PALERMO (ITALPRESS) – Health policy and clinical research, present and future of national infectious diseases, between resistance to antimicrobials regulated in the PNCAR, the fight against hepatitis, the new scenarios of Covid-19, initiatives against The hiv. These are some of the issues discussed by more than 200 specialists at the Meeting on the new models of clinical-managerial governance in Health, which takes place in the town of Mondello, in Palermo.
“Today’s conference is a very broad window on the new challenges of infectious diseases for the coming years, they are challenges that we know, that we have been following for years, the fight against HIV, the fight against viral hepatitis C, to all sexually transmitted diseases, and then the fight against resistant microorganisms – said Salvatore Requirez, director of the regional health secretariat -. There are sections within this conference that are very specifically targeted and will allow training goals to be achieved, such as homogeneity of preparation to build skills beyond the knowledge of not only infectious disease physicians, but all physicians operating in the area. medical. ”.
“We are on the eve of a transition season – Requirez stressed – there will be new general directorates in Sicily, there will be new corporate documents. There is a need to intervene in a homogeneous way in the models, because the clinical management must find an organizational response that is not only homogeneous but also easily applicable. For this, the department that I lead will intervene both at the training level and at the planning level to give the direction of a planned organization with respect to the distribution and size of the infectious disease structures that will have to become operational in our region. from the assignment of new assignments. We need to think about completely different organizational models than the ones that saw us face the coronavirus infection in the first months of 2020, namely the possibility of organizing cross-functional models that refer to inter-company departments. Finally launch a system of collaboration between the different companies that contemplates the modularity of some disciplines in the medical area that are made more flexible depending on the urgency to guarantee the availability, at least sufficient, of the necessary beds for the most complete and timely assistance ”.
The conference is proposed as a starting point for a new synergy of the national network of infectious diseases. In fact, among the topics addressed will also be resistance to antibiotics, hepatitis, the new scenarios of Covid-19, vaccines in the fragile patient. The presidents of the Congress are Chiara Iaria, director of the Infectious and Tropical Diseases Unit-ARNAS Civico Di Cristina Benfratelli, Palermo, and Antonina Franco, director of the Infectious Diseases Unit of the Umberto I Hospital in Syracuse. The Congress is sponsored by the Istituto Superiore di Sanità, the Department of Health of the Sicilian Region, the Municipality of Palermo, the Hospital Cívico Di Cristina Benfratelli, the Italian Society for Infectious and Tropical Diseases. In the opening greetings, the interventions of local institutions are expected, among others. The National Meeting is proposed as a starting point for a new synergy of the national network of infectious diseases, but there is no lack of interest in current issues.
“We understood that at this stage about Covid-19 we should not be alarmists but we should be careful – said Massimo Andreoni, Scientific Director of SIMIT, about the new Xbb variant of Covid-19 found in China -. Data coming out of China tells us that this new Xbb variant is starting to make the rounds and has clearly become mainstream. Today we are almost 90%, there are an estimated 67 million cases in China; the virus has lost virulence, but it is the immunity of the population that makes the difference, so we must keep this concept high in order to vaccinate fragile people. At the moment there is relaxation in terms of vaccination, we are moving away from the 4-6 months of immunization in which we have to do the reinforcement, especially in the most fragile people, this must be said very firmly. So you have to be very attentive to which virus is circulating: the Ministry has also repeated it, you have to maintain control of the variants to see if the variants acquire virulence again, if they respond to vaccines, how I respond to both monoclonal antibodies. and antivirals that we have in our therapeutic arsenal today. We must follow these things so as not to be caught off guard and be ready to respond to any resumption of the epidemic.”
“Certainly – he added – confinement measures can be lowered, but the pandemic has taught us that these measures must be taken regardless of Covid, to protect ourselves from various infectious diseases. Being careful, wearing a mask when we are with the most fragile subjects or when we ourselves have a respiratory infection that we ourselves can transmit to others, washing our hands are precautions that must be maintained and must be part of our culture. We hope that in the future we will forget about Covid but not about these precautions that must be maintained”.
Antonio Cascio, professor of infectious diseases at the University of Palermo, is also on the same wavelength: “Covid has taught us many things, the most important is that we need to work in a network, that it is important to implement the relationship between hospital and territory . There is talk of new diseases that could arrive in the future, which is why we must be prepared to face them in a network and be prepared with adequately equipped laboratories, with adequately equipped hospital structures”.
As for the new Pathway of Diagnostic Therapeutic Assistance to take care of patients with HIV/AIDS in the Sicily Region, it was published in the Official Gazette on May 19. “This PDTA is a response to the needs of the patient – highlighted Chiara Iaria -. In addition to an analysis of local data, the services that hospitals must provide are formalized and standardized, especially important in terms of HIV/AIDS because different pathways are contemplated for subpopulations of patients with specific characteristics, defining counseling, diagnosis, reception by the patient, therapy and follow-up, always based on international guidelines”. The PDTA is the result of the work of the APRI 2.0 Project – Regional Implementation of the AIDS Plan, created by the SDA Bocconi University in collaboration with the SIMIT section of the Region of Sicily, first with President Antonio Davì, then with Prof. Giuseppe Nunnari, acting President, who will hold a session on the subject at the congress venue.
“Our clinic accompanies about 700 patients with HIV infection – stressed Chiara Iaria -. Our services include advisory activities; the prescription and administration of antiretroviral therapies and long-acting medications; laboratory and instrumental follow-up and diagnostic investigations; vaccines; management and treatment of coinfections (HBV-HDV and HCV) and opportunistic infections and comorbidities; comprehensive screening for other sexually transmitted diseases and their therapeutic management; we also have a clinic dedicated to prisoners. In addition, AIFA’s recent decision to make PrEP reimbursable offered an additional solution: we enthusiastically embraced the possibility of using this prevention tool for HIV-negative people with high-risk sexual behaviors by organizing a dedicated PrEP clinic. . The services we offer our patients have been considerably enriched in recent years and, with the imminent arrival of new long-acting drugs and for subjects with limited therapeutic options, they will continue to grow to always guarantee the best level of care. for HIV-positive people.
Initiatives in the area experienced a turning point on December 1, when the first HIV Control Point was inaugurated in Palermo, following Palermo’s adhesion to the ‘Fast Track City’ project, that is, a city committed to the elimination of new infection cases by 2030, a step taken in 2019 but blocked by the pandemic. The checkpoint is active at the Casa deiRights in via Libertà 45, every Wednesday from 4 to 6 pm; here it is possible to carry out tests and acquire information. In addition, a site has been activated (to obtain information and contact the infectologists at the checkpoint through a form. The activity is carried out with the help of infectologists from the Palermo Polyclinic, coordinated by Professor Antonio Cascio , Director of the Infectious Diseases Unit of the Polyclinic, and by Marcello Trizzino, a doctor specializing in infectious diseases.The checkpoint is a safe, non-hospital place, free from discrimination, where citizens can talk with specialists in infectious diseases. , to obtain information about sexual health, but also to take a rapid test for HIV, HCV and syphilis, to take a prevention course (PrEP) To date, about 100 rapid tests for HIV have been carried out, and possible to diagnose two new cases of HIV infection.
The “Spazio Donna” project has started at the Umberto I Hospital in Syracuse: an initiative aimed at restoring the importance of women with HIV and supporting pregnancy projects. In fact, by virtue of U=U, vertical transmission from mother to fetus can also be eliminated and an HIV-positive woman can carry a pregnancy without transmitting the virus to the fetus.
“Devoting space to women is reassuring them and offering them space in the clinic -explains Antonina Franco, promoter of the initiative, for which she was also recently awarded by the Municipality- This space accompanies women from childbearing age to menopause, with special attention especially to pregnancy. The presence of HIV, the use of therapy or PrEP, in fact, have no consequences on fertility. We welcome and follow up both concordant (both HIV positive) and discordant couples. Yes only one of the two members of the couple has the infection, we offer the possibility of using PrEP in the negative subject to prevent contagion.The woman of childbearing age in therapy who wants to plan a pregnancy is followed by birth planning, with attention also to the child thanks to the collaboration of gynecologists.In concordant couples, the therapy is carried out from the planning of the pregnancy: this planning is very effective in Italian couples, while foreign women often arrive already pregnant or even about to give birth, so it is necessary to carry out prophylaxis both for the pregnant woman and for the unborn child. With the neonatologists, we evaluate whether the child is at risk of contracting the infection and we evaluate the use of therapy. Our attention is directed not only to women of childbearing age, but also to women in menopause, to whom we pay attention in coinfections, screening for Sexually Transmitted Infections and hepatitis. In addition, we have collaborated with the archbishopric in the opening of a shelter that welcomes patients with AIDS who do not have family support: ten beds, all currently occupied, in which food, accommodation and therapies are offered.
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