HIV/AIDS as a Chronic Disease Reframing a Public Health Problem in South Africa

Transcription

1 HIV/AIDS as a Chronic Disease Reframing a Public Health Problem in South Africa Ehi Igumbor Senior Lecturer: Epidemiology & Health Information Systems School of Public Health University of the Western Cape 2 nd Annual UWC HIV in Context Research Symposium, March, 2010

2 Female deaths, South Africa Source: MRC Burden of Disease Research Unit

3 Dorrington et al. (2001). "The Impact of HIV/AIDS on Adult Mortality in South Africa."

4 AIDS is a chronic illness treatment should follow the model of cancer Samuel Broder Head: National Cancer Institute International AIDS meeting, Montreal, Quebec. June, 1989

5 Empirical evidence exists of improving life expectancy of people with HIV/AIDS HIV/AIDS is in the realm of chronic diseases in the developed world Source: 17 th Conference on Retroviruses and Opportunistic Infections, San Francisco, USA February, 2010

6 Source: 17 th Conference on Retroviruses and Opportunistic Infections, San Francisco, USA February, 2010

7 At International level, inequality in wealth between developed and developing nations has produced essentially 2 types of AIDS: chronic AIDS in the Western World and acute AIDS in the developing world where there are no funds for treatment

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9 As South Africa and the rest of the developing world respond to the HIV/AIDS crisis, sustained high survival rates of patients can be expected Survival into old age should not only be possible, but be the norm for people living with HIV/AIDS

10 Animation Source: George Tscherny Is change from acute to chronic simply an idiosyncratic flip flop or does this mutation transform the physiognomy of HIV/AIDS?

11 HIV as a Chronic Disease? What are the implications of a pervasive infectious disease becoming chronic in South Africa? Are available public health resources adequate to respond to the double burden of chronic HIV? Will weak health systems be able to implement more complex interventions and programmes?

12 How can the SA Health System resolve the tensions of a chronic COMMUNICABLE disease juxtapose traditional chronic NON COMMUNICABLE diseases?

13 Acute Versus Chronic ACUTE Sudden onset Obvious signs and symptoms Some limitation of normal function Treatment is supportive or curative Resolution to death or normal activity ensues Duration of days or weeks Predictable course CHRONIC Slow and gradual onset May not produce visible signs and symptoms Treatment aimed at relieving symptoms and slowing degeneration, not effecting cure Course of illness is uncertain and unlimited in time

14 Whereas the battle against acute illness is dramatic and heroic, the management of chronic illness, despite its complexity, is banal. Reflecting these priorities, health care systems tend to reward surgeons more than internists - Scandlyn J,(2000)

15 HIV as a Chronic Disease Clinical Outlook Longer lives of patients will be associated with increased prevalence of: 1) adverse effects of HIV infection, 2) adverse effects of the drugs used to treat HIV, and 3) concurrent medical conditions that would occur in the absence of HIV.

16 Public Health in the Age of CHRONIC HIV: Reflections and Redirections

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18 The Chronic Care Model Source: Wagner EH. "Chronic disease management: What will it take to improve care for chronic illness?" Effective Clinical Practice. 1998;1:2 4.

19 Health System implications of a chronic character of HIV/AIDS (1) Shift emphasis from acute, episodic care to provide continuity of care with planned visits and regular follow up Develop health policies, collaboration, legislation and healthcare financing to support comprehensive care strategies Emphasise delivery of services at primary care level to assure broadest access to effective care

20 Health System implications of a chronic character of HIV/AIDS (2) Develop effective communication and referral systems between primary, secondary and tertiary levels of health care Centre care on the patient, educate patients about their disease so they can become active participants in their care and promote adherence to long term treatments Link care to community resources

21 Health Systems implications of a chronic character of HIV/AIDS (3) Provide education and support to family and community members to assist in care Emphasize prevention Monitor and evaluate the quality of services and long term patient outcomes

22 SOME IMPORTANT ISSUES IN OUR CONTEXT Overcoming barriers to multi sector cooperation Support better coordination of resources Integrate disparate health information systems Eliminate duplication and ensure that everyone is working to the same goal

23 THANK YOU Acknowledgements: Thandi Puoane and Lungiswa Tsolekile are thanked for their comments REFERENCES 1. Barker PM, McCannon J, Venter WDF, Mmbara NW. Managing HIV as a chronic disease: using interactive data collection to improve clinical care. The Southern Africa Journal of HIV Medicine, 2004; Nov: Bartlett JG, Cheever LW, Johnson MP, Paauw DS. (Eds) Primary care as chronic care. In: A guide to primary care for people with HIV/AIDS, 2004 (Online: Accessed on 18/03/ Chambre SM. HIV/AIDS as a chronic disease: Emergence from the plague model. American Behavioral Scientist, 1996; Vol. 39, No. 6, Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timaeus IM. The impact of HIV/AIDS on adult mortality in South Africa. Cape Town, Medical Research Council Fee E, Fox DM eds. AIDS: the making of a chronic disease. Berkeley: University of California; Kitahata MM, Tegger MK, Wagner EH, Holmes KK. Comprehensive healthcare for people infected with HIV in developing countries. British Medical Journal, 2002; 325: Matic S, Lazarus JV, Donoghoe MC (Eds) HIV/AIDS in Europe: Moving from death sentence to chronic disease management. World Health Organization. Copenhagen: Denmark. 2006; ISBN Puoane T and Hughes GD. Impact of the HIV/AIDS pandemic on non-communicable disease prevention. South African Medical Journal, 2005; 95 (4): Reagon G and Igumbor EU. Strengthening health systems through training of health care providers in the conduct of routine waiting time and system efficiency surveys. (In press). 10. Sanders D, Igumbor E, Lehmann U, Meeus U, Dovlo D. Public health in Africa In: Beaglehole R and Bonita R (Eds). Global Public Health: A New Era, (2 nd Edition) Oxford University Press, 2009: ISBN Scandlyn J. When AIDS became a chronic disease. Western Journal of Medicine 2000; 172: Stabinski L, Pelley K, Jacob ST, Long JM, Leaning J. Reframing HIV and AIDS. British Medical Journal 2003; 327: Tsolekile L, Puoane T, Zulu J. You are thin and sick, I m fat and healthy. Paper presented at the Public Health Association of South Africa Conference. Challenging Health Inequalities; Forging Progressive Partnership for Public Health. Durban, 6-8 June Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Effective Clinical Practice 1998; 1: Seventeenth Conference on Retroviruses and Opportunistic Infections, San Francisco, USA February, 2010