Integralidade do cuidado de pessoas vivendo com HIV na atenção primária no Brasil : revisão narrativa

Abstract

Introduction: The decentralization of care for people living with HIV (PLHIV) from specialized care to primary health care is a strategy advocated by SUS guidelines aimed at reducing inequalities and maximizing access to health services for an effective response to HIV. This study is justified by the need to understand how care is provided to PLHIV when received in primary health care (PHC), the gateway to the SUS and the organizer of care in the health system, and maximizing access is a way to overcome differences and vulnerabilities. The objective of this research was to understand how comprehensiveness has been operationalized in the care of PLHIV in PHC. Methodology: This is a narrative review with a qualitative approach, based on the theoretical references of vulnerability and comprehensiveness. A bibliographic search was carried out in articles on the subject in SciELO and PubMed. After eligible criteria, 12 articles were obtained, and data were extracted considering information on the context of research sites and participants, access and retention of PLHIV to PHC units, HIV management in the presence of other health demands and transit of PLHIV in the Health Care Network (HCN). Analysis of Results: The areas in which some health units were located bordered places of extreme poverty and vulnerability and sometimes suffered from the crossing of violence that represented a factor that limited access to diagnosis and treatment. The stigma of HIV, associated with the possibility of breaking confidentiality, could expose PLHIV to symbolic violence and risk of death in territories permeated by the drug trafficking war. Some health units were training centers for professionals. Depending on the professional's conduct, vulnerabilities and structural racism were reinforced. The majority of PLHIV characterized were poor, female and black. In some studies, the location of the health facility represented an advantage for access and retention. In others, proximity to residence reinforced vulnerabilities. Training was a criterion to qualify multiprofessional care. The use of technologies helped in the continuity of care during the COVID-19 pandemic. The line of care for adults and children and adolescents living with HIV was strengthened with the co-responsibility of care between specialized care and primary care, with primary care guiding care and responsible for leading the person to access other levels of the HCN if necessary. The data were presented and discussed considering the political, organizational and relational dimensions of comprehensiveness, showing differences between what was proposed in the policies and how it was practiced in the operationalization of care. Conclusion: Despite the federal government's encouragement to decentralize care for PLHIV, the number of people served in PHC is incipient. Professional qualification and commitment of municipalities to provide inputs and training of professionals are necessary so that comprehensive care is fully operationalized as recommended by the Ministry of Health.