Suchergebnisse

Introdução: A presente agenda global de saúde para o VIH/SIDA visa mobilizar os países de todo o mundo para enfrentar as principais lacunas na resposta ao VIH. A ONUSIDA estabeleceu metas ambiciosas para o tratamento do VIH para serem atingidas até 2020. A OMS recomenda que abordagens baseadas na evidência e estratégias inovadoras, incluindo a profilaxia pré-exposição (PrEP) e o autoteste de VIH, façam parte das respostas nacionais à epidemia de HIV. Este compromisso global sem precedentes foi lançado após uma grave crise financeira global, que forçou muitos países a reduzir a despesa em saúde. Este estudo teve como objetivo analisar os potenciais efeitos desses constrangimentos financeiros na resposta e políticas nacionais para o VIH em Portugal, no contexto de outros países do sul da Europa que também receberam programas de assistência financeira. Métodos: Para os objetivos deste estudo, foram realizadas quatro análises, utilizando diferentes abordagens metodológicas: a) Foi utilizado um modelo hierárquico de regressão de Poisson com efeitos aleatórios para analisar a relação entre o tempo de internamento e variáveis do doente, dos cuidados de saúde e do contexto, utilizando dados nacionais de 20,361 internamentos ocorridos entre 2009 e 2014 em 41 hospitais públicos em Portugal; b) Para o período 2009-2018, foram analisados os resultados dos programas de prevenção do VIH em Portugal: apoio financeiro a organizações privadas sem fins lucrativos, programa de troca de seringas, teste rápido de VIH e distribuição de materiais preventivos; c) Para o período 2005- 2017, foram analisados os dados de vigilância de do VIH/SIDA em Portugal, usando análise descritiva e modelos de regressão linear para testar tendências nos novos diagnósticos de VIH e SIDA e diagnósticos tardios de VIH; d) Foram examinados e comparados um conjunto de indicadores de VIH no Chipre, Grécia, Portugal e Espanha, países que receberam assistência económica da União Europeia durante a crise financeira. Resultados: Este estudo constatou que o tempo de internamento dos doentes com VIH/SIDA entre 2010 e 2014 nos hospitais públicos portugueses foi significativamente menor em comparação com 2009, e que diversas variáveis, incluindo sexo feminino, internamento urgente, mortalidade hospitalar, pneumonia pneumocystis, hepatite C, e o rácio de liquidez do hospital contribuiu para a diminuição do tempo de tempo de internamento dos doentes com VIH/SIDA entre 2009 e 2014. Este estudo também mostrou que, apesar dos cortes transitórios de despesa em 2012-13, o Programa Nacional para a Infecção VIH e SIDA conseguiu melhorar a sua eficiência e manter as suas actividades principais, graças à priorização de gastos na expansão do teste de VIH e a um forte envolvimento com organizações da sociedade civil. A análise das tendências do VIH entre 2005 e 2017 mostrou uma redução significativa das novas infecções em todos os grupos, excepto nos homens que têm sexo com homens (HSH), onde foi observada uma tendência de aumento não significativa. O diagnóstico tardio ainda é comum em todos os grupos de transmissão, excepto nos HSH, enquanto a aquisição de VIH no estrangeiro é relevante entre pessoas nascidas fora de Portugal, excepto entre utilizadores de drogas. A análise comparativa com outros três países do sul da Europa que receberam assistência económica mostra que Portugal é o único país que implementou PrEP e autoteste de VIH. Portugal atingiu as metas 90-90-90 da ONUSIDA para o tratamento do VIH em 2017. Conclusão: Os resultados deste estudo mostram que os constrangimentos financeiros com que Portugal se defrontou não prejudicaram o progresso do país em relação à eliminação da SIDA até 2030, tornando Portugal um estudo de caso interessante no contexto europeu. ; Background: The current global health agenda for HIV/AIDS aims to mobilise countries worldwide to address major gaps in HIV response. UNAIDS has set ambitious targets to HIV treatment to be met by 2020. WHO recommends that evidence-based approaches and innovative strategies, including pre-exposure prophylaxis (PrEP) and HIV selftesting (HIVST), should be part of countries' response to the HIV epidemic. This unprecedented call for a global commitment against HIV/AIDS came in the aftermath of a severe global financial crisis that forced many countries to cut health care spending. This study aimed to analyse the potential effects of these financial constraints on the response to HIV/AIDS and associated national policies in Portugal, in the context of other Southern European countries that also received bailout programmes. Methods: For the purposes of this study, four analyses were conducted, using different methodological approaches: a) Hierarchical Poisson regression model with random effects was used to analyse the relation between length of stay and patient, treatment and setting characteristics, using national data from 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals in Portugal; b) For the period 2009-2018, we analysed the outcomes of HIV prevention programmes in Portugal which included: financial support to private non-for-profit organisations; syringe exchange programme; HIV rapid testing; and distribution of preventive materials; c) For the period 2005-2017, we analysed Portuguese HIV/AIDS surveillance data, using descriptive analysis and linear regression models to test for trends in new HIV and AIDS diagnoses and late HIV diagnoses; d) We examined and compared a set of HIV indicators in Cyprus, Greece, Portugal and Spain, countries which received economic assistance from the European Union during the financial crisis. Results: This study found that length of stay of HIV/AIDS patients in Portuguese public hospitals between 2010 and 2014 was significantly shorter compared to 2009, and that a number of variables, including being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contributed to the decrease of HIV/AIDS patients' length of stay between 2009 and 2014. Findings also showed that, despite transitory spending cuts in 2012-13, the Portuguese HIV/AIDS Programme was able to improve its efficiency and sustain its core activities, thanks to prioritisation of spending in HIV testing expansion and a strong engagement with civil society organisations. The analysis of HIV trends between 2005 and 2017 has shown a significant decline in new HIV infections in all groups, except in men who have sex with men, where a non-significant increase trend was observed. Late diagnosis remains common in all transmission groups, except in MSM, while foreign acquisition of HIV is relevant among foreign-born persons, except in people who inject drugs. The comparative analysis with other three Southern European countries that received economic bailout assistance shows that Portugal is the only country that implemented both PrEP and HIVST. Portugal met the UNAIDS 90-90-90 targets for HIV treatment in 2017. Conclusion: Results from this study show that financial constraints experienced in Portugal have not hampered the country's progress towards eliminating AIDS by 2030, making Portugal an interesting case study in the European context.

Funding Information: The authors with to thank FCT (Fundação para a Ciência e Tecnologia) for funds to GHTM – UID/. Publisher Copyright: © 2020 Elsevier B.V. ; The Portuguese National Health Service (NHS) was established in 1979. Since its inception, the relationship of the NHS with private-for-profit and private-non-profit organisations has been controversially discussed between left and right-wing political parties, and this has also led also to academic debate. In 1990, a Health Basic Law was approved by right-wing parties, which allowed public-private partnerships (PPPs) in the health system and led to an increased role of the private sector in health care provision. During the 2015 general elections, the role of PPPs in the health system was an important topic of discussion, with all left-wing parties calling for an end of PPPs in the NHS. In 2019, after two years of intense political controversies, left-wing parties supporting the minority socialist government approved a new Health Basic Law. This paper analyses the process of policy formulation, tracing the process of adoption and the views of the main political parties involved. Although some parties wished to eliminate PPPs and to mandate that services in the NHS should be provided exclusively by public providers, this was not included in the final version of the law. Nevertheless, the new Health Basic Law re-enhances the central role of the NHS in the health system, clarifying that the private and non-profit sectors should only play a complementary role. ; publishersversion ; published

Publisher Copyright: © 2021 John Wiley & Sons Ltd. ; The time and type of the States' responses to the COVID-19 pandemic varied with the severity of the epidemiological situation, the perceived risk, the political organisation and the model of health system of the country. We discuss the response of Germany, Spain, France, Italy, Portugal and the United Kingdom during the first months of the COVID-19 epidemic in 2020, considering the political organisation of the country and its health system model. We analyse public health measures implemented to contain or mitigate the pandemic, as well as those related to governance, resources and reorganisation of services, financing mechanisms, response of the health system itself and health outcomes. To measure the burden of COVID-19, we use several indicators. The adoption of measures, to contain and mitigate epidemic varied in degree and time of adoption. All countries reorganised their governance structure and the provision of care, despite the differences in political models and health systems (ranging from a more unitary and centralised political organisational model—France and Portugal; to a decentralised matrix—Germany, Spain, Italy and the United Kingdom). Rather than the differences in political models and health systems, the explanation for the success in tackling the epidemic seems to lay in other social determinants of health. ; published

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour. ; Sí

Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.