在中国，将“任务转移”至社区组织后，男男性行为者中艾滋病毒预防干预措施的有效性提高，以及艾滋病毒感染者后续护理的有效性提高：一种“按服务提供付酬”模式。
The increased effectiveness of HIV preventive intervention among men who have sex with men and of follow-up care for people living with HIV after 'task-shifting' to community-based organizations: a 'cash on service delivery' model in China.
作者信息
Yan Hongjing, Zhang Min, Zhao Jinkou, Huan Xiping, Ding Jianping, Wu Susu, Wang Chenchen, Xu Yuanyuan, Liu Li, Xu Fei, Yang Haitao
机构信息
Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
出版信息
PLoS One. 2014 Jul 22;9(7):e103146. doi: 10.1371/journal.pone.0103146. eCollection 2014.
BACKGROUND
A large number of men who have sex with men (MSM) and people living with HIV/AIDS (PLHA) are underserved despite increased service availability from government facilities while many community based organizations (CBOs) are not involved. We aimed to assess the feasibility and effectiveness of the task shifting from government facilities to CBOs in China.
METHODS
HIV preventive intervention for MSM and follow-up care for PLHA were shifted from government facilities to CBOs. Based on 'cash on service delivery' model, 10 USD per MSM tested for HIV with results notified, 82 USD per newly HIV cases diagnosed, and 50 USD per PLHA received a defined package of follow-up care services, were paid to the CBOs. Cash payments were made biannually based on the verified results in the national web-based HIV/AIDS information system.
FINDINGS
After task shifting, CBOs gradually assumed preventive intervention for MSM and follow-up care for PLHA from 2008 to 2012. HIV testing coverage among MSM increased from 4.1% in 2008 to 22.7% in 2012. The baseline median CD4 counts of newly diagnosed HIV positive MSM increased from 309 to 397 cells/µL. HIV tests among MSM by CBOs accounted for less than 1% of the total HIV tests in Nanjing but the share of HIV cases detected by CBOs was 12.4% in 2008 and 43.6% in 2012. Unit cost per HIV case detected by CBOs was 47 times lower than that by government facilities. The coverage of CD4 tests and antiretroviral therapy increased from 71.1% and 78.6% in 2008 to 86.0% and 90.1% in 2012, respectively.
CONCLUSION
It is feasible to shift essential HIV services from government facilities to CBOs, and to verify independently service results to adopt 'cash on service delivery' model. Services provided by CBOs are cost-effective, as compared with that by government facilities.
背景
尽管政府机构提供的服务有所增加，但大量男男性行为者（MSM）和艾滋病毒/艾滋病感染者（PLHA）仍未得到充分服务，而许多社区组织（CBO）并未参与其中。我们旨在评估在中国将任务从政府机构转移至CBO的可行性和有效性。
方法
针对MSM的艾滋病毒预防干预以及对PLHA的后续护理从政府机构转移至CBO。基于“按服务付费”模式，每为一名接受艾滋病毒检测并得到结果通知的MSM支付10美元，每确诊一例新的艾滋病毒病例支付82美元，每为一名PLHA提供一套规定的后续护理服务支付50美元，这些费用支付给CBO。根据国家基于网络的艾滋病毒/艾滋病信息系统中的核实结果，每半年进行一次现金支付。
研究结果
任务转移后，CBO在2008年至2012年期间逐渐承担起对MSM的预防干预和对PLHA的后续护理。MSM中的艾滋病毒检测覆盖率从2008年的4.1%增至2012年的22.7%。新确诊的艾滋病毒阳性MSM的基线CD4细胞计数中位数从309增至397个/微升。CBO在MSM中进行的艾滋病毒检测占南京艾滋病毒检测总数的比例不到1%，但CBO检测出的艾滋病毒病例比例在2008年为12.4%，在2012年为43.6%。CBO检测出每例艾滋病毒病例的单位成本比政府机构低47倍。CD4检测和抗逆转录病毒治疗的覆盖率分别从2008年的71.1%和78.6%增至2012年的86.0%和90.1%。
结论
将基本的艾滋病毒服务从政府机构转移至CBO，并独立核实服务结果以采用“按服务付费”模式是可行的。与政府机构提供的服务相比，CBO提供的服务具有成本效益。
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