Abstract in Portuguese:
O artigo apresenta a integração entre os serviços de hanseníase e os serviços gerais de saúde como a estratégia central para garantir que o controle da hanseníase permaneça custo-eficaz e eqüitativo e, como conseqüência, sustentável ao longo dos próximos anos. Os autores apresentam uma revisão extensa sobre a integração dos serviços de hanseníase com os serviços gerais de saúde. Após uma discussão sobre a justificativa pela integração, o artigo destaca diversas inovações recentes no controle da hanseníase e no setor da saúde que ajudam a sustentar o processo de integração. Os autores apresentam um panorama sobre as experiências recentes em países que já iniciaram o processo de integração. Com base nessas experiências, lições importantes podem ser aprendidas e incorporadas a um modelo para o processo de integração. Tal modelo, que é apresentado no final do artigo, irá auxiliar os diversos países na integração dos serviços de hanseníase com os serviços gerais de saúde.Abstract in English:
Integration of leprosy services into the general health services is regarded as the core strategy to ensure that leprosy control remains cost-effective and equitable, and, thus, sustainable in the coming years. In this article an extensive review is presented of the integration of leprosy services into the general health services. After the rationale of integration is discussed, the article highlights several recent developments within leprosy control and the health sector that are in support of the integration process. An overview is presented of recent experiences in countries that have already embarked on the integration process. Based on these experiences important lessons can be learned and incorporated into a model for the process of integration. This model, which is presented at the end of the article, will assist countries to successfully integrate leprosy services into the general health services.Abstract in Spanish:
A lo largo de los últimos veinte años, las hepatitis víricas se han revelado como un importante problema para las comunidades indígenas de la cuenca amazónica y de otros ecosistemas similares del norte y centro de Sudamérica. Los estudios realizados en comunidades de Bolivia, Brasil, Colombia, Perú y Venezuela han demostrado una alta propensión endémica para la infección por el virus de la hepatitis B, que se asocia con frecuencia a una elevada prevalencia de coinfección con el virus de la hepatitis D entre los portadores crónicos. La circulación de ambos agentes responde a su transmisión horizontal durante la infancia, a través de mecanismos aún poco conocidos. Por el contrario, la infección por el virus de la hepatitis C es aún muy infrecuente entre los indígenas. No existen, por el momento, datos suficientes para evaluar el impacto real que esta endemia pueda tener sobre la salud de esas poblaciones. Considerando que la transmisión de estos agentes podría involucrar mecanismos que quizá no actúen en otras regiones, parece indispensable investigar dichos mecanismos y prevenir cuidadosamente la introducción del virus de la hepatitis C en esas comunidades, ya que las consecuencias para su salud podrían ser muy graves.Abstract in English:
On the last twenty years, viral hepatitis has emerged as a serious problem in almost all the Amerindian communities studied in the Amazon Basin and in other Amazon-related ecological systems from the North and Center of South America. Studies performed on communities from Bolivia, Brazil, Colombia, Peru and Venezuela have shown a high endemicity of the hepatitis B virus (HBV) infection all over the region, which is frequently associated to a high prevalence of infection by hepatitis D virus among the chronic HBV carriers. Circulation of both agents responds mainly to horizontal virus transmission during childhood through mechanisms that are not fully understood. By contrast, infection by hepatitis C virus (HCV), which is present in all the urban areas of South America, is still very uncommon among them. At the moment, there is not data enough to evaluate properly the true incidence that such endemicity may have on the health of the populations affected. Since viral transmission might be operated by mechanisms that could not be acting in other areas of the World, it seems essential to investigate such mechanisms and to prevent the introduction of HCV into these populations, which consequences for health could be very serious.