Simplified ART Delivery Models Are Needed for the Next Phase of Scale Up 英文参考文献.docVIP

Perspective SimplifiedARTDeliveryModelsAreNeededfortheNext PhaseofScaleUp NathanFord1,2*,EdwardJ.Mills3 1Me′decinsSansFrontie`res,Geneva,Switzerland,2CentreforInfectiousDiseaseEpidemiologyandResearch,UniversityofCapeTown,CapeTown,SouthAfrica,3Faculty ofHealthSciences,UniversityofOttawa,Ottawa,Ontario,Canada DecentralizedARTProvisiona Necessity health centers since 2006, with outcomes better thanthoseobtainedin thehospital [6]. Reports from South Africa [7] and Lesotho [8] show similarly reassuring outcomesfordecentralizedcare. LinkedResearchArticle Effortstoscaleupantiretroviraltherapy (ART)forpeoplelivingwithHIV/AIDSin resource-limitedsettingsbeganwithaclear recognitionoftheneedtoadaptthemodel ofcarefromindividualizedcaretoapublic health approach [1]. Ten years ago, the main model for ART delivery was the Westernmodel:specializedandindividual- ized,withpatientsreceivingcarefulclinical monitoring and drug regimens that were frequentlyalteredaccordingtotolerability, emergenceofresistance,andpatientpref- erence. Such a level of care was clearly beyondthecapacityofhospitalservicesin sub-Saharan Africa 10 years ago, and which remain for the most part poorly funded,poorlyequipped,understaffed,and overwhelmed. This Perspective discusses the fol- lowingnewstudypublishedinPLoS Medicine: MovingARTProvisionbeyond theHealthSystem LongL,BrennanA,FoxMP,Ndibongo B, Jaffray I, et al. (2011) Treatment Outcomes and Cost-Effectiveness of Shifting Management of Stable ART PatientstoNursesinSouthAfrica:An ObservationalCohort.PLoSMed8(7): e1001055. doi:10.1371/journal.pmed. 1001055 The effectiveness of ART delivery in reducing mortality in resource-limited settingshasbeenestablished[9],andthere isincreasingevidencethatprovidingART earlier will reduce hospitalizations and opportunisticinfections[8]andcontribute to reducing HIV transmission [10]. But the effectiveness of the health system in delivering ART is questionable, consider- ingthehighratesofpatientattritionalong thetreatmen