ANÁLISE DA DESCENTRALIZAÇÃO DO COMPARTILHAMENTO DO CUIDADO DA PESSOA VIVENDO COM HIV (PVHA) À ATENÇÃO PRIMÁRIA À SAÚDE EM CAMPO GRANDE, MS.

Abstract

The decentralization of care for people living with HIV (PLWHA) in Primary Health Care had its initial milestone in 2013, but the municipality of Campo Grande (MS) only incorporated this guideline in 2019, with the systematization of care in 22 care units Health Units (APS), also known as Antiretroviral Medication Dispensing Units (UDM). In this context, the present study aimed to evaluate the decentralization of Care Sharing from PLWHA to PHC in Campo Grande – MS. This is a quantitative, analytical study that was carried out with medical professionals, nurses, pharmacists, managers and UDM users. Primary data were collected through the application of two structured forms. One of these, was adapted from QualiAids, and evaluated aspects corresponding to the structure and process. The second, authored by the researcher herself, was answered by PLWHA undergoing treatment at these health units, from which it was possible to assess the satisfaction of these users with the health service. The collected data were organized in an Excel spreadsheet and then analyzes were performed. The information was described with absolute and relative frequencies, presenting the data distribution in detail. Next, Fisher's Exact test was used to analyze the associations between users' assessments and the vulnerability of the neighborhoods of the health units where they follow up in the PHC. For these association analyses, the neighborhoods of the units were classified as low (0.05 to 0.45), medium (0.46 to 0.61) and high social vulnerability (0.62 to 0.96), based on of social exclusion indexes in the neighborhoods. All analyzes were performed using the R program, considering a significance level of 5%. The results were organized by categories, performing the presentation of the general categorization of the results obtained through primary and secondary data, followed by the presentation of the results considering the four essential attributes for the actions and services of the PHC, being presented in (1) access to the individual's first contact with the health system; (2) longitudinality of care for PLWHA; (3) comprehensive care; and (4) coordination of care for PLWHA, and finally the evaluation of users of Care Sharing Units for people living with HIV (PLWHA) with vulnerability. The results of the study indicated that the medical consultation time for new PLWHA is 30 to 45 minutes and the return visits are 15 to 30 minutes; the medical professional identifies the need to refer PLWHA to another professional and other services; activities are not carried out in the waiting room; the main reason for looking for extra appointments is lack of medication; ARV dispensing is carried out by SICLOM and although user satisfaction is high, the waiting time for the consultation is something that bothers. Among the health care strategies offered to HIV in PHC, the study pointed out the potential for access to diagnosis and timely treatment in the territory close to the home of the PLWHA, important factors for the attachment and retention of this user to the public service, whose main objective is to viral suppression. These care strategies for PLHA meet the essential attributes of PHC in terms of first contact access; longitudinality; coordination and completeness of care for PLWHA and the services that can be accessed, given that HIV is a chronic disease with a significant reduction in morbidity and mortality within the roll of diseases that the health team in the territory needs to manage. The study also pointed out a high degree of satisfaction of the PLWHA who attend the UDM, highlighting the organization of the units and service provided by the reception and the health team. Regarding the follow-up of PLWHA, 65.05% do not have advanced disease and 94.18% diagnosed during the period are alive. With regard to individual and contextual factors that interfere in the health-disease process of PLWHA, three issues were highlighted: satisfaction with the hygiene, cleanliness and organization of the unit; reception service (kindness, attention, information) and, service and treatment received by the health team. The systematic evaluation model incorporated in the decentralization of Care Sharing for PLHIV in PHC produced in this study can influence decisions based on scientifically validated data and support political management strategies, socially appropriate for strengthening the PLHIV Assistance Policy. Descriptors: HIV 1; primary health care; evaluation of health care processes; Family Health Strategy