Comprehensive Health Care for People Infected With HIV in Developing Countries
November 21, 2002
Developing countries healthcare systems are generally ill equipped to cope with HIV infection. In 2001 in the United States, more than 55 percent of the 900,000 people infected with HIV received antiretroviral therapy. Of the 28 million HIV-infected people in sub-Saharan Africa, slightly more than 0.1 percent received treatment. Universal access to comprehensive health services is needed to reduce global HIV-related morbidity and mortality.Adapted from:
The current study explores the question of how effective HIV/AIDS services can be delivered in resource-poor countries to address six crucial needs: voluntary, confidential counseling and testing; prevention of HIV transmission, including sexual, parenteral, and mother to child; prophylaxis against opportunistic infections; diagnosis and treatment of HIV-related conditions including opportunistic infections and neoplasms; antiretroviral treatment; and palliative care.
The authors suggest that the WHOs global strategy for comprehensive health care for people with chronic illnesses could serve as a model for delivering services to people with HIV. The WHO strategy emphasizes patient-centered care that includes planned visits and regular follow up; delivery of services at primary care level for broadest access; standardized monitoring and reporting practices; effective communication and referral systems between primary, secondary, and tertiary levels of health care; patient education; community outreach; prevention; and policies, collaboration, legislation, and financing to support care strategies.
One challenge to implementing the WHO strategy for treating HIV in developing countries is finding doctors and health care workers with experience in the complex medical management of HIV/AIDS. Furthermore, up to 70 percent of HIV-infected people in developing countries are co-infected with TB, creating problems of adverse drug interactions. In many areas of the developing world, HIV patients also suffer from hepatitis B and C, thereby running a high risk of hepatic toxicity from the drugs. The researchers suggested, "Delegating roles and responsibilities for specified services to less-skilled staff, training primary care providers to deliver some aspects of HIV care, and developing effective communication and referral systems to closely link primary providers to more specialized HIV services could begin to address the need for HIV expertise in resource-poor settings."
Different countries have different requirements for establishing comprehensive HIV care. Brazils successful prevention and treatment program relies on government funding of antiretroviral drugs, but Brazils model might not be effective in countries with weaker transportation systems and a larger rural population. Uganda, Thailand, Cambodia and Senegal have also developed successful programs for HIV care and prevention, and a model in Haiti used existing TB control infrastructure to deliver treatment to patients, using community health workers to provide support and education.
The study cited two ideas for customizing health care models to meet different countries needs. The "building blocks" approach proposed by the Pan American Health Organization/WHO, in collaboration with UNAIDS and the International Association of Physicians in AIDS care, posits a phased-in program that would provide basic services as the foundation of more complex and sophisticated services at each level of health care as resources increase. A WHO plan would scale up treatment through a standardized antiretroviral drug regimen. According to this scheme, primary care providers with basic training in HIV would be enabled to provide algorithm-guided treatment, with the aid of evidence-based guidelines for monitoring drugs side effects and toxicities.
The study concluded that the best way to fight the global HIV epidemic is through partnerships between donors, governments, non-governmental organizations, and local organizations to develop effective, sustainable care programs; and coordination of training messages, policy, and guidelines among such groups. The WHO model could serve as a valuable template for the design of comprehensive HIV/AIDS care.
British Medical Journal
10.26.02; Vol. 325: P. 954-957; Mari M. Kitihata; Mary K. Tegger; Edward H. Wagner; King K. Holmes
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.