互联网平台支持下的艾滋病诊疗“一站式服务”HIV筛查阳性者的转介状况研究
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摘要
目的了解基于互联网平台支持下的艾滋病诊疗"一站式服务"的艾滋病病毒(HIV)抗体筛查阳性者的转介情况,为完善艾滋病诊疗"一站式服务"工作模式提供依据。方法利用互联网技术和平台建设,收集珠海市2017年4月26日至2018年5月31日艾滋病筛查阳性者的转介跟踪信息,对转介成功者与转介脱失者进行比较分析。结果共检出筛查阳性者687人次,删除重复检测后实际筛查阳性者为560例,其中既往阳性病例占39.3%(220例),新发现筛查阳性病例占60.7%(340例)。在340例新发现的筛查阳性者中,转介成功279例,转介脱失61例,转介成功比例为82.1%。从HIV抗体筛查阳性到确证采样的时间间隔中位数为3(1～8)天,从筛查阳性到确证阳性的时间间隔中位数为7(4～11)天。首次接受检测者转介成功比例是有重复检测经历者的0.249倍(P<0.05)。以医院感染科就诊者为参照,皮肤性病科就诊者、外科就诊者转介成功比例分别是其0.261倍和0.156倍(P<0.05)。转介脱失的主要原因是无法联系(27.9%)、拒绝确证检测(24.6%)和自述已离开本地(21.3%)。结论开展互联网平台支持下的艾滋病诊疗"一站式服务"后,HIV筛查阳性者转介成功率达80%以上,今后要重点提高非定点治疗机构及重点科室的转介成功率,有利于病例的早发现、早诊断、早治疗。
Objective To understand the status of the screened HIV-positive patients,and the referral services of HIV/AIDS testing and treatment based on the‘one-stop service'model supported by the internet,and provide evidence for improvement of"one-stop service".Methods The referral information of the screened HIV-positive patients was collected by using the internet during April 26 th,2017 to May 31 st,2018,and the difference between successful and unsuccessful referrals was compared and analyzed.Results 687 cases were screened as HIV antibody positive,among which 39.3%(220 cases)were previously screened and 60.7%(340 cases)were newly screened.82.1%(279 newly screened HIV positive cases)were successfully referred to for confirmation and treatment.The time between HIV screening and samples collection for HIV confirmation was 4 d(IQR 1-8).The time between HIV screened positive to HIV confirmed positive were 7 d(IQR 4-11).The patients who had received the first HIV antibody screening were 0.249 times more likely to refer than those who had received screening repeatedly(P<0.05).Compared with patients in the infection department of a hospital,the referral rate of the dermatology/STDs and the surgeon departments was 0.261 times and 0.156 times,respectively.The reasons for drop out of the screened HIV-positive patients for confirmation and treatment were being unable to contact the services(27.9%),refusal for confirmation(24.6%),and moving away from Zhuhai city(21.3%).Conclusion After launch of the one-stop AIDS diagnosis and treatment services supported by the internet,the referral rate for the screened HIVpositive patients reaches over 80%.In order to promote early detection,early diagnosis and early treatment,the focus should be on improving successful referral in the non-designated medical institutions and key departments of a hospital in the future.
Objective To understand the status of the screened HIV-positive patients,and the referral services of HIV/AIDS testing and treatment based on the‘one-stop service'model supported by the internet,and provide evidence for improvement of"one-stop service".Methods The referral information of the screened HIV-positive patients was collected by using the internet during April 26 th,2017 to May 31 st,2018,and the difference between successful and unsuccessful referrals was compared and analyzed.Results 687 cases were screened as HIV antibody positive,among which 39.3%(220 cases)were previously screened and 60.7%(340 cases)were newly screened.82.1%(279 newly screened HIV positive cases)were successfully referred to for confirmation and treatment.The time between HIV screening and samples collection for HIV confirmation was 4 d(IQR 1-8).The time between HIV screened positive to HIV confirmed positive were 7 d(IQR 4-11).The patients who had received the first HIV antibody screening were 0.249 times more likely to refer than those who had received screening repeatedly(P<0.05).Compared with patients in the infection department of a hospital,the referral rate of the dermatology/STDs and the surgeon departments was 0.261 times and 0.156 times,respectively.The reasons for drop out of the screened HIV-positive patients for confirmation and treatment were being unable to contact the services(27.9%),refusal for confirmation(24.6%),and moving away from Zhuhai city(21.3%).Conclusion After launch of the one-stop AIDS diagnosis and treatment services supported by the internet,the referral rate for the screened HIVpositive patients reaches over 80%.In order to promote early detection,early diagnosis and early treatment,the focus should be on improving successful referral in the non-designated medical institutions and key departments of a hospital in the future.
引文
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[7]李剑军,唐振柱,刘伟,等.医疗机构HIV抗体筛查呈阳性反应标本转介的现状分析[J].应用预防医学,2011,17(1):24-26.
[8]郑桦.综合医院艾滋患者告知与转介中的问题与对策[J].医学信息(上旬刊),2011,24(2):790-791.
[9]赵月娟,卢红艳,王娟,等.北京市2012年医疗机构主动提供艾滋病检测咨询情况[J].中国艾滋病性病,2014,20(3):186-188.
[10]郭建梅,田甜,罗桂英,等.医务人员艾滋病歧视态度相关因素结构方程模型分析[J].中国艾滋病性病,2017,23(2):162-164.
[2]单多,段松,高洁,等.我国某艾滋病高流行地区主动提供艾滋病检测咨询早期发现感染者状况分析[J].中华预防医学杂志,2015,49(11):962-966.
[3]Leon N,Mathews C,Lewin S,et al.A comparison of linkage to HIVcare after provider-initiated HIV testing and counselling(PITC)versus voluntary HIV counselling and testing(VCT)for patients with sexually transmitted infections in Cape Town,South Africa[J].BMCHealth Services Research,2014,14(1):350.
[4]Wu Z,Zhao Y,Ge X,et al.Simplified HIV Testing and Treatment in China:Analysis of Mortality Rates Before and After a Structural Intervention[J].PLoS Medicine,2015,12(9):e1001874.
[5]冼建民,邱学俊,农桂德,等.广西钟山县艾滋病治疗“一站式服务”模式的探讨[J].中国艾滋病性病,2014,20(12):952-954.
[6]徐园园,张敏,朱正平,等.南京市医疗机构HIV检测和转介服务的现况调查[J].中国艾滋病性病,2014,20(9):651-653.
[7]李剑军,唐振柱,刘伟,等.医疗机构HIV抗体筛查呈阳性反应标本转介的现状分析[J].应用预防医学,2011,17(1):24-26.
[8]郑桦.综合医院艾滋患者告知与转介中的问题与对策[J].医学信息(上旬刊),2011,24(2):790-791.
[9]赵月娟,卢红艳,王娟,等.北京市2012年医疗机构主动提供艾滋病检测咨询情况[J].中国艾滋病性病,2014,20(3):186-188.
[10]郭建梅,田甜,罗桂英,等.医务人员艾滋病歧视态度相关因素结构方程模型分析[J].中国艾滋病性病,2017,23(2):162-164.