphi phakathi kwama-400,000 kunye nama-600,000.
Phakathi kwezizathu ezichazwe kwiindleko eziphezulu yingozi yokunyuka kwezifo ezinxulumene neHIV kunye nezifo ezingenayo i-HIV kulabo abanamasosha omzimba athathaka. Ngaphezu koko, amathuba okuba umntu uya kukwazi ukubuyisela ukusebenza komzimba kumanqanaba asondeleyo (oko kukuthi, iibalo zeCD4 ze-500-800 iiseli / mL) ziba nzima kamva omnye uqala unyango.
Uhlalutyo olulandelayo olusuka kwi-College ye-Weill Cornell Medical College luxhasa ngokubanzi izigqibo. ukulandela abantu abane-HIV ukususela kwiminyaka engama-35 ukuya kufaka.
Ngelixa iindleko zonyango kulabo baqala unyango ekuxilongweni (i-$ 435,200) zaziphezulu kakhulu kunabo abaye baxilisa unyango (i-$ 326,500), ukusindiswa ngokwemiqathango yesifo kunye nokukhutshwa kwezibhedlele kwakucatshangelwa kakhulu.
Abaphandi banokukwazi ukugqitywa ukuba ixesha lokuphila elindleko lokuphepha ukusuleleka kwintsholongwane kaGawulayo kumntu omnye kwakuphakathi kweedola ezingama-229,800 ukuya kuma-338,400.
Ukubeka iindleko zoBomi ngeNtsholongwane
Nangona iindleko zokuphila zonyango zingabonakala zihamba phambili-zibonisa ukuba zithengiswa ngamaxabiso e- HIV okanye iindleko zokunakekelwa kwempilo yaseMerika-kubalulekile ukujonga iindleko ngokumalunga nezinye izinto ezichaphazelekayo zezempilo.
Khawucinge, umzekelo, ukuba umyinge wexesha lokuphila ukubhema kwindoda eneminyaka engama-24 ubudala i-$ 183,000, ngelixa umfazi oneminyaka engama-24 ubudala unokulindela ukuchitha umyinge wama-86,000. Ngaphandle kweendleko zoogwayi ngokwawo, iindleko zentlalo kwi-Medicare, i-Medicaid, i-Social Security, kunye ne-inshurensi yempilo ibonakala ukuba ibonakala kakhulu kakhulu-nokuba kungenxa yokuyeka ukutshaya , imphysema, umdlavuza wamaphaphu, njl.
(La manani ayancipha ngenxa yokuba ukutshaya, njengento ezimeleyo, kwaziwa ukunciphisa ukulinda ubomi ngo-12.3 iminyaka kubantu abane-HIV.)
Okwangoku, iindleko zobomi bokusela utywala obuthathu ngosuku luza kuma-263,000 amawaka angamawaka ngaphezu kokuphila, ehambelana nokunyuka kwe-41% engozini yomhlaza kumadoda, nokuba ingaba ne-HIV okanye i-HIV.
Izindleko zeContain Strategies
Akukho nanye kule nto, eqinisweni, ihloselwe ukunciphisa impembelelo yeze-HIV, kokubili kwinkqubo yomntu ngamnye kunye nenkqubo yononophelo lwezempilo.
Ukususela kumbono womntu, iindleko zeNtsholongwane kaGawulayo zihambelana ngokuthe ngqo kwindlela isigulane esigcinwa ngayo ekunyamekelweni kunye nendlela loo mntu angakwazi ngayo ukumelana nonyango oluchanekileyo. Ngomhla ka-Meyi 2014 ukuhlaziywa kwezikhokelo zonyango lwe-HIV ye-US, iSebe lezeMpilo kunye neNkonzo zoLuntu (DHHS) lijongene nale nkxalabo ngokucebisa ukuba oogqirha "bancitshiswe iindleko ezichaphazelekayo kwizonyango xa zikhona."
Oku kubandakanya ukusetyenziswa kwezixhobo zamachiza eziqhelekileyo xa kunokwenzeka okanye kunengqiqo. Nangona kunjalo, isigqibo kufuneka sihambisane nokuvavanywa ngokunyamekileyo malunga nokuba iindleko ezincitshisiweyo zinganyusa umthwalo weepilisi kwisigulane.
Kwiimeko ezinjalo, ukusebenzisa i-generics kunokunciphisa iindleko jikelele kodwa ngexabiso lokunamathela kwesigulane . Ukongezelela, i-generic components ye-regimen yezidakamizwa ezininzi zingakhokelela kwi-inshorensi ephezulu yokuhlawula i-inshurensi, ukwandisa kunokunciphisa iindleko ze-out-of-pocket.
Ngendlela efanayo, i-DHHS incomele ukunciphisa ukulandelwa kwe-CD4 kwizigulane ezise-ART ubuncinane kwiminyaka emibini kwaye zinezinto eziqhelekileyo ezingenakubonakala. Nangona oku kubonakala kungenaziphumo ezincinci ngokubhekiselele kwiindleko ezithintekayo, iimvavanyo ezinxulumene ne-CD8 kunye neCD19, ngokwenene, zibiza; ayinayo ixabiso lonyango; kwaye azinconywanga njengenkqubo yokunakekelwa kwe-HIV.
Kwabo baye babonisa ukunyanzeliswa kwegciwane lexesha elide kwi-ART, i-DHHS ngoku ikhuthaza ukuba
- Uhlolo lwe-CD4 lwenziwa rhoqo kwiinyanga ezili-12 kubafundi abaneengxelo ze-CD4 phakathi kwama-300 ne-500 cells / mL, kwaye;
- Ukujonga iliso lwe-CD4 kuthatyathwa njengenqununu kulabo abanama-CD4 amanqaku angaphezulu kwama-500 / mL.
Ngokwezikhokelo, izibalo ze-CD4 zithe ngqo xa ziqala okanye ziyeka unyango lweprophylactic olujoliswe ekukhuseleni izifo ezichaphazelekayo , okanye ukuvavanya ukuba impendulo ye-immunological kwi-ART iyanele. Impendulo "eyaneleyo" ichazwa njengenyuka kwi-CD4 count ngama-50 ukuya ku-150 amaseli kunyaka wokuqala wonyango, kunye nokwanda okufanayo ngonyaka ukwenzela ukuba isimo esifanelekileyo siphumelele.)
Ngokwahlukileyo, ukuhlolwa kwemida ye-viral kufuneka kuthathelwe ingqalelo kwibharometer eyintloko yokuphumelela unyango. Ngaloo ndlela, i-DHHS icebisa ukuhlolwa kwentsholongwane yentsholongwane rhoqo emva kweenyanga ezi-3-4 kwizigulane ezinokunyanzeliswa, okuzinzile.
Imithombo:
Farnham, P .; Gopalappa, C .; Isihlengo, iS .; okqhubekayo. "Ukuhlaziywa kweeNkcitho zoLondolozo lweMpilo kunye noLungiso lwezoBomi kubantu abachaphazelekayo kwi-HIV e-United States: Ixesha elifutshane kunye nokuxilongwa kwangaphambili kunye nokungena kwiNkathalo." I-Journal ye-Immune Deficiency Syndromes. Oktobha 2013: 64: 183-189.
Schackman, B; Fleishman, J .; Su, A ..; okqhubekayo. "Ukugcinwa kweendleko zonyango kwixesha elizeleyo lokukhusela i-HIV eMelika." Inkomfa ka-2015 kwi-Retroviruses kunye neZifo eziKhuselekileyo (CROI). NgoFebruwari 23-26, 2015; Seattle, eWashington, ingqiqo 1104.
ISebe lezeMpilo leSebe lezeMpilo (DHHS). "Izikhokelo zokusetyenziswa kwee-Antiretroviral Agents kwi-HIV-1-abadala nabachaphazelekayo." EBethesda, eMaryn; fi kelele kuMeyi 6, 2016.