HIV and AIDS, Italy late in fighting the disease
After two years, entirely dedicated to both the health and media level to the Covid-19 pandemic with all its new variants, someone tries to focus attention on other medical problems and tackles the problem of how our country is equipped to fight them . This is the case, for example, with HIV. Where are we, for example, with the implementation of PNAIDS, the National Action Plan against HIV and AIDS?
Aids, a national study by SDA Bocconi and Gilead Sciences
We talked about it with Lucia Ferrara, “Lecturer” and Researcher at CERGAS SDA Bocconi. “To answer this question – the doctor confirms – the study was born APRI – Aids Plan Regional Implementation created by SDA Bocconi School of Management with the contribution of Gilead Sciences. Understanding what has been done at the regional level to combat the spread of HIV and to take care of HIV + patients is the first step to improve access to tests, bring out the undeclared diagnostic and implement diagnostic therapeutic care pathways that have a positive relapse in terms of the course of the disease and the patients’ quality of life “. And what are the results that emerge? “The first photograph taken showed a not exactly comforting picture: in 2019, only half of the Regions had implemented the PNAIDS with regional resolutions, only in 38% of cases the Regional AIDS Commission was appointed and only 37% of the Regions had carried out communication campaigns for the target populations and only 28% had defined an HIV PDTA ”.
Aids, the new challenges to face
Yet much has been done against this disease? “It is certainly true. Forty years after its discovery, much has already been done in the fight against HIV, but the new challenges posed by the aging of the population, the chronicization of the disease and the increase in comorbidities, as well as therapeutic advances require a revision of the current model. organizational and patient care, from diagnosis to follow-up. It is necessary to invest in vertical and horizontal integration among the various actors involved in taking care of patients, from the territory, to general medicine, to specialists, to the community to achieve the objectives set by UNAIDS to 2025, or “the six 95%” for which it is hoped that 95% of HIV-positive people are aware of their status, that 95% of diagnosed people have access to antiretroviral therapies, that 95% of those in treatment obtain viral load suppression, that 95% of women of reproductive age are assisted by a health service that ensures their needs in terms of sexual and reproductive health and for the treatment of HIV; that there is 95% coverage of services for the elimination of vertical transmission of the virus and, finally, that 95% of people at risk of contracting HIV have access to a combination of personalized, appropriate and effective options “.
AIDS, many delays in fighting the disease highlighted
Did the project stop at this photograph? “Absolutely no. Given the initial photograph of an Italy at different speeds in the implementation of PNAIDS, with delays in terms of communication, awareness, access to tests and patient care paths, we have launched a second phase, APRI 2.0, which could support some Regions in the development of exploratory lines of intervention and organizational and managerial responses to apply of the specific actions of the PNAIDS. The project has seen the constant comparison and collaboration of the actors involved at local and regional level to favor the circulation of information and knowledge. Not only: it was a precious opportunity to create connections and encourage collaboration between these various actors and to identify the change management levers to be activated to initiate change processes “
Aids, the four regional cases studied
And how did you move? “Starting from the critical issues that emerged, we have therefore developed four case studies to give concrete answers to the priority areas of intervention and the needs that have emerged. It is therefore necessary to strengthen the communication programs addressed to the target populations, to promote strategies and interventions of continuous awareness, to spread the culture and access to the test, to invest in the continuous care of the patient “. Some concrete examples at the regional level? “I can give you four related to the Piedmont Region, Puglia, Sicily and Veneto. With the aim of improving the opportunities for access to screening and linkage to care for taking care of people with HIV, the case study was born with the Piedmont Region, which saw coordinated and integrated action between services person and community. Thus, new potential forms of connection and coordination were identified between the District, Hospital, SERD and the Department of Prevention “.
Aids, in PUglia greater integration between hospital and territory
“Goal instead of the case study of Puglia was to lay the foundations for strengthening the hospital-territory connection / integration as a basis for the creation of the Apulian infectious disease network. In fact, concrete actions were identified to strengthen the forms of coordination and highlighted the importance of a greater investment in integration between the various actors in the management of the disease. The case of Sicily, instead, aimed at understanding how to improve the path of integrated patient care and how to govern the supply chain, it has made it possible to identify the standards that must be guaranteed throughout the region in the various phases of diagnosis, treatment and follow-up and to identify a set of indicators for monitoring patient pathways. “
Aids, work in Veneto
Lastly, the Veneto case aimed to investigate the perception of HIV + patients towards telemedicine. With the aim of developing a pilot model for taking care of patients with HIV in a multichannel logic, the opportunities associated with remote patient care have been identified: multi-channel, tele-consultation, television. And what are your latest considerations on the entire project?“The project YOU OPEN testifies how the fight against the HIV pandemic can only be carried out through a synergistic commitment and collaboration between various stakeholders. The commitment made by the institutions on the occasion of the national day against HIV was to contribute to eliminate the structural and managerial-organizational limitations that prevent an effective fight against the spread of the virus. On the same occasion the first was signed Manifesto for a renewed commitment in the fight against HIV, without barriers in the implementation on the territory and without gaps between regions “.