河南农村艾滋病防治模式与效果评价
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摘要
研究目的
调查河南省艾滋病高流行地区乡村两级卫生资源状况,评估卫生机构艾滋病防治服务能力;了解HIV感染人群的健康状况、卫生需求及卫生服务利用情况;评价农村卫生机构在艾滋病防治方面的功能和作用;调查艾滋病防治活动开展情况和HIV感染、发病、死亡情况,评估艾滋病防治效果;调查HIV感染人群对卫生机构的满意度和反应性评价,评估卫生机构服务效果;探讨河南省农村艾滋病医疗救治模式,分析可能存在的问题,为下阶段农村艾滋病防治工作提出政策性建议。
研究方法
本研究采用了文献检索法、现场调查法、描述性分析法对农村卫生机构和艾滋病医疗救治情况进行了调查分析。现场调查选取上蔡县和睢县两个具有代表性的艾滋病高流行地区,分别采取整群抽样和分层随机抽样等方法,调查乡卫生院47所,村卫生室84所,乡、村两级医务人员131人、HIV感染人群720人、一般对照人群726人。资料分析和数据处理采用SPSS15.0统计软件进行描述性分析、x~2检验、非参数假设检验以及模糊综合评价等方法进行统计学分析。
研究结果
1、农村艾滋病防治模式:农村艾滋病防治“三级网”模式已经形成,艾滋病定点卫生机构已覆盖全省疫情较严重的13个省辖市,目前全省共有乡级定点机构577家,村级定点机构253家。本次调查地区定点乡卫生院23家,村卫生室51家。
2、HIV感染人群健康状况及影响因素:HIV感染者绝大多数处于艾滋病发病期,有症状的占88.2.%,机会性感染发生率为57.1%,影响HW感染人群健康的主要原因为上呼吸道感染和腹泻。
3、HW感染人群对卫生服务需求和利用远远高于一般居民:HIV感染人群两周患病率为45.2%,一般人群13.5%;HIV感染人群两周就诊率和两周患病平均就诊次数分别为46.7%和5.0±3.9次,一般人群分别为12.1%和3.2±2.9。在就医地点选择上,HIV感染人群较一般居民更倾向于基层卫生机构,91.3%的HIV感染者门诊就医地点选择在乡卫生院和村卫生所。两县HIV感染人群就诊流向有所不同,上蔡县选择在村卫生室就诊的占91.7%,睢县约2/3选择在乡卫生院,1/3在村卫生室。
4、具备艾滋病服务能力的卫生机构分布:两县9所县级医疗机构全部具备开展HIV咨询检测和HIV初筛工作能力;每县都有一家具备开展CD4细胞检测能力的卫生机构。艾滋病定点乡卫生院占乡卫生院总数的48.9%,分布在两县23个乡卫生院;定点村卫生室51所,占村卫生室总数的4.5%,分布在HIV感染者和AIDS病人集中的10个乡镇。
5、卫生资源配置:①床位设备:每千农业人口卫生院床位数上蔡县为0.4张,睢县0.8张。定点机构平均床位数(张)、设备金额(万元)和千元以上设备数(件)分别为25、21.4和13;非定点机构分别为28.5、30.2和11.4。②人员数:定点机构卫生人员数占乡卫生院人员总数的54.4%,卫技人员占卫生人员的54.2%;非定点机构卫生人员占45.6%,卫技人员占45.8%。每千农业人口拥有乡卫生院人员数和卫技人员数上蔡县分别为1.1人和0.7人;睢县为1.0人和0.7人。③学历和资质:乡级卫生人员大专以上的仅占12.5%,有30.7%人员学历在中专以下。定点乡卫生院具有中专以上学历的占人员总数的67.4%;非定点机构占71.6%。抽样村卫生室人员具有中专以上学历者占91.3%。具有执业(助理)医师资格和乡村医师资格的分别占41.8%;54.5%。④艾滋病防治经费:上蔡艾滋病经费总额高于睢县10倍,资金流向也有所不同。上蔡县经费分配最高的是村卫生室(60.6%),睢县为乡卫生院(30.2%)。
6、知识技能:医务人员对艾滋病相关知识的平均知晓率为80.3%,平均得分85.55分,(85.55±8.31)。知晓率最高的主要为艾滋病传播和预防方面知识,晓率最低的是有关艾滋病诊断治疗及职业防护等专业性较强的知识。不同机构医务人员艾滋病知识知晓率存在差异:乡卫生院高于村卫生室;定点医疗机构高于非定点医疗机构的:上蔡县高于睢县。
7、防治活动评价:接受抗病毒药物治疗的人数占调查HIV感染总数的82.3%,抗机会性感染治疗率为100%。对HIV阳性孕产妇采取综合干预措施覆盖率97.2%。在分娩的HIV阳性孕产妇中,100%实施了抗病毒药物阻断。接受抗病毒治疗随访服务的比例81.9%。HIV感染人群能及时获得安全套的比例为63.8%。HIV阳性孕产妇所分娩的婴儿接受随访比例为99.3%,婴儿人工喂养率94.4%。
8、艾滋病防治效果评价:两县当年报告HIV感染人数和AIDS病人数由2004年的162人和3569人下降到2007年的102人和210人;2003、2004和2007年两县总的全人群HIV感染率分别为0.13%、0.31%和0.37%:截止2007年,两县累计HIV阳性孕产妇352例,分娩婴儿283名,满18月婴儿HIV阳性3例,母婴传播比例为0.85%;艾滋病病死率由2004年的5.2%,下降到2007年的3.0%。
9、卫生机构反应性和满意度评价:HIV感染人群对乡卫生院和村卫生室卫生服务系统反应性评分为62.96分和64.6分,都介于“很好”与“好”之间;一般人群对乡卫生院和村卫生室卫生服务系统反应性评分为53.54分和56.28分,都介于“好”与“一般”之间。HIV感染人群对乡卫生院和村卫生室服务满意的比例分别为60.1%和70.2%,一般人群为52.8%和83.0%。
研究结论
以县级艾滋病定点医院、疾病预防控制机构为龙头,乡镇卫生院为枢纽,村卫生室为基础的农村地区艾滋病医疗救治模式已经形成:乡村两级卫生机构成为农村艾滋病医疗救治的主体,农村医务人员承担了医疗救治的主要任务;HIV感染人群对卫生需求远远高于一般人群,不同流行地区对卫生服务利用不同;艾滋病定点卫生机构分布合理,具备了基本服务能力;农村艾滋病防治工作成效显著;HIV感染人群对卫生反应性和满意度好于一般人群,但仍有提升空间。
建议通过农村艾滋病定点机构建设、提高救治能力;通过多种形式分级分类培训,对从事艾滋病医疗服务的一线医务人员进行系统培训,提高救治水平;通过对加强HIV感染人群及其性伴健康宣传和行为干预,提高安全套使用率,降低艾滋病经性传播的危险;通过建立科学有效地艾滋病防治效果评价体系,对艾滋病防治工作的执行能力和效果进行客观评价,及时发现和解决存在的问题,提高艾滋病资源利用效率和艾滋病防治效果。
Objective
The objectives of the study are to survey the condition of health resources at township and village levels in high AIDS prevalence areas of Henan province and assess the health service capacity on AIDS prevention and treatment,to investigate the health status of HIV-infected people,the demand and utilization of health services,evaluate the function and role of the health institution in AIDS prevention and treatment in rural areas, investigate the situation of AIDS prevention and treatment activities and HIV infection rates,morbidity,mortality and evaluate the effects of AIDS prevention and treatment.This study also surveys HIV-infected people's satisfaction level and responsive judgment on health institution and,assesses the effectiveness of health services in order to explore the mode of medical treatment and analyze the problem of this mode,and then make policy recommendations for the next stage of AIDS in rural areas.
Method
In this study,literature search,spot investigation,descriptive analyses are used to analyze the situation of health care institutions and medical treatment of AIDS in the rural areas.In this investigation,the researcher selected two representative areas of high prevalence of AIDS,Shangcai and Sui County.Cluster sampling and the stratified random sampling are used in this spot investigation.The objects includes 47 township hospitals,84 village clinics,131 medical staffs from township and village,720 HIV-infected people,726 healthy people.SPSS15.0 was applied to analyze the data;x2 test,non-parametric hypothesis testing,and fuzzy comprehensive evaluation method are used for statistical analysis.
Results
1.AIDS Prevention and treatment mode in rural areas:"the three-level network" mode has been formed,and the appointed health institutions of AIDS have covered the 13 provincial cities with more serious epidemic.Currently,the province had 577 appointed health institutions at the township level,253 at village level.This investigation includes 23 designated rural hospitals and 51 designated village clinics.
2.Health status of HIV-infection people and effect factors:The vast majority of HIV-infected people are in onset period,88.2%of patients have symptoms.The rate of opportunistic infections is 57.1%and,the main factors affecting the health HIV-infected people are the upper respiratory tract infection and diarrhea.
3.The needs for Health services and the utility of them on behalf of HIV-infection people are much greater than those of the general population.Their two-week morbidity rate is 45.2%;the general population's rate is 13.5%.Their rate of going to hospital every two weeks and the average number of visits are 46.7%and 5.0±3.9 times respectively;for the general population,the figures are 12.1%and 3.2±2.9.In the selection of medical institution,HIV-infection patients are more likely to go to the basic health service institutions,91.3%of them choose township hospitals and village clinics.The results show that the patients' choices of health institutions in the two counties are different.In Shangcai County,91.7%of the patients choose village health clinic while in Sui County two-third of them choose township hospital an one-third of them the village clinic.
4.Distribution of qualified AIDS health Service institutions:The results show that nine county-level medical institutions could carry out HIV counseling and testing and preliminary screening in the two counties;each of them has a health institution which could carry out CD4 cell detection.The number of designated township hospitals for the control of HIV/AIDS has accounted for 48.9%of all the hospitals and all of them are located in 23 township hospitals in two counties.The 51 designated village clinics has accounted for 4.5%of all the clinics which are distributed in 10 AIDS-concentrated townships.
5.Health resources allocation:①Number of sickbeds and medical equipment:In the two counties' hospitals,the number of sickbeds for every 1000 people of Rural Population is 0.4 in Shangcai,0.8 in Sui County.In the appointed institutions of AIDS,average number of beds,Equipment worth(ten thousand Yuan) and medical equipment which is worth more than one thousand Yuan,were 25,21.4 and 13 respectively.In non-appointed health institutions,they were 28.5,30.2 and 11.4.②The number of personnel:the medical personnel of the appointed health institution of AIDS account for 54.4%of all the medical personnel of all the township medical institutions;the medical professionals,account for 54.2%;in non-appointed health institution of AIDS,medical personnel account for 45.6%, the health professionals accounted for 45.8%.Number of medical personnel and the medical professionals for every 1000 people of Rural Population in Shangcai was 1.1 and 0.7;in Sui County was 1.0 and 0.7.③Educational level and qualifications:The numbers of medical personnel who have college education and the above only account for 12.5%and, 30.7%medical personnel are only with technical secondary education.In appointed township hospitals,the number of medical personnel who have secondary education and the above account for 67.4%.The figure is 71.6%in non-appointed health institution of AIDS.In sample village clinics,medical personnel with secondary education and the above account for 91.3%.The qualified physicians and rural physicians account for 41.8%,54.5% respectively.(4) Fund for AIDS prevention:the total amounts of fund of Shangcai County were 10 times larger than that of Sui County and the fund allocation is also different.In Shangcai most of the fund goes to the village clinics(60.6%) while in Sui County goes to rural hospitals(30.2%).
6.Knowledge and Skills:80.3%of the medical professionals have a good knowledge of AIDS and the average score is 85.55 points,(85.55±8.31).What they know very well are the knowledge about the spread of AIDS and the knowledge on prevention.What they know less is the professional knowledge,such as the diagnosis and treatment of AIDS and occupational protection.Medical professionals in different institutions have different AIDS awareness rates:the rate of township hospitals is higher than that of rural clinics;the rate of appointed health institution of AIDS is higher than that of non-appointed health institution of AIDS;Shangcai County has a higher rate than Sui County.
7.Evaluation on activities of prevention and treatment:the HIV-infected people who have taken antiretroviral treatment account for 82.3%;accepted anti-opportunistic infection rate is 100%.The percentage of HIV-positive pregnant women who has taken an integrated intervention is 97.2%.All HIV-positive pregnant women who are in delivery have taken the anti-viral drugs.81.9%of them have received follow-up interview service.63.8% HIV-infected people can timely get condoms,99.3%of their newly-born infants have received the follow-up services and the artificial feeding rate among the infant is 94.4%.
8.Evaluation on effect of AIDS prevention and treatment,data show that the number of HIV-infected people in the two counties has dropped from 162 and 3569 in 2004 down to 102 and 210 in 2007.In 2003,2004 and 2007 the total HIV infection rate of the entire population of the two counties was 0.13%,0.31%and 0.37%.By 2007,the two counties had totally 352 HIV-positive pregnant women who gave birth to 283 infants of whom only three infants are with HIV when 18-month-old,the ratio of mother-to-child transmission was 0.85%;AIDS mortality has dropped from 5.2%in 2004 down to 3.0%in 2007.
9.Evaluation on responsiveness and satisfaction of medical institutions:scores given by the HIV-infected people to the responsiveness of the two kinds of medical services system,township hospitals and village clinics,are 62.96 and 64.6 which are between "very good" and "good".The scores by the general people are 53.54 and 56.28 which are between "good" and "common"。60.1 of HIV-infected people expressed their satisfaction with township hospitals and 70.2%expressed their satisfaction with village clinics.
Conclusions
Mode of AIDS medical treatment has been formed in rural areas with County-level AIDS hospitals and Centers for disease control and prevention as the leading part,township hospital as the hinge and village clinics as the basis.The two levels rural medical institutions,township and village,have made up the main body of AIDS medical treatment and the medical staff in rural areas are undertaking the main task of medical treatment. HIV-infected people have a greater medical need than the general people and different endemic areas have used medical services differently.The distribution of the appointed medical institution of AIDS was reasonable,and the institutions also have the capacity of basic medical services.The effectiveness of AIDS prevention and treatment in rural areas are significant and the HIV-infected people have expressed greater satisfaction with the responsiveness than the general population,but the service still has some room for improvement.
Recommendations:the build-up of AIDS prevention and treatment institutions in rural areas can improve the capacity of medical treatment.Through the training of medical professionals we can enhance their skills of treatment.By strengthening medical education and behavioral interventions among the HIV-infected people we can enhance condom use among them and reduce the risk of sexually transmitted AIDS.By establishing a scientific evaluation system for AIDS prevention and treatment and giving an objective assessment on the capacity and effectiveness of implementation,we can discover and solve problems, and improve the utilization of anti-AIDS resources and efficiency of prevention and treatment.
调查河南省艾滋病高流行地区乡村两级卫生资源状况,评估卫生机构艾滋病防治服务能力;了解HIV感染人群的健康状况、卫生需求及卫生服务利用情况;评价农村卫生机构在艾滋病防治方面的功能和作用;调查艾滋病防治活动开展情况和HIV感染、发病、死亡情况,评估艾滋病防治效果;调查HIV感染人群对卫生机构的满意度和反应性评价,评估卫生机构服务效果;探讨河南省农村艾滋病医疗救治模式,分析可能存在的问题,为下阶段农村艾滋病防治工作提出政策性建议。
研究方法
本研究采用了文献检索法、现场调查法、描述性分析法对农村卫生机构和艾滋病医疗救治情况进行了调查分析。现场调查选取上蔡县和睢县两个具有代表性的艾滋病高流行地区,分别采取整群抽样和分层随机抽样等方法,调查乡卫生院47所,村卫生室84所,乡、村两级医务人员131人、HIV感染人群720人、一般对照人群726人。资料分析和数据处理采用SPSS15.0统计软件进行描述性分析、x~2检验、非参数假设检验以及模糊综合评价等方法进行统计学分析。
研究结果
1、农村艾滋病防治模式:农村艾滋病防治“三级网”模式已经形成,艾滋病定点卫生机构已覆盖全省疫情较严重的13个省辖市,目前全省共有乡级定点机构577家,村级定点机构253家。本次调查地区定点乡卫生院23家,村卫生室51家。
2、HIV感染人群健康状况及影响因素:HIV感染者绝大多数处于艾滋病发病期,有症状的占88.2.%,机会性感染发生率为57.1%,影响HW感染人群健康的主要原因为上呼吸道感染和腹泻。
3、HW感染人群对卫生服务需求和利用远远高于一般居民:HIV感染人群两周患病率为45.2%,一般人群13.5%;HIV感染人群两周就诊率和两周患病平均就诊次数分别为46.7%和5.0±3.9次,一般人群分别为12.1%和3.2±2.9。在就医地点选择上,HIV感染人群较一般居民更倾向于基层卫生机构,91.3%的HIV感染者门诊就医地点选择在乡卫生院和村卫生所。两县HIV感染人群就诊流向有所不同,上蔡县选择在村卫生室就诊的占91.7%,睢县约2/3选择在乡卫生院,1/3在村卫生室。
4、具备艾滋病服务能力的卫生机构分布:两县9所县级医疗机构全部具备开展HIV咨询检测和HIV初筛工作能力;每县都有一家具备开展CD4细胞检测能力的卫生机构。艾滋病定点乡卫生院占乡卫生院总数的48.9%,分布在两县23个乡卫生院;定点村卫生室51所,占村卫生室总数的4.5%,分布在HIV感染者和AIDS病人集中的10个乡镇。
5、卫生资源配置:①床位设备:每千农业人口卫生院床位数上蔡县为0.4张,睢县0.8张。定点机构平均床位数(张)、设备金额(万元)和千元以上设备数(件)分别为25、21.4和13;非定点机构分别为28.5、30.2和11.4。②人员数:定点机构卫生人员数占乡卫生院人员总数的54.4%,卫技人员占卫生人员的54.2%;非定点机构卫生人员占45.6%,卫技人员占45.8%。每千农业人口拥有乡卫生院人员数和卫技人员数上蔡县分别为1.1人和0.7人;睢县为1.0人和0.7人。③学历和资质:乡级卫生人员大专以上的仅占12.5%,有30.7%人员学历在中专以下。定点乡卫生院具有中专以上学历的占人员总数的67.4%;非定点机构占71.6%。抽样村卫生室人员具有中专以上学历者占91.3%。具有执业(助理)医师资格和乡村医师资格的分别占41.8%;54.5%。④艾滋病防治经费:上蔡艾滋病经费总额高于睢县10倍,资金流向也有所不同。上蔡县经费分配最高的是村卫生室(60.6%),睢县为乡卫生院(30.2%)。
6、知识技能:医务人员对艾滋病相关知识的平均知晓率为80.3%,平均得分85.55分,(85.55±8.31)。知晓率最高的主要为艾滋病传播和预防方面知识,晓率最低的是有关艾滋病诊断治疗及职业防护等专业性较强的知识。不同机构医务人员艾滋病知识知晓率存在差异:乡卫生院高于村卫生室;定点医疗机构高于非定点医疗机构的:上蔡县高于睢县。
7、防治活动评价:接受抗病毒药物治疗的人数占调查HIV感染总数的82.3%,抗机会性感染治疗率为100%。对HIV阳性孕产妇采取综合干预措施覆盖率97.2%。在分娩的HIV阳性孕产妇中,100%实施了抗病毒药物阻断。接受抗病毒治疗随访服务的比例81.9%。HIV感染人群能及时获得安全套的比例为63.8%。HIV阳性孕产妇所分娩的婴儿接受随访比例为99.3%,婴儿人工喂养率94.4%。
8、艾滋病防治效果评价:两县当年报告HIV感染人数和AIDS病人数由2004年的162人和3569人下降到2007年的102人和210人;2003、2004和2007年两县总的全人群HIV感染率分别为0.13%、0.31%和0.37%:截止2007年,两县累计HIV阳性孕产妇352例,分娩婴儿283名,满18月婴儿HIV阳性3例,母婴传播比例为0.85%;艾滋病病死率由2004年的5.2%,下降到2007年的3.0%。
9、卫生机构反应性和满意度评价:HIV感染人群对乡卫生院和村卫生室卫生服务系统反应性评分为62.96分和64.6分,都介于“很好”与“好”之间;一般人群对乡卫生院和村卫生室卫生服务系统反应性评分为53.54分和56.28分,都介于“好”与“一般”之间。HIV感染人群对乡卫生院和村卫生室服务满意的比例分别为60.1%和70.2%,一般人群为52.8%和83.0%。
研究结论
以县级艾滋病定点医院、疾病预防控制机构为龙头,乡镇卫生院为枢纽,村卫生室为基础的农村地区艾滋病医疗救治模式已经形成:乡村两级卫生机构成为农村艾滋病医疗救治的主体,农村医务人员承担了医疗救治的主要任务;HIV感染人群对卫生需求远远高于一般人群,不同流行地区对卫生服务利用不同;艾滋病定点卫生机构分布合理,具备了基本服务能力;农村艾滋病防治工作成效显著;HIV感染人群对卫生反应性和满意度好于一般人群,但仍有提升空间。
建议通过农村艾滋病定点机构建设、提高救治能力;通过多种形式分级分类培训,对从事艾滋病医疗服务的一线医务人员进行系统培训,提高救治水平;通过对加强HIV感染人群及其性伴健康宣传和行为干预,提高安全套使用率,降低艾滋病经性传播的危险;通过建立科学有效地艾滋病防治效果评价体系,对艾滋病防治工作的执行能力和效果进行客观评价,及时发现和解决存在的问题,提高艾滋病资源利用效率和艾滋病防治效果。
Objective
The objectives of the study are to survey the condition of health resources at township and village levels in high AIDS prevalence areas of Henan province and assess the health service capacity on AIDS prevention and treatment,to investigate the health status of HIV-infected people,the demand and utilization of health services,evaluate the function and role of the health institution in AIDS prevention and treatment in rural areas, investigate the situation of AIDS prevention and treatment activities and HIV infection rates,morbidity,mortality and evaluate the effects of AIDS prevention and treatment.This study also surveys HIV-infected people's satisfaction level and responsive judgment on health institution and,assesses the effectiveness of health services in order to explore the mode of medical treatment and analyze the problem of this mode,and then make policy recommendations for the next stage of AIDS in rural areas.
Method
In this study,literature search,spot investigation,descriptive analyses are used to analyze the situation of health care institutions and medical treatment of AIDS in the rural areas.In this investigation,the researcher selected two representative areas of high prevalence of AIDS,Shangcai and Sui County.Cluster sampling and the stratified random sampling are used in this spot investigation.The objects includes 47 township hospitals,84 village clinics,131 medical staffs from township and village,720 HIV-infected people,726 healthy people.SPSS15.0 was applied to analyze the data;x2 test,non-parametric hypothesis testing,and fuzzy comprehensive evaluation method are used for statistical analysis.
Results
1.AIDS Prevention and treatment mode in rural areas:"the three-level network" mode has been formed,and the appointed health institutions of AIDS have covered the 13 provincial cities with more serious epidemic.Currently,the province had 577 appointed health institutions at the township level,253 at village level.This investigation includes 23 designated rural hospitals and 51 designated village clinics.
2.Health status of HIV-infection people and effect factors:The vast majority of HIV-infected people are in onset period,88.2%of patients have symptoms.The rate of opportunistic infections is 57.1%and,the main factors affecting the health HIV-infected people are the upper respiratory tract infection and diarrhea.
3.The needs for Health services and the utility of them on behalf of HIV-infection people are much greater than those of the general population.Their two-week morbidity rate is 45.2%;the general population's rate is 13.5%.Their rate of going to hospital every two weeks and the average number of visits are 46.7%and 5.0±3.9 times respectively;for the general population,the figures are 12.1%and 3.2±2.9.In the selection of medical institution,HIV-infection patients are more likely to go to the basic health service institutions,91.3%of them choose township hospitals and village clinics.The results show that the patients' choices of health institutions in the two counties are different.In Shangcai County,91.7%of the patients choose village health clinic while in Sui County two-third of them choose township hospital an one-third of them the village clinic.
4.Distribution of qualified AIDS health Service institutions:The results show that nine county-level medical institutions could carry out HIV counseling and testing and preliminary screening in the two counties;each of them has a health institution which could carry out CD4 cell detection.The number of designated township hospitals for the control of HIV/AIDS has accounted for 48.9%of all the hospitals and all of them are located in 23 township hospitals in two counties.The 51 designated village clinics has accounted for 4.5%of all the clinics which are distributed in 10 AIDS-concentrated townships.
5.Health resources allocation:①Number of sickbeds and medical equipment:In the two counties' hospitals,the number of sickbeds for every 1000 people of Rural Population is 0.4 in Shangcai,0.8 in Sui County.In the appointed institutions of AIDS,average number of beds,Equipment worth(ten thousand Yuan) and medical equipment which is worth more than one thousand Yuan,were 25,21.4 and 13 respectively.In non-appointed health institutions,they were 28.5,30.2 and 11.4.②The number of personnel:the medical personnel of the appointed health institution of AIDS account for 54.4%of all the medical personnel of all the township medical institutions;the medical professionals,account for 54.2%;in non-appointed health institution of AIDS,medical personnel account for 45.6%, the health professionals accounted for 45.8%.Number of medical personnel and the medical professionals for every 1000 people of Rural Population in Shangcai was 1.1 and 0.7;in Sui County was 1.0 and 0.7.③Educational level and qualifications:The numbers of medical personnel who have college education and the above only account for 12.5%and, 30.7%medical personnel are only with technical secondary education.In appointed township hospitals,the number of medical personnel who have secondary education and the above account for 67.4%.The figure is 71.6%in non-appointed health institution of AIDS.In sample village clinics,medical personnel with secondary education and the above account for 91.3%.The qualified physicians and rural physicians account for 41.8%,54.5% respectively.(4) Fund for AIDS prevention:the total amounts of fund of Shangcai County were 10 times larger than that of Sui County and the fund allocation is also different.In Shangcai most of the fund goes to the village clinics(60.6%) while in Sui County goes to rural hospitals(30.2%).
6.Knowledge and Skills:80.3%of the medical professionals have a good knowledge of AIDS and the average score is 85.55 points,(85.55±8.31).What they know very well are the knowledge about the spread of AIDS and the knowledge on prevention.What they know less is the professional knowledge,such as the diagnosis and treatment of AIDS and occupational protection.Medical professionals in different institutions have different AIDS awareness rates:the rate of township hospitals is higher than that of rural clinics;the rate of appointed health institution of AIDS is higher than that of non-appointed health institution of AIDS;Shangcai County has a higher rate than Sui County.
7.Evaluation on activities of prevention and treatment:the HIV-infected people who have taken antiretroviral treatment account for 82.3%;accepted anti-opportunistic infection rate is 100%.The percentage of HIV-positive pregnant women who has taken an integrated intervention is 97.2%.All HIV-positive pregnant women who are in delivery have taken the anti-viral drugs.81.9%of them have received follow-up interview service.63.8% HIV-infected people can timely get condoms,99.3%of their newly-born infants have received the follow-up services and the artificial feeding rate among the infant is 94.4%.
8.Evaluation on effect of AIDS prevention and treatment,data show that the number of HIV-infected people in the two counties has dropped from 162 and 3569 in 2004 down to 102 and 210 in 2007.In 2003,2004 and 2007 the total HIV infection rate of the entire population of the two counties was 0.13%,0.31%and 0.37%.By 2007,the two counties had totally 352 HIV-positive pregnant women who gave birth to 283 infants of whom only three infants are with HIV when 18-month-old,the ratio of mother-to-child transmission was 0.85%;AIDS mortality has dropped from 5.2%in 2004 down to 3.0%in 2007.
9.Evaluation on responsiveness and satisfaction of medical institutions:scores given by the HIV-infected people to the responsiveness of the two kinds of medical services system,township hospitals and village clinics,are 62.96 and 64.6 which are between "very good" and "good".The scores by the general people are 53.54 and 56.28 which are between "good" and "common"。60.1 of HIV-infected people expressed their satisfaction with township hospitals and 70.2%expressed their satisfaction with village clinics.
Conclusions
Mode of AIDS medical treatment has been formed in rural areas with County-level AIDS hospitals and Centers for disease control and prevention as the leading part,township hospital as the hinge and village clinics as the basis.The two levels rural medical institutions,township and village,have made up the main body of AIDS medical treatment and the medical staff in rural areas are undertaking the main task of medical treatment. HIV-infected people have a greater medical need than the general people and different endemic areas have used medical services differently.The distribution of the appointed medical institution of AIDS was reasonable,and the institutions also have the capacity of basic medical services.The effectiveness of AIDS prevention and treatment in rural areas are significant and the HIV-infected people have expressed greater satisfaction with the responsiveness than the general population,but the service still has some room for improvement.
Recommendations:the build-up of AIDS prevention and treatment institutions in rural areas can improve the capacity of medical treatment.Through the training of medical professionals we can enhance their skills of treatment.By strengthening medical education and behavioral interventions among the HIV-infected people we can enhance condom use among them and reduce the risk of sexually transmitted AIDS.By establishing a scientific evaluation system for AIDS prevention and treatment and giving an objective assessment on the capacity and effectiveness of implementation,we can discover and solve problems, and improve the utilization of anti-AIDS resources and efficiency of prevention and treatment.
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1.UNAIDS&WHO.07 AIDS epidemic update[R].Geneva:UNAIDS,2007.3-25State council AIDS working committee office UN theme group on AIDS in China.
2.AIDS epidemic update UNIAIDS/WHO December 2002
3.08 AIDS epidemic update UNIAIDS/WHO December 2008
4.中华人民共和国卫生部,联合国艾滋病中国专题组,中国艾滋病防治需求评估报告.1997年
5.汪宁.艾滋病在中国和全球的流行现状及面临的挑战[J].科技导报,2005,23(7):4.8.
6.China Ministry of Health and UN Theme Group on HIV/AIDS in China,A Joint Assessment of HIV/AIDS Prevention,Treatment and Care in China.2003
7.State Council AIDS Working Committee Office UN Theme Group on AIDS in China,A Joint Assessment of HIV/AIDS Prevention,Treatment and Care in China.(2004)
8.中华人民共和囤卫生部,联合国艾滋病规划署,世界卫生组织.2005年中国艾滋病疫情与防治工作进展报告.
9.State council AIDS working committee office UN theme group on AIDS in China.A joint assessment of HIV/AIDS prevention,treatment and care in China(2007)[R]
10.Gury DJ.AIDS and Paid donor[letter],Lancet,1983 Sep 3,2(8349):575.
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13.Gluek D,Koemer K,Caspari G,et al.The Prevalence of human immunodeficiency.virus(HIV) in blood donors in West Germany And West Berlin.Beitr Infusionsther,1988,21:139-42.
14.HatZidimitriou K,KontoPouloul,Mandalaki T,et al.HIV seropositivity in Greek blood donors(1985-1990)[letter].Vox Sang,1991,61(3):215-6.
15.Avila C,Stetler HC,SepulvedaJ,et al.The epidemiology of HIV transmission among Paidplasmadonors,MexicoCity,Mexieo.AIDS,1989Oet,3(10):631-3.
16.Marin LA.Prevalence of antibodies against human immunodeficiency virus(HIV) and other infectious disease markers in blood donors from the city of Puebla.Rev Invest Clin,1987Jul-SeP,39(3):219-32.
17.Banerjee K,Rodrigues J,Israel Z,et al.Out break of HIV seropositivity among Commercial plasma donors in pune,India[letter].Lancet,1989,Jul 15,2(8655):166.
18.Bhushan N,PulimoodBR,Babu PG,et al.Rising trend in the Prevalence of HIV infection among blood donors.Indian J Med Res,1994 May,99:195-7.
19.Mundee Y,Kamtom N,ChaiyaPhruk S,et al.Infection disease markers in blood donors in northern Thailand.Thansfusion,1995 Mar,35(3):264-7.
20.Fiseher PR,Toko RM1.HIV seroprevalence in healthy blood donors in northerneastern Zaire.Int J STDAIDS,1995,Jul-Aug,6(4):284-6.
21.Sullivan,etal.Transfusion,1998:38:189-192.
22.Herrera J,et al.12~(Th) World AIDS Conference,Geneva,June28-July 3 1998:23153.
23.16,State council AIDS working committee office UN theme group on AIDS in China.A joint assessment of HIV/AIDS prevention,treatment and care in China(2004)[R].3-6
24.国务院,关于切实加强艾滋病防治工作的通知(国发[2004]7号
25.朱新义,黄祚军,崔兆麟,等.既往非法采供血地区某行政村HIV二代传播的流行病学调查[J].中国全科医生,2008,11(7a)1176-1177
26.郭金玲,张亮,王宇明等.基层HIV感染和艾滋病防治工作主要问题探讨.中国公共卫生2006,22(1):73-75
27.赵亮,田庆丰,河南省艾滋病政策分析.河南医学研究.2006,15(2):181-184
28.32、赵红心,艾滋病的农村防治问题和策略.中华全科医师杂志.2006,5(11)662-663
29.黄敬堂,村卫生所医护人员艾滋病知识、态度调查.中国健康教育.2006,22(11):877-878
30.胡小兵,陈献春,肖素香.乡村医生对经血传播HIV现状知情调查及对策.河北医药.2004,26(8):677-678
31.孙丽君,王署照,姚勤伟等.农村地区艾滋病抗病毒治疗依从性及应对策略分析.中国艾滋病性病.2007,13(4):317-319
32.Kent DM,McGrath D,Ioannidis JP,et al.Suitable monitoring approaches to antiretroviral therapy in resource poor settings:setting the research agenda.Clin Infect Dis,2003,37(Supp 11):S13224.
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