Futhi Kungani Kufanele Kukhathazeke Konke Sonke
I- HIV Treatment Cascade imodeli yokumelela esetshenziselwa izinhlaka zikahulumeni, zombuso kanye nezendawo ukuze kubonakale kangcono izikhala ekunakekelweni ukunakekelwa kubantu abaphila negciwane lesandulela ngculaza. Eyaziwa nangokuthi i- HIV / AIDS Care Continuum , lo mdwebo unikeza umfanekiso oqhathanisayo wenani labantu baseMelika ababandakanyeka esinyathelweni ngasinye sokunakekelwa kwegciwane lesandulela ngculaza ngokuhlehla kusuka:
- Inani elilinganisiwe labantu abanesandulela ngculazi;
- Inani elitholwe;
- Inani elihlanganisiwe nokunakekelwa;
- Inani eligcinwe ekunakekeleni;
- Inani elidinga ukwelashwa kwama-antiretroviral;
- Inani elitholayo ngempela ukwelashwa, futhi;
- Ingxenye ekwazi ukugcina imithwalo engavamile engavamile (ibhekwe njengendlela yokwelapha impumelelo).
Le nqubo yahlonywa okokuqala nguDkt. Edward Gardner kanye nozakwabo eMnyangweni WezeMpilo kaDenver ngoMashi 2011. Ukuhlaziywa kwafumanisa ukuthi kwakukhona ukwehla okuphawulekayo phakathi kwesinyathelo ngasinye sokuqhubekela phambili kuze kube yilapho sakha ipiramidi engaphenduliwe lapho ifakwa umongo wesichazamazwi ( bona umfanekiso ).
Ngokweqile kakhulu, lokho okushiwo yi-HIV Treatment Cascade kubangelwa abantu baseMelika abangaba ngu-1.2 million abanesifo sengculaza, cishe ama-25% kuphela akwazi ukuhamba ngokuphumelela ekunakekeleni ukunakekelwa kokuthola ukwelashwa ekuqedeni ukwedlulela okuphelele kwegciwane lesandulela ngculaza.
Okubi nakakhulu, kulabo abangama-66% abaqala ukuxhunyanwa nokunakekelwa, cishe isigamu salabo (cishe abantu abangu-219,000) balahlekelwa ukulandela noma abangakwazi ukufinyelela ukunakekelwa okuqondene ne-HIV.
Ngenkathi sekuye kwaba nokuthuthukiswa kwezifo zokuxilonga kanye nokuxhunyaniswa kokunakekelwa kusukela ngo-2010 kuya ku-2012 (okwandisa u-2% no-4%, ngokulandelana), ukulahlekelwa kuka-3% no-4% kwaphawulwa kuzo zonke ezinye izigaba.
Okushiwo yi-HIV Treatment Cascade Kusitshela
Lezi zibalo ziqokomisa izinselelo ezizofika kubagqugquzeli njengoba iziqondiso zamanje zase-US zibiza ukuhlolwa kokuhlolwa kwe-HIV kwabaningi baseMelika abaneminyaka engu-15-65 kuphela kodwa futhi zifuna ukuqala ukwelashwa kwe-HIV ngesikhathi sokuxilongwa kungakhathaliseki ukuthi i-CD4 count.
Ekugcineni, inhloso yalezi zinqubomgomo ukuphatha kahle abantu abaningi ngangokunokwenzeka ukuze wehlise lokho okubizwa ngokuthi "umthamo wegciwane lomphakathi" (CVL) phakathi kwabantu abaphezulu. Ngokwenza kanjalo, ukusakazwa kwe-HIV kungancipha ngendlela ephawulekayo njengoba ukunciphisa kwalesi sabantu kwancipha kancane kancane.
Kodwa-ke, icela ukuba ibuze ukuthi lezi zimgomo zingafinyelelwa yini ngokuqondile uma kunezikhala ezibalulekile ekuqhubekeni kokunakekelwa, ikakhulukazi phakathi kwabase-Afrika baseMelika abangenakutholakala ukuthi banakekelwa ukunakekelwa (62%) kanye nokunciphisa amathuba okunciphisa i-viral (21% ).
Abancane baseMelika (abaneminyaka engama-25-34) bahamba kakhulu nakakhulu, ngo-56% kuphela abahlotshaniswa nokunakekelwa futhi kuphela 15% abafeza imithwalo engavamile engavamile.
Ngaphezu kwalokho, abanye baye bathi, njengethuluzi, i-CVL yinkomba engafanele yokutheleleka njengoba ibeka umthelela wabantu abanemithwalo ephezulu yegciwane ngenkathi kunqunywa imithwalo yegciwane lalabo abahlala bengatholakali.
Enye isifundo esinjalo esenziwa yi-University of Chapel Hill, eNorth Carolina iphakamisa ukuthi i-CVL ingahle ibe kabili okwamanje okubikiwe lapho kwenziwa izinguquko ze-epidemiological.
Ukuvala izikhala
Ukuze kufinyelele ezinye zeziphala ekuqhutshweni kokunakekelwa, izinhlelo zokukhulisa ukunakekelwa ngcono zihlolwe yizinombolo eziningi zeziphathimandla zezempilo zikahulumeni kanye nomasipala. Phakathi kwezinhloso eziyinhloko:
- Nikeza ukufinyelela 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.
- Ukudla ngokunciphisa ngokuhlola, ukuxhumanisa ukunakekelwa, nokuphatha iziguli endaweni ehlanganisiwe (uhlelo oluyaziwa ngokuthi i-TCL-Plus). I-San Francisco, i-Los Angeles, i-Birmingham, ne-Washington, DC ziphakathi kwamadolobha ase-US ahlale ekhonjelwa njengokubonisa imikhuba emihle ye-TLC-Plus.
- Yenza imizamo yokuthola iziguli "ezilahlekile" futhi uzixhumanise kabusha ukuze uzikhathalele. Ngo-2013, uMnyango WezeMpilo waseMelika waseNew York City wakwazi ukuthola iziguli ezingu-689 ezingama-797 ze-HIV ezilahlekelwe ukulandelwa, ekugcineni ziphinde zixhumane no-77% zazo ukuze zilungele ukwelashwa.
- Yabelana ngamarekhodi ezokwelapha e-electronic phakathi kwama-ejensi ezempilo ezigunyaziwe ukuqinisekisa ukuthi "ukuxhumana nge-electronic" kulabo abalahlekelwa ukulandela noma abadinga ukwelashwa. Phakathi kuka-2009 no-2011, uMnyango WezeMpilo waseLouisana wakwazi ukubona nokuqapha iziguli ezingu-345 ezine-HIV ngokusebenzisa i-Louisiana Public Health Information Exchange (LaPHIE), i-database yangempela yesikhombimsebenzisi sezempilo.
- Hlola kokubili izindlela ezintsha nezendabuko zokuthuthukisa ukunamathela phakathi kwabantu abane-antiretroviral therapy. Lokhu kuhlanganisa ukwandisa ukusebenzisana nodokotela nesiguli. Ucwaningo lubonisa ukuthi iziguli ezinomunye udokotela ovakashele ngonyaka zingamathuba angu-94% okugula noma okufa kunomuntu onezingane ezine. Ukukhulumisana nodokotela nesiguli okwandisiwe kufana nokuhambisana nezilinganiso zokunamathela kwezidakamizwa.
Imithombo:
Cohen, M .; UMiller, W .; Amandla, K .; kanye no-Smith, M. "Imithwalo yemindeni yomphakathi njengendlela yokuhlola ukuphathwa kwegciwane lesandulela ngculazi njenge-Prevention." Izifo ezithathelwanayo zeLancet. May 2013; 13 (5): 459-464.
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.
Giordano, T .; Gifford, A .; Okumhlophe, A .; et al. "Ukugcinwa ekunakekelweni: Inselelo Yokusinda Ngokwe-HIV." Izifo Ezithathelwanayo Emitholampilo. Julayi 4, 2007; 44 (11): 1493-1499.
I-Herwehe, J .; UWilbright, W .; Abrams, A .; et al. "Ukusetjenziswa kweRiphabhulikhi yezokuThintana ye-Electronic (Integrated Electronic), i-Integrated Electronic (EMR) ne-Public Health Information Exchange ye-HIV / AIDS." I-Journal ye-American Medical Information Association. May-Juni 2012; 19 (3): 448-452.
Project Inform. "I-TLC +: Izindlela Ezinhle Zokuthi Zisebenze Ukuqinisa Ukuhlolwa Kwegciwane lesandulela ngculazi, Ukuxhumanisa Ukuxhumanisa, Ukuphathwa Kwengeziwe (TLC-Plus) Emadolobheni amane E-US." I-San Francisco, eCalifornia; Agasti 2011.
Udeagu, C .; I-Webster, T .; I-Bocour, A .; et al. "Ukulahlekelwa noma Ukungahambisani Njalo: Umzamo Wempilo Kahulumeni Wokuphinde Wenze Abantu Ababhekene Negciwane lesandulela ngculazi Abalahlekelwe Ukulandela Ukunakekelwa Kwezempilo nge-HIV." AIDS. Septemba 10, 2013; 27 (14): 2271-2279.
Amasevisi aseMelika okuLawula nokuvimbela izifo (CDC). "I-CDC Fact Sheets | I-HIV e-United States: Izinyathelo Zokunakekela." I-Atlanta, Georgia; eshicilelwe ngoJulayi 2012.