Maxay tahay sababta ay tahay in ay ka welwelsan tahay dhammaanteen
Cascade Daaweynta HIV waa habka wakiil ee ay isticmaasho hay'adaha federaalka, gobolka iyo degaanka si loo ogaado khariidooyinka daryeelka ee dadka qaba HIV. Sidoo kale loo yaqaan ' Continuous Care Continuous Care' , moodalku wuxuu bixiyaa sharaxaad adag oo ah saamiga Americans ee ku hawlan tallaabo kasta oo ah daryeelka HIV ee amarka soo koobaya:
- Qiyaasta tirada dadka qaba cudurka HIV;
- Qaybta la ogaaday ;
- Qeybta la xiriirta daryeelka;
- Qaybta lagu hayo daryeelka;
- Qiyaasta u baahan daaweynta antiretroviral;
- Qaybta dhabta ah ee hela teraabiyada, iyo;
- Heerka awood u leh inuu ilaaliyo culeyska fayruuska aan la ogaan karin (oo loo tixgelinayo qiyaasta daaweynta guusha).
Tusaalaha ayaa markii ugu horreysay ku sharxay Dr. Edward Gardner iyo asxaabtiisii ka tirsan Waaxda Caafimaadka Denver bishii Maarso 2011ka. Falanqaynta ayaa lagu ogaaday in ay ahayd wax aad u yar oo u dhexeeya talaabo kasta oo ka mid ah sii wadida ilaa meesha uu abuuray haram rogan marka la geliyo shaxda gaaban ( fiiri sawirka ).
Marka ugu badan ee uu ku dhaco, waxa Cascade Daaweyntu muujinayso in qiyaastii 1.2 milyan oo Maraykan ah lagu qiyaasey inay qabaan HIV, keliya 25% kaliya ayaa si guul leh u socdaalaya joogitaanka xanuunka ka yimid cudurka dabiiciga ah si loo daweeyo si looga hortago hawlaha fayraska HIV.
Hase yeeshee, 66% ee hore ee la xidhiidhay daryeelka, ku dhawaad kala badh kuwa (qiyaastii 219,000 qof) ayaa lumay inay raacaan ama aysan awoodin in ay helaan daryeel gaar ah HIV.
In kastoo ay jiraan horumarin ku saabsan baaritaanada bukaanka iyo isku xirnaanta xanaaneynta laga soo bilaabo 2010 illaa 2012 (kordhinta 2% iyo 4%, siday u kala horreeyaan), khasaarihii u dhexeeya 3% iyo 4% ayaa lagu qoray dhammaan qaybaha kale.
Waa maxay Cascade Daaweynta HIV
Tirooyinkani waxay hoosta ka xarriiqayaan caqabadaha hortaagan siyaasad-dejiyeyaasha sida ku cad xeerarka hadda ee Maraykanka ee ku baaqaya inaanay kaliya baaritaanada HIV-da ee dhammaan dadka Maraykanka da'doodu u dhaxayso 15-65 laakiin waxay sidoo kale ku baaqeysaa in la bilaabo daweynta HIV ee waqtiga baaritaanka iyada oo aan loo eegin tirinta CD4.
Ugu dambeyntii, ujeedada siyaasadahan waa in si wax ku ool ah loo daaweeyo dad badan oo suurtogal ah si loo yareeyo sida loogu yeero "viral load community" (CVL) oo ku dhex jira dadweynaha tiro badan. Marka sidaas la sameeyo, faafidda HIV-ga ayaa si aad ah hoos ugu dhigi karta sida infekshanka dadka si tartiib tartiib ah loo yareeyo.
Si kastaba ha noqotee, waxay ka jawaabaysaa su'aasha ah in hadafyadani ay noqdaan kuwo dhab ah oo la gaaro iyada oo la adeegsanayo isbeddel weyn oo ku yimid daryeelka bukaanka, gaar ahaan dadka Afrikaan ah oo aan u badneyn inay xiriir la leeyihiin daryeelka (62%) oo ay u badantahay in ay gaaraan cirridka fayraska (21% ).
Dhalinyarada Maraykanku (da'doodu u dhaxayso 25-34) way ka sii liidataa, iyada oo 56% kaliya ay ku xidhan tahay daryeelka iyo kaliya 15% oo gaari kara culeyska fayruska aan la ogaan karin.
Intaa waxaa dheer, qaar ka mid ah ayaa ku dooday in, sida qalab, CVL waa calaamad khasaare ah ee faafinta infekshanka iyada oo ay hoosta ka xariiqeyso saameynta shakhsiyaadka leh fayraska fayraska oo sarreeya iyada oo hoos u dhigaysa culeyska fayruska kuwa aan weli la ogaan.
Mid ka mid ah daraasaddan oo ay samaysay Jaamacadda Chapel Hill, North Carolina ayaa soo jeedisay in CVL ay, dhab ahaantii noqon karto laba jeer oo hadda la soo sheego markii la sameeyo isbedelka epidemiological.
Xiritaan la'aanta
Si loo xakameeyo qaar ka mid ah barraaqyada joogtada ah ee daryeelka caafimaadka, nidaamyada daryeelka caafimaad ee kor u kaca ayaa waxaa baaraya hay'ado badan oo dawlad goboleedyada iyo degmooyinka. Ujeedooyinka ugu muhiimsan:
- Bixinta helitaanka daryeel gaar ah HIV, gaar ahaan beelaha la sooco. Kordhinta helitaanka Medicaid iyo caymiska caafimaadka gaarka ah ee hoos yimaada Xeerka Daryeelka Lacagta la Yiqiin karo ayaa kaa caawin kara yareynta farqiga caafimaad ee dadka dhibaateysan.
- Isku day inaad qaadatid baaritaanka, isku xirka daryeelka, iyo daaweynta bukaanka ee xarun isku dhafan (nidaam caan ah oo loo yaqaan TCL-Plus). San Francisco, Los Angeles, Birmingham, iyo Washington, DC ayaa ka mid ah magaalooyinka Maraykanka si joogto ah loogu qadaray inay soo bandhigaan hababka ugu wanaagsan ee TLC-Plus.
- Kicinta dadaallada lagu helayo bukaannada "lumay" oo dib loogu xiro si ay u daryeelaan. Sannadkii 2013, Waaxda Caafimaadka ee Magaalada New York iyo Nadaafadda Maskaxda waxay heshay 689 oo bukaan ah 797 bukaanno bukaanno ah oo la waayay, kadibna waxay dib u soo celiyeen 77% iyaga daryeel caafimaad oo haboon.
- La wadaag diiwaanka caafimaadka elektiroonada u dhexeeya hay'adaha caafimaadka ee la oggol yahay si loo hubiyo "faafinta elektaroonikada" kuwa kuwa lumay inay raacaan ama u baahdaan daaweyn. Intii u dhaxaysay 2009 iyo 2011, Waaxda Caafimaadka ee Louisiana waxay awood u yeelatay inay aqoonsato oo ay u feejignaato 345 bukaanno qaba HIV-ga iyada oo loo marayo Lacagta Macluumaadka Caafimaadka Bulshada ee Lambarka Bulshada (LaPHIE), oo ah xog dhab ah oo macluumaadka caafimaadka ah.
- Raadi habab cusub iyo dhaqameed si loo hagaajiyo xajinta dadka dhexdiisa daaweynta antiretroviral. Tani waxaa ka mid ah isdhexgalka sii-socodka bukaanka. Daraasaduhu waxay soo jeedinayaan in bukaanka hal dhakhtar booqdo sannadkiiba 94% ay u badan tahay inuu jirrado ama u dhinto qof ka kooban afar. Isdhexgalka dhakhtarka-bukaanka sii kordhaya ayaa sidoo kale xiriir la leh xoojinta xajinta daroogada.
Ilaha:
Cohen, M .; Miller, W .; Awoodaha, K.; iyo Smith, M. "Bulshada Viral Loads sida Measur ah Qiimeynta Daaweynta HIV sida Ka Hortagga." Lancet Cudurrada faafa. May 2013; 13 (5): 459-464.
Gardner, E .; McLees, M .; Steiner, J .; et al. "Miisaaniyadda Is-dhexgalka ee Daryeelka HIV-ga iyo Ujeedadeeda Tijaabinta Istaraatiijiga-iyo-Daaweynta ee Ka-hortagga Caabuqa HIV-ga." Cudurada Cudurrada Cudurrada ah. Maarso 2011; 52 (6): 793-800.
Giordano, T .; Gifford, A .; White, A ;; et al. "Daryeelka Daryeelka: Caqabadda Lagu Helo Hurgumada HIV." Cudurada Cudurrada Cudurrada ah. Julaay 4, 2007; 44 (11): 1493-1499.
Herwehe, J .; Wilbright, W .; Abrams, A .; et al. "Hirgelinta Diiwaangelinta Caafimaad ee Midaysan, Isdhexgalka Dakhliga ee Electronic (EMR) iyo Isdhaafsiga Macluumaadka Caafimaadka Bulshada ee HIV / AIDS." Wargeyska Ururka Macluumaadka Caafimaadka Maraykanka. May-Juunyo 2012; 19 (3): 448-452.
Mashruuca Barnaamijka. "TLC +: Hababka ugu Fiican ee Hirgelinta Kobcinta Imtixaanka HIV-ga, Isku-xirka Daryeelka, Plus Treatment (TLC-Plus) Istaraatijiyadaha Afar Maraykan ah." San Francisco, California; Agoosto 2011.
Udeagu, C .; Webster, T .; Bocour, A .; et al. "Lost ama Only Non-follow up: Hadafka Caafimaadka Bulshada ee Dib-u-Shaqeynta Dadka Qabaa Cudurka HIV-ga Lost Inay Raacaan Daryeelka Caafimaadka HIV." AIDS. Sebtembar 10, 2013; 27 (14): 2271-2279.
Xarumaha Xakamaynta iyo Kahortagga Cudurrada Maraykanka (CDC). "Warqada Xaqiiqda CDC | HIV-ga ee Mareykanka: Heerarka Daryeelka." Atlanta, Georgia; la daabacay July 2012.