Enye yezinkomba zokuqala ukuthi isiguli ngeke siphumelele ukubhekana nokutheleleka kwemishanguzo ye-antiretroviral (ART) lapho umuntu ekhonjiswe ngokuthi okuthiwa "udokotela wezilwane" -kufaka nje nje, umuntu ovakashela imitholampilo eminingi noma odokotela ngale nkambo iminyaka, izinyanga, noma amasonto.
Kukhona noma yiziphi izizathu ezenza kungani isiguli sikhetha ukwenza kanjalo.
Ngezinye izikhathi, kungenzeka ukuthi isiguli asiyithandi udokotela noma imtholampilo ethile, noma sidinga ukwelashwa kwesimo esihambisanayo, njenge- hepatitis C (HCV) , ukusetshenziswa kabi kwezidakamizwa, noma impilo yengqondo.
Kodwa, kaningi kunalokho, kumane nje ukuthi isiguli asizimisele ukwamukela noma ukubhekana nokuthile okuhlobene nokuxilongwa , ukuphathwa noma ukwelashwa kwe-HIV . Izibonelo zifaka:
- Ukwehliswa, noma ukwesaba ukudalulwa nokuhlambalaza .
- Iziguli eziye zabhekana nokuhluleka kokwelapha ngenxa yokunamathela kwezidakamizwa futhi kungcono ukuthuthela kwesinye udokotela kunokuvuma (noma ukubhekana) izimpande zabo ezingabambeleli.
- Iziguli ezingenakuvuma ukwamukela noma ukuhluleka ukubhekana nesifo sokuxilongwa, ngubani osuka kudokotela kuya kudokotela enethemba lokuthola umphumela ohlukile.
- Ukuhluleka ukwamukela izidingo zokunamathela kwezidakamizwa nsuku zonke noma imikhuba yobulili ephephile .
Ukuqhathaniswa kanye nePhrofayli kaDokotela abaHlengi
Isifundo se-2013 esikoleni sasePerelman of Medicine eYunivesithi yasePennsylvania sabheka ububanzi kanye nomphumela wokudokotela odokotela eminyakeni emibili kusukela ngo-2008 kuya ku-2010.
Ekucwaningweni kwabo, abaphenyo bahlola ukufika kwabo emtholampilo, umlando we-ART, kanye nomthwalo wegciwane lesandulela ngculazi ku-13,000 iziguli emitholampilo yomphakathi kaRyan White eyimali engu-26. Kulabo bantu, cishe abangaba ngu-1 000 babonakala behambele imitholampilo eminingi.
Ucwaningo alugcini nje ukuqinisekisile ukuthi lezi ziguli eziningi ze-clinic zazingenakukwazi ukufezekisa ukwedlula ukwelashwa kwegciwane kunezihlobo zabo zomtholampilo (68% kuya kuma-78%), futhi babengenakuthola kakhulu ukuthatha i-ART uma kudingeka (69% kuya kuma-83%) .
Ngaphezu kwalokho, nakuba iningi lala dokotela liqhubekile phakathi nonyaka wokuqala wokunakekelwa, 20% yaqhubeka kulo lonke isikhathi.
Odokotela be-hoppers kulolu cwaningo babhekwe kakhulu ukuthi bancane, i-African American, i-female, ngaphandle kweminshuwalense noma emshuwalense wezempilo yomphakathi.
Umphumela weDokotela oPhezulu
Imiphumela yodokotela yokugaya ingaba yinto ephawulekayo ngoba eziningi zalezi ziguli zihluleka ukudalula umlando odlule nodokotela wabo omusha. Lokhu kungaholela ekudaleni amaphutha kanye nokungahambisani kwezidakamizwa nezidakamizwa ezingaziwa, ukuveza lowo muntu eminye imiphumela emibi yokugwema kanye / noma ukuthuthukiswa kusengaphambili kwe- HIV ukumelana nezidakamizwa .
Ngaphezu kwalokho, ikhwalithi, imvamisa, kanye nokuvumelana kwe-patient-provider-interaction-lapho isiguli sigcinwa khona ekunakekeleni emtholampilo owodwa noma nodokotela ofanayo-ayaziwa ukuthuthukisa imiphumela yomtholampilo. Ucwaningo oluvela eVanderbilt University School of Medicine luye lwabonisa ukuthi ukunakekelwa okungajwayelekile esikhathini sokuqala konyaka wezokwelapha kungaphezu kokuphindwe kabili ingozi yokufa ezigulini ezine-HIV, nge-2.3 ukufa ngonyaka ngamunye weziguli eziyi-100 ngokubhekene nokufa okungu-1.0 kuphela nge-100- umuntu-iminyaka kulabo abanokunakekelwa okuqhubekayo, okukodwa komtholampilo.
Kusukela embonweni wezempilo womphakathi, udokotela wezinkukhu angase abe nethonya elilinganayo, okuholela ekuphindaphindeni okungadingekile kwezinsizakalo kanye nokuchitha imithombo eyandisa izindleko zokunakekelwa kwezempilo jikelele.
Ukubona izimbangela zalokho kuzoba yisinyathelo esilandelayo uma izikhulu zezempilo zikahulumeni zase-US zithemba ukuthola ukunciphisa okuqhubekayo kwezokudluliswa kwe-HIV ngokuhambisana nemihlahlandlela yokuhlola kanye nokwelashwa okubuyekeziwe.
Izincomo zamanje zihlanganisa:
- Ukunciphisa ukuguliswa kwesiguli ngokuhlanganisa ukuhlolwa, ukuxhunyaniswa nokunakekelwa, nokwelashwa kwe-HIV endaweni ehlanganisiwe, isu elibizwa ngokuthi "i-TLC-Plus."
- Ukukwabelana kwamarekhodi wezokwelapha nge-elektroniki phakathi kweziphathimandla zezempilo ezigunyaziwe ukukhomba kangcono iziguli ezingaba udokotela owehlayo noma unomlando wokunakekelwa kwezempilo okungaqondakali.
- Ukuhlinzeka ngokufinyelela okukhulu ekunakekelweni okuqondene ne-HIV, ikakhulukazi emiphakathini ehlukanisiwe. Ukwandisa ukufinyeleleka kumshuwalense wezempilo kanye nomshuwalense wangasese wezempilo ngaphansi koMthetho Wokunakekelwa Okungenakusiza kungasiza ekunciphiseni ukungalingani kwezempilo kubantu abathintekayo.
Imithombo:
Yehia, B .; I-Schranz, A .; Momplaisir, F .; et al. AIDS kanye nokuziphatha. "Imiphumela yeziguli ezithathelwana ngegciwane lesandulela ngculazi ezithola ukunakekelwa emitholampilo eminingi." Septemba 28, 2013; e-eshicilelwe ngaphambi kokuphrinta; I-PMID: 2407731.
Gardner, E .; McLees, M .; Steiner, J .; et al. "I-Spectrum Yokuzibandakanya Ekunakekelweni Kwegciwane lesandulela ngculaza kanye nokubhekela kwayo ekuhlolweni-futhi-nokuphatha izindlela zokuvimbela ukutheleleka nge-HIV." Izifo Ezithathelwanayo Emitholampilo. Mashi 2011; 52 (6): 793-800.
I-Herwehe, J .; UWilbright, W .; Abrams, A .; et al. "Ukuqaliswa kwerekhodi yezokwelapha edidiyelwe, edidiyelwe (EMR) nolwazi lwezempilo lomphakathi lokushintshaniswa ngeHIV / AIDS." I-Journal ye-American Medical Information Association. May-Juni 2012; 19 (3): 448-452.
I-Mugavero, M .; I-Lin, i-H .; U-Willig, J .; et al. "Ukuvakashelwa nokufa okungahambi kahle phakathi kweziguli ezisungula ukwelashwa kokuqala kwegciwane lesandulela ngculaza." Izifo Ezithathelwanayo Emitholampilo . NgoJanuwari 15, 2009; 48 (2): 248-256.