Ong Jason J, Peng Minghui, Zhu Shanzhu, Lo Ying-Ru J, Fairley Christopher K, Kidd Michael R, Roland Martin, Jiang Sunfang, Wong William C W
Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
General Practice Department, Zhongshan Hospital Fudan University, Shanghai, China.
Sex Transm Infect. 2017 Dec;93(8):566-571. doi: 10.1136/sextrans-2017-053196. Epub 2017 Aug 26.
China has strengthened its primary care workforce and implemented a wide network of community health centres (CHCs). However, STI testing and management are not currently included in the 'Essential Package of Primary Health Care in China'. Legislation change to encourage STI service delivery would be important, but it is also critical to determine if there are also provider-related opportunities and barriers for implementing effective STI programmes through CHCs if future legislation were to change.
A national representative survey was conducted between September and December 2015 in a stratified random sample of 180 CHCs based in 20 cities in China. Primary care practitioners (PCPs) provided information on current experiences of STI testing as well as the barriers and facilitators for STI testing in CHCs. Multivariate logistic regression was conducted to determine factors associated with PCPs performing STI testing.
3580 out of 4146 (86%) invited PCPs from 158 CHCs completed the survey. The majority (85%, 95% CI 84% to 87%) of doctors stated that STI testing was an important part of healthcare. However, less than a third (29%, 95% CI 27% to 31%) would perform an STI test if the patients asked. Barriers for performing STI testing included lack of training, concerns about reimbursement, concerns about damage to clinics' reputations and the stigma against key populations. Respondents who reported that they would perform an STI test were likely to be younger, received a bachelor degree or higher, received specific training in STIs, believed that STI test was an important part of healthcare or had resources to perform STI testing.
There is potential for improving STI management in China through upskilling the primary care workforce in CHCs. Specific training in STIs is needed, and other structural, logistical and attitudinal barriers are needed to be addressed.
中国已加强基层医疗服务人员队伍建设，并建立了广泛的社区卫生服务中心（CHC）网络。然而，性传播感染（STI）检测和管理目前并未纳入“中国基本医疗保健服务包”。立法变革以鼓励提供STI服务固然重要，但如果未来立法有所改变，确定通过社区卫生服务中心实施有效STI项目是否还存在与提供者相关的机遇和障碍也至关重要。
2015年9月至12月间，在中国20个城市的180家社区卫生服务中心进行了分层随机抽样的全国代表性调查。基层医疗从业者（PCP）提供了有关当前STI检测经验以及社区卫生服务中心进行STI检测的障碍和促进因素的信息。进行多变量逻辑回归以确定与基层医疗从业者进行STI检测相关的因素。
来自158家社区卫生服务中心的4146名受邀基层医疗从业者中，有3580名（86%）完成了调查。大多数（85%，95%置信区间84%至87%）医生表示STI检测是医疗保健的重要组成部分。然而，如果患者要求，不到三分之一（29%，95%置信区间27%至31%）的医生会进行STI检测。进行STI检测的障碍包括缺乏培训、对报销的担忧、对诊所声誉受损的担忧以及对重点人群的污名化。报告愿意进行STI检测的受访者可能更年轻、拥有学士学位或更高学历、接受过STI方面的特定培训、认为STI检测是医疗保健的重要组成部分或拥有进行STI检测的资源。
通过提升社区卫生服务中心基层医疗服务人员的技能，中国在改善STI管理方面具有潜力。需要进行STI方面的特定培训，并且需要解决其他结构、后勤和态度方面的障碍。
