The need to focus on primary health care for chronic diseases
2016; Elsevier BV; Volume: 4; Issue: 9 Linguagem: Inglês
10.1016/s2213-8587(16)30148-6
ISSN2213-8595
AutoresDavid Beran, François Chappuis, Sandro Cattacin, Albertino Damasceno, Nilambar Jha, Peter Somerville, L. Suzanne Suggs, J. Jaime Miranda,
Tópico(s)HIV/AIDS Impact and Responses
ResumoIn The Lancet Diabetes & Endocrinology, a recent Editorial1The Lancet Diabetes & EndocrinologyHIV and NCDs: the need to build stronger health systems.Lancet Diabetes Endocrinol. 2016; 4: 549-550Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar and a Review by Eric Nou and colleagues2Nou E Lo J Hadigan C Grinspoon SK Pathophysiology and management of cardiovascular disease in patients with HIV.Lancet Diabetes Endocrinol. 2016; 4: 598-610Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar about the link between HIV/AIDS and cardiovascular disease address the double burden of communicable diseases and non-communicable diseases (NCDs), a problem often overlooked in the scientific literature and by donors. As researchers active in the areas of NCDs and neglected tropical diseases, we believe that several additional points warrant consideration. The Millennium Development Goals (MDGs) included clear targets for HIV/AIDS, tuberculosis, and malaria, but not for NCDs and neglected tropical diseases, which have now been included in the Sustainable Development Goals (SDGs).3Beaglehole R Bonita R Horton R et al.Priority actions for the non-communicable disease crisis.Lancet. 2011; 377: 1438-1447Summary Full Text Full Text PDF PubMed Scopus (1192) Google Scholar Not mentioned in the Editorial, the SDGs also include universal health coverage, a key tool to address health inequities as a way to build stronger health systems and ensure accessibility to care. Universal health coverage alone is not enough to deliver health services and its implementation requires quality and accessible primary health care. Primary health care provides the first point of entry for health-care delivery, with links to higher levels of the health system and other services. Primary care focuses on the individual by including not only health-related services, but also community resources to tackle health and social issues. However, mention of primary health care and its role within the health system is missing from the SDGs, as well as from the Editorial1The Lancet Diabetes & EndocrinologyHIV and NCDs: the need to build stronger health systems.Lancet Diabetes Endocrinol. 2016; 4: 549-550Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar and Review.2Nou E Lo J Hadigan C Grinspoon SK Pathophysiology and management of cardiovascular disease in patients with HIV.Lancet Diabetes Endocrinol. 2016; 4: 598-610Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar We recognise the dearth of information on the management of HIV/AIDS and cardiovascular diseases in low-resource settings, but in view of the burden in these contexts, the concepts presented should be discussed with a view of delivering services at the level of primary care. HIV/AIDS, neglected tropical diseases, and NCDs are all chronic diseases and their management poses problems for health systems organised to provide acute care.4WHOInnovative care for chronic conditions: building blocks for action. World Health Organization, Geneva2002Google Scholar Chronic diseases, whether communicable or non-communicable, require similar approaches centring care on the individual. Chronic disease is a burden on the household and individual in terms of lost productivity, cost of care, disability, and death, as well as social aspects, such as stigma and the role that family members, especially women and children, have as caregivers. Focusing on primary health care allows for people-centred care rather than disease-oriented care.5Epping-Jordan J Pruitt S Bengoa R Wagner E Improving the quality of health care for chronic conditions.Qual Saf Health Care. 2004; 13: 299-305Crossref PubMed Scopus (510) Google Scholar The SDGs offer the promise of a more horizontal approach to improving health, moving beyond the siloed approach of the MDGs and responses to HIV/AIDS. HIV/AIDS, NCDs, and neglected tropical diseases are diseases of poverty and causes of poverty (SDG 1). Universal health coverage (SDG 3) needs to be addressed, as well as determining which services will be provided. Because exposure to risk factors and access to care is different for women and men, gender-sensitive approaches are needed in the design, development, and implementation of interventions (SDG 5). And because diseases have their determinants in the environments where people live, interventions at policy, health system, and community levels should address elements included in SDG 11, which focuses on making cities inclusive, safe, resilient, and sustainable. Focusing on the quality of services at the primary health care level, irrespective of the diseases people have, can help to achieve the health-related SDG to "ensure healthy lives and promote wellbeing for all at all ages". The COHESION (COmmunity HEalth System InnovatiON) Project is funded by the Swiss National Science Foundation and the Swiss Development Cooperation under the Swiss Program for Research on Global Issues for Development. We declare no competing interests. HIV and NCDs: the need to build stronger health systemsOne of the greatest health achievements of recent decades is turning HIV infection from a death sentence to a chronic disease. Widespread access to combination antiretroviral therapy means that people with HIV are now living near normal life spans—and thereby facing different health challenges. Cardiovascular disease (CVD) is now one of the leading causes of non-AIDS-related morbidity and mortality in people with HIV. Full-Text PDF
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