Managing TB, HIV and viral hepatitis in Primary care
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Alexandre Lourenço's keynote on "Managing TB, HIV and viral hepatitis in Primary care", at the international conference "Primary health care policy and practice: implementing for better results", organized by WHO/Europe, together with UNICEF and the Government of Kazakhstan, 2023.
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Managing TB, HIV and viral hepatitis in Primary care
- 1. Managing TB, HIV and viral hepatitis in Primary care EU country perspective on primary-care based model Alexandre Lourenço Hospital Administrator, Coimbra Hospital and University Centre Adjunct Assistant Professor, NOVA School of Public Health www.alexandrelourenco.pt
- 2. Weak coordination & integration among different service providers Rigidness of services Inadequate, unskilled and staff Not evidence-based interventions and procedures Stigma and Discrimination environment Examples of inadequate services 17-19 October 2018 -- Tbilisi, Georgia Towards integrated, people-centered and efficient health services for impactful response to HIV, TB and malaria
- 3. 17-19 October 2018 -- Tbilisi, Georgia Towards integrated, people-centered and efficient health services for impactful response to HIV, TB and malaria Conceptual framework of integrated people-centred health services © 2020 ALEXANDRE LOURENÇO CONFIDENTIAL AND PROPRIETARY Country setting & development status Other sectors: education, sanitation, social assistance, labour, housing, environment & others Health sector: governance, financing & resources < Service delivery: Networks, Facilities & practitioners PERSON
- 5. hospital admission in adults, 2019 (or nearest year) and 2020 Asthma and COPD Congestive heart failure Diabetes
- 6. The program is centered on Primary Health Care and sustained by the Pulmonary Diagnostic Centers (CDP) Pulmonary Diagnostic Centers Family Health Units Public Health Unit Inpatient Hospital Outpatient A&E Drug addicts treatment centers Outreach programs CDP Ambulatory services Prevention, diagnostic (including contact tracing) and treatment of tuberculosis, in its many forms. Family doctors, pulmonologists, nurses, X- ray technicians, and administrative staff. Some of them also have pediatricians or infectious disease specialists in their staff. At least one center in each district.
- 7. The key role of the dispensaries (1902) LANCASTRE, António de - O valor dos dispensários na lucta contra a tuberculose. A Medicina Moderna. Porto: Imprensa Civilisação. Vol. 3, n.o 107 (1902), pp. 366-367.
- 8. Patient centered clinical pathway DOT managed by a multidisciplinary health team Decision to initiate treatment is based on a probable diagnosis Clinical evaluation and collection of samples for laboratory testing A person with presumptive TB CDP At Home According to patient needs Contagious period
- 9. Prevention Continuum Care Continuum Testing & Counselling Entry point NGOs Volunteers PLWA Outpatient care Social care Specialists & Specialized facilities Paliative care & Self-care Primary Healthcare Secondary care Community care Tertiary care Home care Group support PHC centres Diagnostic centres Addiction treatment centre
- 10. The example of the HIV Testing and diagnostics strategies Methodologies • Medical prescription • Voluntary Point of care • Self-test Contexts • PHC centers • Walk In Diagnostic centers • CDP - tuberculosis • Addiction Treatment centers • NGOs (including outreach) • Community pharmacies • Hospitals • Prisons
- 11. Rapid tests: 50 518 tests 34% PHC centers (+) 0,06%) 62% NGOs (+) 1,37%) 3,6% Walk In Diagnostic centers (+) 2,3% PHC prescribed tests: 282 874 tests Self-tests: 8 133 tests HIV Testing and Diagnostics 2021
- 12. Challenges PHC • Work overload at the FD level • Priority given to more prevalent conditions by PHC teams • Increased role of community pharmacies • Key populations lack trust in formal PHC Challenges specialized services • Medical specialties with low attractiveness • Low prevalence questions the existence of some dedicated providers Take home messages
- 13. New organizational models, bringing together primary healthcare and hospital services within the same umbrella organization Care integration is an opportunity to strengthen HIV TB and viral hepatitis 13
- 14. Obrigado! Alexandre Lourenço Hospital Administrator, Coimbra Hospital and University Centre Adjunct Assistant Professor, NOVA School of Public Health www.alexandrelourenco.pt
Editor's Notes
- The Portuguese National Health Service (NHS) aims at the comprehensive coverage on a universal basis and is predominantly funded through general taxation and comprises all services and public entities providing health care, namely: groups of primary care centers (ACES), hospitals and local health units (LHUs). NHS has a National Health Plan and the National Tuberculosis Program (NTP) is a part of it. TB diagnostic and treatment are delivery through NHS free of charge. NTP is managed by a national committee with seven regional branches, and it is responsible for the regulation, guidance and coordination of all TB activities, as well as defining the technical conditions for proper care and planning of national health policy. The program is centered on Primary Health Care and sustained by the Pulmonary Diagnostic Centers (CDP). CDP are responsible for the prevention, diagnostic (including contact tracing) and treatment of tuberculosis, in its many forms. These ambulatory services are constituted by family doctors, pulmonologists, nurses, X-ray technicians, and administrative staff, and it least there is one center in each district. Some of them also have pediatricians or infectious disease specialists in their staff.