oa South African Health Review - HIV and AIDS, STI and TB in the private sector : health care delivery
This chapter reviews the delivery of HIV and AIDS, sexually transmitted infections and tuberculosis care within the private sector. The orientation and approach to these infectious diseases within the private sector is different to the public sector as each disease is treated vertically as a discreet episode and a client could consult three different service providers to obtain treatment and care for each of these diseases. This presents a major challenge in delivering continuity and quality of care. A clear limitation of this chapter is the focus on treatment and not prevention as this is the orientation of the private sector.
There are some 100 000 patients receiving HIV and AIDS care within disease management programmes in the private sector and approximately 67 600 are currently receiving Highly Active Antiretroviral Therapy. HIV and AIDS still remains stigmatised, resulting in the majority of clients enrolling late for treatment on disease management programmes. Treatment for sexually transmitted infections is known to be of poor and variable quality in the private sector with general practitioners not being sufficiently knowledgeable about the World Health Organization's syndromic management of sexually transmitted infections. However, there are examples of public-private partnerships which have proven to be cost effective in tuberculosis case management and these include employer-based private providers, private for-profit providers and private not-for-profit providers. Given the interrelatedness of these diseases, it would be important to model partnerships to deliver integrated comprehensive disease management programmes.
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