云南省临沧市临翔区艾滋病“五位一体”联合“全生命周期”综合管理模式的应用

Application of"Five-in-One"and"Full Life Cycle Care"Comprehensive Management Model of AIDS in Linxiang District,Lincang City,Yunnan Province

云南省临沧市临翔区为适应当地现阶段艾滋病防治要求,充分发挥医共体优势,建立并应用了艾滋病“五位一体”并“全生命周期”综合管理模式。主要是在当地卫生行政部门领导下,整合区医院、区妇幼保健院、区中医医院、区疾控中心和下辖10家社区卫生服务中心/乡镇卫生院资源,明确分工,协同工作,“五位一体”为辖区HIV/AIDS患者提供HIV检测咨询、结果告知、动员治疗、新患者ART咨询、检测评估、有效抗机会性感染治疗、规范化ART、疗效评估、服药依从性教育和支持、预防性健康教育、ART转诊转介、高危人群联动干预、脱失患者联动找回等,并同时开展社会心理支持。同时,建立以感染科为枢纽的患者“全生命周期”临床诊疗服务模式,形成了儿科、心内科、内分泌科、骨科、外科、重症ICU、康复科等多个学科会诊、转诊机制,实现了HIV/AIDS患者获得更良好生活质量的目标。

In order to meet the local requirements of AIDS prevention and treatment at this stage,Linxiang District,Lincang City,Yunnan Province has established and applied the"five-inone"and"full life cycle care"comprehensive management model of HIV/AIDS,mainly under the leadership of the local health administrative department,integrating the resources of district hospitals,district maternal and child health hospitals,district traditional Chinese medicine hospitals,district centers for disease control and prevention and ten community health service centers/township health centers under its jurisdiction,with a clear division of labor and collaborative work,and"five-in-one"as the jurisdiction of HIV/AIDS patients provide HIV testing consultation,result notification,mobilization treatment,new patient ART counseling,testing and evaluation,effective antiopportunistic infection treatment,standardized ART,efficacy evaluation,medication adherence education and support,preventive health education,ART referral,high-risk group linkage intervention,and linkage recovery of lost patients,etc.,and at the same time carry out psychosocial support.At the same time,the"whole life cycle"clinical diagnosis and treatment service model of patients with infectious diseases as the hub has been established,and a consultation and referral mechanism has been formed for pediatrics,cardiology,endocrinology,orthopedics,surgery,intensive care ICU,rehabilitation and other disciplines.The goal of the better quality of life for HIV/AIDS patients was achieved.