基于艾滋病时空数据的防治效果综合评价模型研究
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摘要
艾滋病预防控制工作，是全球范围的公共卫生问题，是一个庞大的团队合作的过程，需要多个机构和部门的分工合作、协调配合、国际间的交流，还涉及到相关政策的支持、大众的参与，资源的投入利用等。督导评估是国内外对艾滋病防治工作评价所采用的主要方式，虽然对具体的防治工作内容进行了评价，却忽略了防治工作中的资金投入、资源配置和利用、工作效率等问题，而导致了评价内容的不够全面，以绩效的思想进行对艾滋病防治工作的综合评价，成为弥补当前艾滋病防治效果督导评估不足的一种可能，有益于优化资源配置和提高防治工作质量的有效途径。
本研究基于2006年至2012年在中国全球基金艾滋病项目基金资助下积累起的全面、客观海量时空数据，运用合理的分析方法进行综合评价。由于数据普遍遵循统一的质量控制标准，因此综合评价结果能够应用于全面、科学、客观的实际评估工作中，而且，所涉及的主要危险因素等基本情况以及主要投入成本情况和管理模式相同，使得综合评价结果能够进行推广应用。
系统动力学思想和建模方法有助于探索评价指标之间的逻辑和数量关系，构建适合中国国情的评价逻辑模型和量化模型，优化艾滋病防治策略。为艾滋病防治工作的延续性和可持续发展等问题以及中长期规划提供战略性的决策支撑和参考依据，促进艾滋病防治工作的进发展。同时拓展了艾滋病防治工作的数据分析方法，为后续的研究累积部分经验。
研究方法包括了定性与定量的分析方法。运用描述性统计、文献复习法、Delphi专家咨询法、层次分析法进行了指标体系和权重的建立、综合评价模型（主要包括Z分值法、Topsis法、密切值法、秩和比法、加权线性综合指数法、混合综合指数法、功效系数法）对重庆市艾滋病防控形势、艾滋病防控经费投入和利用情况进行排序分析。运用K-means聚类、系统动力学建模方法、系统思考、专家咨询、回归分析、统计预测、计量经济学模型等方法完成了重庆市艾滋病防治的系统动力学模型的构建并进行了模拟运行。运用系统分析、文献归纳、专家咨询、系统动力学方法进行重庆市艾滋病防治的系统动力学模型政策干预实验与评价。
本研究采用的资料来源分为常规性统计资料、专项调查资料以及专著文献与文件资料，包括中国全球艾滋病项目数据，重庆市疾病预防控制中心和39个区县的疾病预防控制中心提供的从2006年到2012年7年间的数据（基础数据、监测数据和各个区县所填的日常防治工作相关数据），重庆市MSM人群HIV感染发病情况及HIV知识知晓情况的问卷调查资料（2006-2012年），重庆市艾滋病防治满意度问卷调查资料，2006-2012年重庆市艾滋病预防控制总费用测算资料，中国疾病预防控制中心性病艾滋病中心专家组对重庆市2012年艾滋病防治数据质量评估资料等调查资料。并建立艾滋病时空数据库。
主要研究结果：
1．前两轮专家咨询结果显示，第一轮专家积极性系数是94%，第二轮专家积极性系数是85.7%，表明专家对本课题较为重视，且所咨询专家的职称、工作经验、受教育程度都较好，反应了专家咨询的可靠性较好。结果构建了一套基于绩效和投入产出思想为基础的艾滋病综合评价指标体系，该套指标体系共有三层，一级指标包括：投入情况和产出情况；二级指标包括：组织保障评价、预防活动评价、治疗活动评价、防治效果评价、经济学评价、满意度与反应性评价；三级指标有31个。通过对文献的深入分析、两轮专家咨询和专题小组讨论，对该套指标体系的三级指标进行了指标意义、目的、频度、测量方式等方面的详细定义和说明。
2．第三轮专家咨询，咨询表回收率和有效率均是100%，专家对一级指标投入情况的权威系数在0.8以上的占83.33%，其余的权威系数均在0.72~0.8之间；产出情况的权威系数为0.8以上的专家占91.7%，其余的权威系数均在0.73~0.8之间。表明所选权重咨询专家在艾滋病防治领域有较高的权威性。专家对各级指标的等级打分，均通过了一致性检验，最后得到一级指标的权重分别是：0.4458，0.5542；二级指标权重分别是：0.0890，0.2096，0.1375，0.2844，0.1335，0.1460。该套指标体系通过了克朗巴哈系数信度检验和因子分析效度检验，表明指标体系设计合理具有较好的内部一致性，指标重复测量效果较好。
3．采集重庆市39个区县2006到2012年间的三级指标数据，7种综合评价方法研究结果显示7种排序结果的差异性较大，经Kendall一致性检验发现7种方法对39个地区7年的排序W系数均在0.5~0.7之间，表明7种评价方法的一致性一般。以2012年的数据排序结果为参照，计算两两评价方法评价结果的一致性，发现Z分值和密切值的W=0.925，P=0.001； Z分值和Topsis的W=0.904, P=0.002；密切值和Topsis的W=0.993，P=0.000；三种评价方法的W=0.921，P=0.000，其余方法间的两两一致性均在0.7左右。因此，最终选择Z分值、密切值和Topsis法对39个地区7年数据每一年进行一次综合重排序评价。每一年的排序结果表明，序列号靠前的地区大部分都是经济状况较好的地区，而连续几年排名靠后的地区基本上是经济发展状况较差且偏远的地区。
4．本研究对重庆艾滋病综合防治工作评价系统进行系统思考和系统分析，从宏观水平上刻画了系统的因果关系，所建立的系统动力学模型经过多次模拟运行和参数修正后确定，共包括40个变量和方程，模型通过了有效性检验。并对第I类，第II类，第III类地区进行政策干预实验模拟，艾滋病专项经费投入不同程度地增加以及不同的分配方案对艾滋病综合防治工作产出的影响。干预实验结果显示在艾滋病专项经费按地区经济水平基础分别进行增长，第I类地区18%-20%，第II类地区30%，第III类地区10%的年增长率，提高大众宣传成本，大力推广高危人群性行为时安全套的使用，对提高大众艾滋病知识知晓率，降低高危人群梅毒感染率，降低特定人群艾滋病感染率都会产生显著效应。
政策建议：
重庆市艾滋病防治工作应当在政府大力倡导与支持下，以政府行为为主导，特别培养一批骨干的艾滋病防治的非官方组织或社会团体进行全方位长期的合作，形成重庆市卫生局、重庆市疾病预防控制中心以及延伸至各区县基层卫生机构的层级式的全市覆盖的地域布局网络。政策干预方式上，要重点强化政府的领导职责，一方面坚持防治政策的延续性，加大对基层卫生机构和公共卫生的持续投入，提高对大众宣传和高危人群预防干预预算；另一方面对艾滋病综合防治工作实行长期动态的评价，对防治与干预措施进行及时调整及优化。
HIV/AIDS prevention and control are global challenges in public health filed. It requiresgreat teamwork and coordination from numbers of institutions and departments, as well asinternational communications, supportive policies, public participation and commitments ofresources etc. Supervision and evaluation is the major assessment for HIV/AIDS preventionand control. Although the specific works have been evaluated, in the way, financial input,resource allocation and commitments, and work efficiency were not considered. In this case,current evaluation is not a full-scale assessment. Synthetic evaluation methods may becomecompensate for the shortage of current assessment. And to apply the Synthetic evaluationmethods can optimize resource allocation and improve the quality of prevention and controlactivities.
The study was based on HIV/AIDS spatiotemporal data from2006to2012funded byChina Global Fund AIDS Program. And the data has generally followed unified qualitycontrol standards, the synthetic evaluation results can be used in a full-scale, scientific,objective practical assessment. In addition, the similarity of major risk factors, or financialinputs and costs, or management, etc. in synthetic evaluation may lead its results to be appliedand extended in this field.
The concept of system dynamics and modeling methods are helpful in exploring thelogical and quantitative relations between evaluation index, and constructing logical andquantitative models to optimize the strategy of HIV/AIDS prevention and control, which willbenefit the national condition in China. And it also provides strategic decision support for thecontinuity and sustainable development in long-term plan of HIV/AIDS prevention andcontrol, and promotes HIV/AIDS prevention and control works. Meanwhile, it expands dataanalysis methods in HIV/AIDS prevention and control and accumulates experiences forfurther study in this area.
Methods of the study include qualitative analysis and quantitative analysis. Descriptivestatistics, literature review, Delphi method and analytic hierarchy process (AHP) were appliedfor the establishment of index system and weights. Synthetic evaluation model were using Z-Score method, Topsis (Technique for Order of Preference by Similarity to Ideal Solution),osculating value method、 rank sum ratio (RSR) and Efficacy Coefficient Method, etc.System dynamics (SD) model of Chongqing HIV/AIDS prevention and control wereestablished and stimulated by K-means, SD modeling methods, systematic thinking, expertconsultation, regression, statistical prediction, quantitative economic model, etc. Policyinterventions experiment and evaluation were conducted with systematic analysis、literatureinduction、expert consultation and SD model.
The sources of information in this study include conventional statistical information,special survey and monograph literature and documents, e.g. China Global Fund AIDSProgram Data,2006-2009Chongqing Centre CDC and39local counties CDC data (basicdata, surveillance data and routine data),2006-2012annual questionnaire investigationChongqing MSM population HIV/AIDS infection,2006-2012annual questionnaireinvestigation in HIV/AIDS knowledge awareness, HIV/AIDS patient satisfaction survey, andreport of HIV/AIDS control and prevention data quality by National Centre for AIDS/STDprevention and control, China CDC. HIV/AIDS spatiotemporal data base was formed withthose sources.
Major Results：
1. After two-round specialists consulting, vitality of94%and85.7%respectively in1stand2ndround have shown the study has attracted attention from the experts who were advised.And they had upper ranks in professional field, more work experiences and higher educationbackground. Therefore, the consultation is reliable. Build up HIV/AIDS prevention andcontrol index system which has three levels, including input and output two indicators on the1st level, and evaluation in six aspects is on2ndlevel, e.g. organization support, preventionactivities, treatment activities prevention and control quality and satisfaction, and the3rdlevelincludes31indicators. After literature review, two-round consulting and panel discussion, thethree-level index system was detailed in definition and description.
2. In the3rdround specialist consulting, the recovery rate and validity of inquiry formwere both100%. At1stlevel, authority coefficients in the input section were about83.33% above0.8and the rest were in between0.72and0.8, about91.7%in the output section wereabove0.8and the rest were in between0.73and0.8. It indicates that the selected consultantsin HIV/AIDS prevention field have a higher authority. The weights of1stlevel two indicatorsare0.4458and0.5542. The six indicators in2nd level were weighted0.0890,0.2096,0.1375,0.2844,0.1335and0.1460, respectively. The index system satisfied the requirements ofpassing Cronbach’s alpha reliability testing and factor analysis validity testing. It implies thedesign of index system has good internal consistency. And it performed well in indicatorsrepeated measurement.
3. Collected data of the3rdlevel indicators from39counties in Chongqing between2005and2013, the results have shown the difference among seven synthetic evaluation methods.39counties were sorted according to evaluation method. The entire sorted W coefficients overseven years were in the range of0.5to0.7after Kendall’s test, it indicated that theconsistency is general among seven methods. For example, in2012, the consistency Wcoefficient are W=0.925(P=0.001) between Z-Score and osculating value methods, W=0.904(P=0.002) between Z-Score and Topsis, and W=0.993(P=0.000) between osculating valuemethod and Topsis, and W=0.921(P=0.000) among Z-Score, Osculating value and Topsismethods. And consistency values in all other pairwise comparison were about0.7. Eventually,thirty-nine counties were comprehensively re-ranked yearly by Z-Score, Osculating value andTopsis methods from2006to2012. On the top of rank list were better economic areas,conversely, those appeared at the lower place of the list for a few consecutive years weredeveloping areas and also were remote.
4. Systematic thinking and analysis was applied in Chongqing HIV/AIDS prevention andcontrol synthetic evaluation system. In a macroscopic view, it has depicted the systemcausality. The system dynamics model was determined after a number of simulation runs andparameter modification, including a total of40variables and equations, and it has passedvalidity testing. Intervention experiments have conducted into each classified area, it took thesteps of raising HIV/AIDS prevention and control fund based on local economic level, by18%-20%in class I,30%in class II and10%in class III annually, increasing budget forpublicity and promoting condom usage in high-risk population, that has shown statisticalsignificance in growing public HIV/AIDS knowledge awareness, and reducing syphilisinfection and HIV/AIDS infection in both high-risk population and very certain of population.
Policy recommendation：
Chongqing HIV/AIDS prevention and control work should be based on government'sadvocacy and support, and be cooperated fully with some certain well trained HIV/AIDSprevention non-government organizations or groups. Government cast in the lead role of thehierarchy network which consists of Chongqing Municipal Health Bureau and ChongqingCDC, local county CDC and grass-roots health institutions. In aspect of policy interventions,Government’s leadership and responsibilities should be strengthened in two ways. The one ispersisting in continuing HIV/AIDS prevention and control policies, which are expanding thefinancial input into grass-roots health institutions and public health field, and increasing thebudget on publicity and high-risk population interventions; the other is keeping assessing thequality of HIV/AIDS prevention and control works dynamically and, adjusting andoptimizing the prevention and intervention measures timely.
本研究基于2006年至2012年在中国全球基金艾滋病项目基金资助下积累起的全面、客观海量时空数据，运用合理的分析方法进行综合评价。由于数据普遍遵循统一的质量控制标准，因此综合评价结果能够应用于全面、科学、客观的实际评估工作中，而且，所涉及的主要危险因素等基本情况以及主要投入成本情况和管理模式相同，使得综合评价结果能够进行推广应用。
系统动力学思想和建模方法有助于探索评价指标之间的逻辑和数量关系，构建适合中国国情的评价逻辑模型和量化模型，优化艾滋病防治策略。为艾滋病防治工作的延续性和可持续发展等问题以及中长期规划提供战略性的决策支撑和参考依据，促进艾滋病防治工作的进发展。同时拓展了艾滋病防治工作的数据分析方法，为后续的研究累积部分经验。
研究方法包括了定性与定量的分析方法。运用描述性统计、文献复习法、Delphi专家咨询法、层次分析法进行了指标体系和权重的建立、综合评价模型（主要包括Z分值法、Topsis法、密切值法、秩和比法、加权线性综合指数法、混合综合指数法、功效系数法）对重庆市艾滋病防控形势、艾滋病防控经费投入和利用情况进行排序分析。运用K-means聚类、系统动力学建模方法、系统思考、专家咨询、回归分析、统计预测、计量经济学模型等方法完成了重庆市艾滋病防治的系统动力学模型的构建并进行了模拟运行。运用系统分析、文献归纳、专家咨询、系统动力学方法进行重庆市艾滋病防治的系统动力学模型政策干预实验与评价。
本研究采用的资料来源分为常规性统计资料、专项调查资料以及专著文献与文件资料，包括中国全球艾滋病项目数据，重庆市疾病预防控制中心和39个区县的疾病预防控制中心提供的从2006年到2012年7年间的数据（基础数据、监测数据和各个区县所填的日常防治工作相关数据），重庆市MSM人群HIV感染发病情况及HIV知识知晓情况的问卷调查资料（2006-2012年），重庆市艾滋病防治满意度问卷调查资料，2006-2012年重庆市艾滋病预防控制总费用测算资料，中国疾病预防控制中心性病艾滋病中心专家组对重庆市2012年艾滋病防治数据质量评估资料等调查资料。并建立艾滋病时空数据库。
主要研究结果：
1．前两轮专家咨询结果显示，第一轮专家积极性系数是94%，第二轮专家积极性系数是85.7%，表明专家对本课题较为重视，且所咨询专家的职称、工作经验、受教育程度都较好，反应了专家咨询的可靠性较好。结果构建了一套基于绩效和投入产出思想为基础的艾滋病综合评价指标体系，该套指标体系共有三层，一级指标包括：投入情况和产出情况；二级指标包括：组织保障评价、预防活动评价、治疗活动评价、防治效果评价、经济学评价、满意度与反应性评价；三级指标有31个。通过对文献的深入分析、两轮专家咨询和专题小组讨论，对该套指标体系的三级指标进行了指标意义、目的、频度、测量方式等方面的详细定义和说明。
2．第三轮专家咨询，咨询表回收率和有效率均是100%，专家对一级指标投入情况的权威系数在0.8以上的占83.33%，其余的权威系数均在0.72~0.8之间；产出情况的权威系数为0.8以上的专家占91.7%，其余的权威系数均在0.73~0.8之间。表明所选权重咨询专家在艾滋病防治领域有较高的权威性。专家对各级指标的等级打分，均通过了一致性检验，最后得到一级指标的权重分别是：0.4458，0.5542；二级指标权重分别是：0.0890，0.2096，0.1375，0.2844，0.1335，0.1460。该套指标体系通过了克朗巴哈系数信度检验和因子分析效度检验，表明指标体系设计合理具有较好的内部一致性，指标重复测量效果较好。
3．采集重庆市39个区县2006到2012年间的三级指标数据，7种综合评价方法研究结果显示7种排序结果的差异性较大，经Kendall一致性检验发现7种方法对39个地区7年的排序W系数均在0.5~0.7之间，表明7种评价方法的一致性一般。以2012年的数据排序结果为参照，计算两两评价方法评价结果的一致性，发现Z分值和密切值的W=0.925，P=0.001； Z分值和Topsis的W=0.904, P=0.002；密切值和Topsis的W=0.993，P=0.000；三种评价方法的W=0.921，P=0.000，其余方法间的两两一致性均在0.7左右。因此，最终选择Z分值、密切值和Topsis法对39个地区7年数据每一年进行一次综合重排序评价。每一年的排序结果表明，序列号靠前的地区大部分都是经济状况较好的地区，而连续几年排名靠后的地区基本上是经济发展状况较差且偏远的地区。
4．本研究对重庆艾滋病综合防治工作评价系统进行系统思考和系统分析，从宏观水平上刻画了系统的因果关系，所建立的系统动力学模型经过多次模拟运行和参数修正后确定，共包括40个变量和方程，模型通过了有效性检验。并对第I类，第II类，第III类地区进行政策干预实验模拟，艾滋病专项经费投入不同程度地增加以及不同的分配方案对艾滋病综合防治工作产出的影响。干预实验结果显示在艾滋病专项经费按地区经济水平基础分别进行增长，第I类地区18%-20%，第II类地区30%，第III类地区10%的年增长率，提高大众宣传成本，大力推广高危人群性行为时安全套的使用，对提高大众艾滋病知识知晓率，降低高危人群梅毒感染率，降低特定人群艾滋病感染率都会产生显著效应。
政策建议：
重庆市艾滋病防治工作应当在政府大力倡导与支持下，以政府行为为主导，特别培养一批骨干的艾滋病防治的非官方组织或社会团体进行全方位长期的合作，形成重庆市卫生局、重庆市疾病预防控制中心以及延伸至各区县基层卫生机构的层级式的全市覆盖的地域布局网络。政策干预方式上，要重点强化政府的领导职责，一方面坚持防治政策的延续性，加大对基层卫生机构和公共卫生的持续投入，提高对大众宣传和高危人群预防干预预算；另一方面对艾滋病综合防治工作实行长期动态的评价，对防治与干预措施进行及时调整及优化。
HIV/AIDS prevention and control are global challenges in public health filed. It requiresgreat teamwork and coordination from numbers of institutions and departments, as well asinternational communications, supportive policies, public participation and commitments ofresources etc. Supervision and evaluation is the major assessment for HIV/AIDS preventionand control. Although the specific works have been evaluated, in the way, financial input,resource allocation and commitments, and work efficiency were not considered. In this case,current evaluation is not a full-scale assessment. Synthetic evaluation methods may becomecompensate for the shortage of current assessment. And to apply the Synthetic evaluationmethods can optimize resource allocation and improve the quality of prevention and controlactivities.
The study was based on HIV/AIDS spatiotemporal data from2006to2012funded byChina Global Fund AIDS Program. And the data has generally followed unified qualitycontrol standards, the synthetic evaluation results can be used in a full-scale, scientific,objective practical assessment. In addition, the similarity of major risk factors, or financialinputs and costs, or management, etc. in synthetic evaluation may lead its results to be appliedand extended in this field.
The concept of system dynamics and modeling methods are helpful in exploring thelogical and quantitative relations between evaluation index, and constructing logical andquantitative models to optimize the strategy of HIV/AIDS prevention and control, which willbenefit the national condition in China. And it also provides strategic decision support for thecontinuity and sustainable development in long-term plan of HIV/AIDS prevention andcontrol, and promotes HIV/AIDS prevention and control works. Meanwhile, it expands dataanalysis methods in HIV/AIDS prevention and control and accumulates experiences forfurther study in this area.
Methods of the study include qualitative analysis and quantitative analysis. Descriptivestatistics, literature review, Delphi method and analytic hierarchy process (AHP) were appliedfor the establishment of index system and weights. Synthetic evaluation model were using Z-Score method, Topsis (Technique for Order of Preference by Similarity to Ideal Solution),osculating value method、 rank sum ratio (RSR) and Efficacy Coefficient Method, etc.System dynamics (SD) model of Chongqing HIV/AIDS prevention and control wereestablished and stimulated by K-means, SD modeling methods, systematic thinking, expertconsultation, regression, statistical prediction, quantitative economic model, etc. Policyinterventions experiment and evaluation were conducted with systematic analysis、literatureinduction、expert consultation and SD model.
The sources of information in this study include conventional statistical information,special survey and monograph literature and documents, e.g. China Global Fund AIDSProgram Data,2006-2009Chongqing Centre CDC and39local counties CDC data (basicdata, surveillance data and routine data),2006-2012annual questionnaire investigationChongqing MSM population HIV/AIDS infection,2006-2012annual questionnaireinvestigation in HIV/AIDS knowledge awareness, HIV/AIDS patient satisfaction survey, andreport of HIV/AIDS control and prevention data quality by National Centre for AIDS/STDprevention and control, China CDC. HIV/AIDS spatiotemporal data base was formed withthose sources.
Major Results：
1. After two-round specialists consulting, vitality of94%and85.7%respectively in1stand2ndround have shown the study has attracted attention from the experts who were advised.And they had upper ranks in professional field, more work experiences and higher educationbackground. Therefore, the consultation is reliable. Build up HIV/AIDS prevention andcontrol index system which has three levels, including input and output two indicators on the1st level, and evaluation in six aspects is on2ndlevel, e.g. organization support, preventionactivities, treatment activities prevention and control quality and satisfaction, and the3rdlevelincludes31indicators. After literature review, two-round consulting and panel discussion, thethree-level index system was detailed in definition and description.
2. In the3rdround specialist consulting, the recovery rate and validity of inquiry formwere both100%. At1stlevel, authority coefficients in the input section were about83.33% above0.8and the rest were in between0.72and0.8, about91.7%in the output section wereabove0.8and the rest were in between0.73and0.8. It indicates that the selected consultantsin HIV/AIDS prevention field have a higher authority. The weights of1stlevel two indicatorsare0.4458and0.5542. The six indicators in2nd level were weighted0.0890,0.2096,0.1375,0.2844,0.1335and0.1460, respectively. The index system satisfied the requirements ofpassing Cronbach’s alpha reliability testing and factor analysis validity testing. It implies thedesign of index system has good internal consistency. And it performed well in indicatorsrepeated measurement.
3. Collected data of the3rdlevel indicators from39counties in Chongqing between2005and2013, the results have shown the difference among seven synthetic evaluation methods.39counties were sorted according to evaluation method. The entire sorted W coefficients overseven years were in the range of0.5to0.7after Kendall’s test, it indicated that theconsistency is general among seven methods. For example, in2012, the consistency Wcoefficient are W=0.925(P=0.001) between Z-Score and osculating value methods, W=0.904(P=0.002) between Z-Score and Topsis, and W=0.993(P=0.000) between osculating valuemethod and Topsis, and W=0.921(P=0.000) among Z-Score, Osculating value and Topsismethods. And consistency values in all other pairwise comparison were about0.7. Eventually,thirty-nine counties were comprehensively re-ranked yearly by Z-Score, Osculating value andTopsis methods from2006to2012. On the top of rank list were better economic areas,conversely, those appeared at the lower place of the list for a few consecutive years weredeveloping areas and also were remote.
4. Systematic thinking and analysis was applied in Chongqing HIV/AIDS prevention andcontrol synthetic evaluation system. In a macroscopic view, it has depicted the systemcausality. The system dynamics model was determined after a number of simulation runs andparameter modification, including a total of40variables and equations, and it has passedvalidity testing. Intervention experiments have conducted into each classified area, it took thesteps of raising HIV/AIDS prevention and control fund based on local economic level, by18%-20%in class I,30%in class II and10%in class III annually, increasing budget forpublicity and promoting condom usage in high-risk population, that has shown statisticalsignificance in growing public HIV/AIDS knowledge awareness, and reducing syphilisinfection and HIV/AIDS infection in both high-risk population and very certain of population.
Policy recommendation：
Chongqing HIV/AIDS prevention and control work should be based on government'sadvocacy and support, and be cooperated fully with some certain well trained HIV/AIDSprevention non-government organizations or groups. Government cast in the lead role of thehierarchy network which consists of Chongqing Municipal Health Bureau and ChongqingCDC, local county CDC and grass-roots health institutions. In aspect of policy interventions,Government’s leadership and responsibilities should be strengthened in two ways. The one ispersisting in continuing HIV/AIDS prevention and control policies, which are expanding thefinancial input into grass-roots health institutions and public health field, and increasing thebudget on publicity and high-risk population interventions; the other is keeping assessing thequality of HIV/AIDS prevention and control works dynamically and, adjusting andoptimizing the prevention and intervention measures timely.
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