1. Managing TB, HIV and viral
hepatitis in Primary care
EU country perspective on primary-care based model
Alexandre Lourenço
Hospital Administrator,
Coimbra Hospital and
University Centre
Adjunct Assistant Professor,
NOVA School of Public Health
www.alexandrelourenco.pt

2. Weak coordination &
integration among
different service
providers
Rigidness of services
Inadequate, unskilled
and staff
Not evidence-based
interventions and
procedures
Stigma and
Discrimination
environment
Examples of inadequate services
17-19 October 2018 -- Tbilisi, Georgia
Towards integrated, people-centered and efficient health services
for impactful response to HIV, TB and malaria

3. 17-19 October 2018 -- Tbilisi, Georgia
Towards integrated, people-centered and efficient health services
for impactful response to HIV, TB and malaria
Conceptual framework of integrated people-centred health services
©
2020
ALEXANDRE
LOURENÇO
CONFIDENTIAL
AND
PROPRIETARY
Country setting
& development status
Other sectors:
education,
sanitation,
social assistance,
labour, housing,
environment
& others
Health
sector:
governance,
financing &
resources
<
Service delivery:
Networks,
Facilities &
practitioners
PERSON

5. hospital admission in adults, 2019 (or nearest year) and 2020
Asthma and COPD
Congestive heart failure
Diabetes

6. The program is centered on Primary Health Care and sustained by
the Pulmonary Diagnostic Centers (CDP)
Pulmonary
Diagnostic
Centers
Family
Health
Units
Public
Health
Unit
Inpatient
Hospital
Outpatient
A&E
Drug
addicts
treatment
centers
Outreach
programs
CDP
Ambulatory services
Prevention, diagnostic (including contact
tracing) and treatment of tuberculosis, in its
many forms.
Family doctors, pulmonologists, nurses, X-
ray technicians, and administrative staff.
Some of them also have pediatricians or
infectious disease specialists in their staff.
At least one center in each district.

7. The key role of the
dispensaries (1902)
LANCASTRE, António de - O valor dos dispensários na lucta contra a tuberculose. A Medicina Moderna. Porto: Imprensa Civilisação. Vol. 3, n.o 107 (1902), pp. 366-367.

8. Patient centered clinical pathway
DOT managed by a multidisciplinary health team
Decision to initiate treatment is based on a probable
diagnosis
Clinical evaluation and collection of samples for laboratory
testing
A person with presumptive TB
CDP
At
Home
According to
patient needs
Contagious
period

9. Prevention
Continuum
Care Continuum
Testing &
Counselling
Entry
point
NGOs
Volunteers
PLWA
Outpatient care
Social care
Specialists
&
Specialized
facilities
Paliative care &
Self-care
Primary Healthcare
Secondary care
Community care
Tertiary care Home care
Group support
PHC centres
Diagnostic centres
Addiction
treatment centre

10. The example of the HIV Testing and diagnostics
strategies
Methodologies
• Medical prescription
• Voluntary Point of care
• Self-test
Contexts
• PHC centers
• Walk In Diagnostic centers
• CDP - tuberculosis
• Addiction Treatment centers
• NGOs (including outreach)
• Community pharmacies
• Hospitals
• Prisons

11. Rapid tests: 50 518 tests
34% PHC centers
(+) 0,06%)
62% NGOs
(+) 1,37%)
3,6% Walk In Diagnostic centers
(+) 2,3%
PHC prescribed tests:
282 874 tests
Self-tests: 8 133 tests
HIV Testing and Diagnostics 2021

12. Challenges PHC
• Work overload at the FD level
• Priority given to more prevalent
conditions by PHC teams
• Increased role of community pharmacies
• Key populations lack trust in formal PHC
Challenges specialized services
• Medical specialties with low
attractiveness
• Low prevalence questions the existence
of some dedicated providers
Take home messages

13. New organizational models, bringing together primary healthcare and
hospital services within the same umbrella organization
Care integration is an
opportunity to strengthen HIV
TB and viral hepatitis
13

14. Obrigado!
Alexandre Lourenço
Hospital Administrator, Coimbra Hospital and University Centre
Adjunct Assistant Professor, NOVA School of Public Health
www.alexandrelourenco.pt