Decentralising HIV treatment in lower- and middle-income countries
São Paulo med. j
; 132(6): 383-383, Nov-Dec/2014.
Article
in English
| LILACS
| ID: lil-726380
Responsible library:
BR1.1
ABSTRACT
BACKGROUND:
Policy makers, health staff and communities recognise that health services in lower- and middle-income countries need to improve people's access to HIV treatment and retention to treatment programmes. One strategy is to move antiretroviral delivery from hospitals to more peripheral health facilities or even beyond health facilities. This could increase the number of people with access to care, improve health outcomes, and enhance retention in treatment programmes. On the other hand, providing care at less sophisticated levels in the health service or at community-level may decrease quality of care and result in worse health outcomes. To address these uncertainties, we summarised the research studies examining the risks and benefits of decentralising antiretroviral therapy service delivery.OBJECTIVES:
To assess the effects of various models that decentralised HIV treatment and care to more basic levels in the health system for initiating and maintaining antiretroviral therapy.METHODS:
Searchmethods:
We conducted a comprehensive search to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress) from 1 January 1996 to 31 March 2013, and contacted relevant organisations and researchers. The search terms included "decentralisation", "down referral", "delivery of health care", and "health services accessibility". Selection criteria Our inclusion criteria were controlled trials (randomised and non-randomised), controlled-before and after studies, and cohorts (prospective and retrospective) in which HIV-infected people were either initiated on antiretroviral therapy or maintained on therapy in a decentralised setting in lower- and middle-income countries. We define decentralisation as providing treatment at a more basic level in the health system to the comparator. Data collection andanalysis:
Two authors applied the inclusion criteria and extracted ...
Full text:
Available
Collection:
International databases
Health context:
SDG3 - Target 3.7 Universal access to health services related to reproductive and sexual health
/
SDG3 - Health and Well-Being
Health problem:
Sexually Transmitted Infections: Prevention and Care
/
Target 3.8 Achieve universal access to health
/
Target 3.3: End transmission of communicable diseases
Database:
LILACS
Main subject:
HIV Infections
/
Anti-HIV Agents
/
Developing Countries
/
Medication Adherence
/
Health Services Accessibility
Type of study:
Controlled clinical trial
/
Prognostic study
Aspects:
Social determinants of health
Limits:
Humans
Language:
English
Journal:
São Paulo med. j
Journal subject:
Cirurgia Geral
/
Cincia
/
Ginecologia
/
Medicine
/
Medicina Interna
/
Obstetr¡cia
/
Pediatria
/
Sa£de Mental
/
Sa£de P£blica
Year:
2014
Document type:
Article