Isu sihlose ukuguqula amazinga emiphakathini eyingozi kakhulu
Ukwelashwa kwe-HIV njenge-Prevention (i-TasP) kuyindlela esekelwe ebufakazini lapho abantu abanomthamo wegciwane elingenakutholakali kakhulu amathuba okudlulisela igciwane kumlingani ongacanswanga ongathinteki.
Ngenkathi i-TasP yabonakala kuqala njengendlela yokunciphisa ingozi yomuntu lapho ingqungquthela isungulwa ngo-2006, kwaba ngo-2010 kuphela ukuthi ubufakazi obuvela ku-HTPN 052 ucwaningo luphakamisa ukuthi lungasetshenziswa njengethuluzi lokuvimbela abantu.
Ukuphenywa kocwaningo kubhekwa njengenguquko yemidlalo
Isivivinyo se-HTPN 052-esiye sabheka umthelela we- antiretroviral therapy (ART) ngamanani okudlulisa emibhangqwaneni engashadile yocansi -yavalwa cishe eminyakeni emine ekuqaleni kokuthi kuboniswe ukuthi abantu ekwelapheni babengamaphesenti angama-96 okutheleleka abalingani babo kunabalingani ababengekho 't.
Imiphumela yalesilingo yabangela abaningi ukuba bacabange ukuthi ngabe i-TasP ingase ibuye ijubane, uma ingavumi, ukusakaza kwe-HIV ngokunciphisa lokho okubizwa ngokuthi "umthamo wegciwane lomphakathi." Ngokwalokho, ngokunciphisa isilinganiso samagciwane egazini labantu, ukuhanjiswa kwegciwane lesandulela ngculazi ekugcineni kuzoba okungajwayelekile kuzo ukumelana nalesi sifo kumathrekhi akhe.
Ubufakazi Ekusekelweni kwe-TasP
Ngaphambi kokusungulwa kwezidambisigciwane ezishaya isizukulwane esisha, i-TasP yayibhekwa ngokungenakwenzeka ngenxa yamazinga aphezulu okudakwa kwezidakamizwa kanye namazinga okunciphisa ama-viral aphezu kwamaphesenti angaba ngu-80 kuphela, ngisho nalabo abanamathela ngokugcwele.
Isithombe sishintshile kakhulu eminyakeni yamuva, ngokusungulwa kwemithi ephumelelayo, engabizi. Ngisho emazweni ahlasela kakhulu njengeNingizimu Afrika, ukutholakala kwama generic aphansi-okungekho ama-dollar 10 ngenyanga) uye wabeka umqondo oseduze uma ungafinyeleleki.
Nakuba zonke lezi zici zikhomba ukuthi i-TasP njengengxenye ebalulekile yesulo lokuvimbela ngabanye, ingabe kusho ukuthi kuyoba ngesilinganiso esisezingeni labantu?
Izinselele ekusetshenzisweni
Kusukela ekuqaleni, kwacaca ukuthi kuzoba nezinselele eziningana zokunqotshwa uma ngabe i-TasP yayingenzeka:
- Kungadinga ukuhlolwa okuphezulu kokuhlolwa kwe-HIV nokwelashwa, ikakhulukazi emiphakathini engapheli, emiphakathini ephezulu. E-US, abaningi kubantu abahlanu abane-HIV abazi ngokugcwele isimo sabo. Ephendula, i-US Prevention Services Task Force manje isincoma ukuhlolwa okukodwa kwabaningi baseMelika abaneminyaka eyi-15 kuya ku-65 njengengxenye yokuvakasha kukadokotela njalo.
- Kungadinga ukuqinisa ukulandelwa kweziguli ezikhona. Ngokwezikhungo zokulawulwa nokuvimbela izifo (CDC), amaphesenti angu-44 kuphela aseMelika athola ukuthi une-HIV ahlobene nokunakekelwa kwezokwelapha. Ucwaningo lubonisa ukuthi ukwesaba ukudalulwa nokuntuleka kokunakekelwa kwe-HIV kungenye yezizathu eziningi zokubambezela ukwelashwa kuze kuvele ukugula kwesifo.
- Kungadinga izindlela zokuqinisekisa ukunamathela komphakathi, impumelelo yayo eguquguqukayo kakhulu futhi kunzima ukubikezela. Ngokusho kwe-CDC, abantu abane-HIV okwamanje abakwelashwa, cishe eyodwa kwezine abakwazi ukugcina ukubambelela okudingekayo ukuze bafeze ukucindezelwa okuphelele kwegciwane.
- Okokugcina, izindleko zokuqaliswa kubonakala kuyisithiyo esikhulu ikakhulukazi njengoba ukuxhaphazwa kwe-HIV emhlabeni wonke kuyaqhubeka kunciphisa kakhulu.
Ubufakazi bokusekela ku-TasP
Idolobha laseSan Francisco lingase libe yinto esondelene kakhulu nobufakazi bokuthi i-TasP. Ngama- gay nabesilisa nabesifazane abesilisa nabesifazane abangamaqembu angamaqembu angamaqembu angamaqembu angama-90 anesifo esithintekayo, umuzi ongenamkhawulo, ohlosiwe ube nomphumela ophansi wezimo ezingatholakali. Ukusabalalisa okubanzi kwe-ART kuye kwabangela ngokuqondile ukwehla kwamaphesenti angu-33 ezithombeni ezintsha kusukela ngo-2006 kuya ku-2008. Ngo-2010, ukusungulwa kokwelashwa kwansukuzonke ekuxilongweni kwaphumela ekukhuleni okuphindwe kasithupha kwinani labantu abakwazi ukugcina ukucindezelwa okugcwele kwegciwane .
Kodwa iningi liyavuma ukuthi i-San Francisco inomthelela ohlukile kwabanye abantu abane-HIV. Kukhona ubufakazi obanele bokusekela ukuthi ngabe i-TasP izokwehlisa izinga lokutheleleka ngendlela efanayo nakwezinye izindawo.
Eqinisweni, isifundo se-2015 esivela eNyuvesi yaseNorth Carolina sesiphakamise ukuthi ukusebenza kwezwe langempela kwe-TasP kungase kungapheli kwezinye izindawo eziyinhloko. Ucwaningo olwalubheke imibhangqwana engu-4,916 e-Henan esifundazweni saseChina kusukela ngo-2006 kuya ku-2012, yahlola umthelela we-ART ngamanani okudlulisela emphakathini lapho ukusetshenziswa kwamakhondomu okuqhubekayo kwakuphakeme kakhulu (amaphesenti angu-63) kanye nesilinganiso sezifo ezithathelwana ngocansi Ukulala ngokocansi kwakuphansi kakhulu (0.04 kanye namaphesenti angu-0.07, ngokulandelana).
Ngokusho kocwaningo, amaphesenti angama-80 wabalingani abane-HIV, bonke ababesanda kuphulukiswa ekuqaleni kokuvivinywa, bebekwe kwi-ART ngo-2012. Ngaleso sikhathi, ukwehla kokutheleleka okusha kuhambisana nokunciphisa jikelele ingozi yama-48%.
Ngaphezu kwalokho, njengoba lolu cwaningo luqhubeka futhi abalingani abaningi abane-HIV bebekwe ku-ART, amanani abonakala ehlehla ngisho nakakhulu. Kusukela ngo-2009 kuya ku-2012, ukusetshenziswa okuqhubekayo kwe-ART kwanciphisa ingozi ye-HIV ngamaphesenti angama-67, cishe izikhathi ezintathu okubonwayo kusukela ngo-2006 kuya ku-2009 lapho kwakungamaphesenti angu-32 kuphela.
Izwi elivela
Njengoba kuphoqeleka njengoba le miphumela ikhona, kubalulekile ukuqaphela ukuthi, ngesisekelo somuntu ngamunye, i-TasP ayikaze ibhekwe njengeqhinga lokuzimela, ngisho naphakathi kokuzibophezela, imibhangqwana ye-serodiscordant. Kwakungakaze kuhloswe ukufaka amakhondomu esikhundleni noma ukunikeza ilayisense yamahhala yokushiya imikhuba yobulili ephephile.
Ngalokho kuthiwa, izinhloso zalolu qhinga zihlala ziqinile. Lokhu kuyiqiniso ikakhulukazi emibhangqwaneni efuna ukuba nezingane noma ngabanye abasengozini enkulu yokutheleleka . Ezimweni ezinjalo, pre-exposure prophylaxis (i-PrEP) ingabuye ibekwe ukuba iqhubeke nokuvikela umlingani ongenawo i-HIV. Uma isetshenziselwa ndawonye, i-TasP ne-PrEP inganciphisa ingozi yokutheleleka ekungeneni okungalingani.
Hlala uxoxisana nalezi zindlela nodokotela wakho ngaphambi kokuqala noma yiluphi isu elifanayo.
> Imithombo:
> Cohen, M .; I-Chen, i-Y .; UMcCauley, uM .; et al. "Ukuvimbela ukutheleleka nge-HIV-1 nge-antiretroviral yokuqala yokwelapha." I-New England Journal of Medicine. Agasti 11, 2011; 365 (6): 493-505.
> Gill, V .; Lima, V .; Zhang, W .; et al. "Imiphumela Ephuthumayo Yezinhlelo Zokuhlukunyezwa EBrithani Columbia Ehambisana Ne-Increasing Incidence of HIV Type 1 Ukutholakala Kwemithi Yokumelana Nezidakamizwa." Izifo Ezithathelwanayo Emitholampilo. NgoJanuwari 1, 2010; 50 (1): 98-110.
> Amasevisi aseMelika okuLawula nokuVimbela (CDC). "Izimpawu Ezibalulekile: Ukuvimbela I-HIV Ngokunakekela Nokunakekelwa - I-United States." Ukulimala nokufa Kwembiko Yamaviki onke (MMWR). NgoDisemba 2, 2011; 60 (47): 1618-1623.
> Charlebois, B .; Das, M .; Porco, T .; kanye neHavlir, D. "Umphumela Wezinhlelo Zokunakekelwa Kwe-Antiretroviral Treatment Extended kwi-HIV Epidemic phakathi Kwabesilisa Abalala Ngesilisa E-San Francisco." Izifo Ezithathelwanayo Emitholampilo. Ngo-Ephreli 15, 2011; 52 (8): 1046-1049.
> Smith, K .; I-Westreich, i-D .; U-Liu, H .; et al. "Ukwelashwa Ukuvimbela Ukudluliswa Kwegciwane Lesandulela Ngculazi Emibhangqweni YaseSerodiscordant eHenan, eChina, ngo-2006 kuya ku-2012." Izifo Ezithathelwanayo Emitholampilo. Ngo-Mashi 13, 2015; i-pii: i-civ200. [I-Epub ngaphambi kokuphrinta].