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[中国社区卫生服务中心开展艾滋病预防与干预的可行性]

[The feasibility of Community Health Service Center-based HIV prevention and intervention in China].

作者信息

Hao Yang, Shan Duo, Fu Xiaojing, Qi Jinlei, Meng Sining, Li Chengmei, Zhang Dapeng

机构信息

People's Medical Publishing House, Beijing 100021, China. Email:

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2014 May;48(5):386-90.

Abstract

OBJECTIVE

To explore and analyze the feasibility of Community Health Service Center(CHSC)-based HIV prevention and intervention in China.

METHODS

Data on case finding and case management indexes were collected from 42 CHSCs in 8 cities from November, 2011 to December, 2012, and complemented by questionnaires to investigate the willingness to accept community-based HIV services among health care providers and the service targets.

RESULTS

During November, 2011 and December, 2012, 6 729 person-times HIV tests were carried out among MSM in the cooperation between CHSCs and CBOs, and 235 HIV positives were found. A total of 40 CHSCs among 42 have conducted HIV rapid tests. The sample sources were broad and the HIV screening positive detection rate from high-risk populations in key divisions of CHSCs 0.66% (38/5 769) was higher than that in outreach high-risk populations 0.41% (15/3 623) and people receiving physical check 0.31% (20/6 532). HIV positive detection rate in CHSCs was higher 0.4% (96/23 609) than that in conventional medical institutions 0.1% (11 870/9 644 944) and newly found positives among the confirmed positives was a little lower 73.7% (56/76) than conventional programs 80.1% (8 038/10 039). The case follow-up and CD4(+) T cell testing rates in CHSCs were 100.0% (1 046/1 046) and 99.1% (1 037/1 046), respectively. The testing cost was 6.1 RMB per person on average, and the cost of 1 case found positive was 2 727.3 RMB on average. Among 361 service providers, 68.1% (246)and 91.4% (330) service providers were willing to be involved in AIDS response and support HIV service in local CHSCs. Among 755 service targets including people who seek health care in key divisions of CHSCs, MSM, and high-risk populations in local communities, 77.3% (348), 73.9% (173) and 78.1% (57) were willing to accept free HIV tests in local CHSCs.

CONCLUSION

The effect of case finding and case management in CHSCs was good and the cost of conducting HIV tests and finding new cases were relatively low, meanwhile, most of the service provides in CHSCs and service targets support HIV service in local CHSCs. The future CHSC-based HIV prevention and intervention was feasible.

摘要

目的

探讨并分析在中国以社区卫生服务中心(CHSC)为基础开展艾滋病预防与干预工作的可行性。

方法

收集2011年11月至2012年12月期间8个城市42家社区卫生服务中心的病例发现和病例管理指标数据,并辅以问卷调查,以了解医护人员和服务对象接受社区艾滋病服务的意愿。

结果

2011年11月至2012年12月期间,社区卫生服务中心与社区组织合作,对男男性行为者进行了6729人次的艾滋病检测,发现235例艾滋病病毒阳性者。42家社区卫生服务中心中共有40家开展了艾滋病快速检测。样本来源广泛,社区卫生服务中心重点科室高危人群的艾滋病筛查阳性检出率为0.66%(38/5769),高于外展高危人群的0.41%(15/3623)和接受体检人群的0.31%(20/6532)。社区卫生服务中心的艾滋病病毒阳性检出率为0.4%(96/23609),高于传统医疗机构的0.1%(11870/9644944),确诊阳性者中新发现阳性的比例略低于传统项目,分别为73.7%(56/76)和80.1%(8038/10039)。社区卫生服务中心的病例随访率和CD4(+)T细胞检测率分别为100.0%(1046/1046)和99.1%(1037/1046)。检测成本平均每人6.1元,发现1例阳性病例的成本平均为2727.3元。在361名服务提供者中,68.1%(246名)和91.4%(330名)的服务提供者愿意参与艾滋病防治工作并支持当地社区卫生服务中心的艾滋病服务。在755名服务对象中,包括在社区卫生服务中心重点科室就诊的人群、男男性行为者和当地社区高危人群,77.3%(348名)、73.9%(173名)和78.1%(57名)愿意在当地社区卫生服务中心接受免费艾滋病检测。

结论

社区卫生服务中心的病例发现和病例管理效果良好,开展艾滋病检测和发现新病例的成本相对较低,同时,社区卫生服务中心的大多数服务提供者和服务对象支持当地社区卫生服务中心的艾滋病服务。未来以社区卫生服务中心为基础开展艾滋病预防与干预工作是可行的。

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