淮安市医务人员主动提供艾滋病检测咨询效果分析
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摘要
目的对医务人员主动提供艾滋病检测咨询(PITC)进行效果评估,为进一步完善检测策略提供依据。方法收集2012年和2016年全市HIV抗体检测量和发现的感染者数据,以及部分医院的就诊量,对PITC实施前后的相关指标进行分析。结果 2016年HIV抗体检测量和检测阳性数均较2012年显著增加,分别增长104.61%和54.12%,PITC途径发现的感染者构成比由40.00%上升到56.49%。HIV感染者发现主要在大中型医疗机构,医疗机构规模越高,HIV抗体检测阳性率越高,差异有统计学意义(χ~2趋势=43.25,P<0.01)。皮肤性病科HIV抗体检测阳性率较高,与自愿咨询检测(VCT)相比,PITC途径发现的感染者较晚,既往检测比例低,差异有统计学意义(P<0.01)。结论 PITC在HIV感染者发现方面具有重要作用,性病门诊是开展PITC服务的重点科室,应加强在性病门诊推广PITC服务。
Objective To evaluate the results of provider initiated HIV testing and counseling(PITC),and improve the testing strategy. Methods Data of 2012 and 2016 were collected,including number of HIV testing and HIV positive,number of hospital visits. The relevant indexes before and after PITC were analyzed. Results The number of HIV testing and HIV positive were significantly increased compared with 2012,increasing by 104.61% and 54.12%,respectively. The percentage of HIV infected persons found by PITC increased from 40.00% to 56.49%. Most of HIV positive patients were found in large and medium-sized medical institutions. The higher the scale of medical institutions,the higher the positive rate of HIV antibody detection,the difference were statistically significant(χ~2趋势=43.25,P<0.01). The positive rate of HIV detection was higher in STD clinic. Compared with voluntary counseling and testing(VCT),HIV positive patients found by PITC was late(P<0.01). Conclusion PITC plays an important role in the discovery of HIV infected persons. PITC service should be strengthened in STD clinic,which is the key department for PITC service.
Objective To evaluate the results of provider initiated HIV testing and counseling(PITC),and improve the testing strategy. Methods Data of 2012 and 2016 were collected,including number of HIV testing and HIV positive,number of hospital visits. The relevant indexes before and after PITC were analyzed. Results The number of HIV testing and HIV positive were significantly increased compared with 2012,increasing by 104.61% and 54.12%,respectively. The percentage of HIV infected persons found by PITC increased from 40.00% to 56.49%. Most of HIV positive patients were found in large and medium-sized medical institutions. The higher the scale of medical institutions,the higher the positive rate of HIV antibody detection,the difference were statistically significant(χ~2趋势=43.25,P<0.01). The positive rate of HIV detection was higher in STD clinic. Compared with voluntary counseling and testing(VCT),HIV positive patients found by PITC was late(P<0.01). Conclusion PITC plays an important role in the discovery of HIV infected persons. PITC service should be strengthened in STD clinic,which is the key department for PITC service.
引文
[1] Marks G,Crepaz N,Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA[J]. AIDS,2006,20(10):1447-1450.
[2] WHO,UNAIDS. Guidance on provider-initiated HIV testing and counseling in health facilities[R]. Geneva:World Health Organization,2006.
[3]刘德清,李新,韩建华,等.基层医疗机构开展PITC效果评估[J].公共卫生与预防医学,2014,25(1):98-99.Liu DQ,Li X,Han JH,et al. Evaluation of PITC effect in grassroots medical institutions[J]. J of Pub Health and Prev Med,2014,25(1):98-99.
[4]祁耀,崔倩.盐城市HIV/AIDS流行特征和晚发现影响因素[J].江苏预防医学,2015,26(2):24-26.Qi Y,Cui Q. Analysis of epidemiological characteristics of HIV/AIDS and influencing factors of late diagnosis in Yancheng[J].Jiangsu J Prev Med,2015,26(2):24-26.
[5]王婉薇,王美凤.内江市推行PITC后艾滋病防治主要措施落实评估[J].公共卫生与预防医学,2014,25(4):42-44,47.Wang WW,Wang MF. Evaluation on HIV/AIDS prevention and control after implementing PITC in Neijiang city[J]. J of Pub Health and Prev Med,2014,25(4):42-44,47.
[6]霍俊丽,施玉华,韩瑜,等.云南省2009-2015年医疗机构PITC结果分析[J].中国艾滋病性病,2017,23(10):959-961.Huo JL,Shi YH,Han Y,et al. Result analysis of providerinitiated HIV testing and counseling for clients to medical institutions from 2009 to 2015 in Yunnan province[J]. Chin J AIDS STD,2017,23(10):959-961.
[7]赵晓燕,奚静,王德伟,等.成都市成华区艾滋病PITC工作模式及效果分析[J].中国初级卫生保健,2016,30(10):55-57,60.Zhao XY,Xi J,Wang DW,et al. PITC working mode and effect analysis of AIDS in Chenghua district,Chengdu[J]. Chinese Primary Health Care,2016,30(10):55-57,60.
[8]胡强,李艳春,罗雅凌. 2014-2016年江西省医疗机构主动提供艾滋病检测咨询工作情况分析[J].应用预防医学,2017,23(5):374-376.Hu Q,Li YC,Luo YL. Analysis of AIDS testing and consulting work in Jiangxi medical institutions from 2014 to 2016[J]. J Applied Prev Med,2017,23(5):374-376.
[9]罗珍胄,李岚,李真,等.深圳市医务人员艾滋病检测咨询效果分析[J].中国热带医学,2012,12(5):556-558.Luo ZZ,Li L,Li Z,et al. Results of provider-initiated HIV testing and counselling in health facility in Nanshan District of Shenzhen[J]. China Tropical Medicine,2012,12(5):556-558.
[10]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.Shan D,Duan S,Gao J,et al. Analysis of early detection of HIV infections by provider initiated HIV testing and counselling in regions with high HIV/AIDS epidemic in China[J]. Chin J Prev Med,2015,49(11):962-966.
[11]高洁,项丽芬,沈勤丰,等.德宏州乡镇卫生院2013年免费主动提供艾滋病咨询检测服务人群HIV感染率及其影响因素[J].中国艾滋病性病,2016,22(1):29-31.Gao J,Xiang LF,Shen QF,et al. HIV infection and influencing factors of the patients receiving PITC in township hospitals in Dehong Prefecture[J]. Chin J AIDS STD,2016,22(1):29-31.
[12]朱艳文,金燕,杨慧,等. 2008-2016年济南市医疗机构检测发现的艾滋病病例情况分析[J].中国艾滋病性病,2017,23(9):859-860.Zhu YW,Jin Y,Yang H,et al. Analysis of AIDS cases detected by medical institutions in Ji'nan from 2008 to 2016[J]. Chin J AIDS STD,2017,23(9):859-860.
[13]董玉梅,靳桂明,祝松,等.综合性医院扩大HIV检测咨询服务模式运行与实施[J].中国艾滋病性病,2014,20(10):784-785.Dong YM,Jin GM,Zhu S,et al. Operation and implementation of expanded HIV testing and consultation service mode in general hospitals[J]. Chin J AIDS STD,2014,20(10):784-785.
[14]黄胜萍,王建梅,姚在节,等.以性病诊疗为依托的预防艾滋病行为干预模式研究[J].右江医学,2017,45(2):180-183.Huang SP,Wang JM,Yao ZJ,et al. A study on intervention mode of HIV/AIDS prevention based on clinical service of sexually transmitted disease[J]. Chinese Youjiang Medical Journal,2017,45(2):180-183.
[15]左桐,庞作章,齐秀英.性病门诊男性就诊者HIV/TP感染状况及影响因素[J].中国公共卫生,2017,33(3):361-364.Zuo T,Pang ZZ,Qi XY. HIV/TP infection and related factors of among male attendees of STD clinic[J]. Chin J Public Health,2017,33(3):361-364.
[16]杨晓华,朱鑫,刘英,等.洛阳市艾滋病扩大检测效果评价[J].中国医学创新,2016,13(25):59-62.Yang XH,Zhu X,Liu Y,et al. Evaluation on the effect of AIDS extended detection in Luoyang city[J]. Medical Innovation of China,2016,13(25):59-62.
[17]金霞,熊燃,毛宇嵘. 2008-2013年我国医疗机构检测发现艾滋病病例情况分析[J].中华流行病学杂志,2015,36(4):323-326.Jin X,Xiong R,Mao YR. HIV/AIDS cases detection in medical institutions from 2008 to 2013 in China[J]. Chin J Epidemiol,2015,36(4):323-326.
[18]张娜娜,宋明明,刘冬莹,等.潍坊市2005-2015年HIV/AIDS病例晚发现情况分析[J].中国艾滋病性病,2017,23(7):609-612.`Zhang NN,Song MM,Liu DY,et al. Analysis on the diagnosed HIV/AIDS cases reported during 2005-2015 in Weifang city[J].Chin J AIDS STD,2017,23(7):609-612.
[19]金霞,熊燃,王丽艳,等. 2010-2014年我国HIV感染病例的晚发现情况分析[J].中华流行病学杂志,2016,37(2):218-221.Jin X, Xiong R, Wang LY, et al. Analysis on the ‘late diagnosis’(LD)phenomena among newly identified HIV/AIDS cases in China,2010-2014[J]. Chin J Epidemiol,2016,37(2):218-221.
[20]赵秀萍,傅卓华,赵艳秋,等.苏州市扩大艾滋病检测措施实施效果评价[J].中国艾滋病性病,2013,19(11):823-825.Zhao XP,Fu ZH,Zhao YQ,et al. Evaluation on strategy of scaling-up HIV testing in Suzhou,Jiangsu Province[J]. Chin J AIDS STD,2013,19(11):823-825.
[2] WHO,UNAIDS. Guidance on provider-initiated HIV testing and counseling in health facilities[R]. Geneva:World Health Organization,2006.
[3]刘德清,李新,韩建华,等.基层医疗机构开展PITC效果评估[J].公共卫生与预防医学,2014,25(1):98-99.Liu DQ,Li X,Han JH,et al. Evaluation of PITC effect in grassroots medical institutions[J]. J of Pub Health and Prev Med,2014,25(1):98-99.
[4]祁耀,崔倩.盐城市HIV/AIDS流行特征和晚发现影响因素[J].江苏预防医学,2015,26(2):24-26.Qi Y,Cui Q. Analysis of epidemiological characteristics of HIV/AIDS and influencing factors of late diagnosis in Yancheng[J].Jiangsu J Prev Med,2015,26(2):24-26.
[5]王婉薇,王美凤.内江市推行PITC后艾滋病防治主要措施落实评估[J].公共卫生与预防医学,2014,25(4):42-44,47.Wang WW,Wang MF. Evaluation on HIV/AIDS prevention and control after implementing PITC in Neijiang city[J]. J of Pub Health and Prev Med,2014,25(4):42-44,47.
[6]霍俊丽,施玉华,韩瑜,等.云南省2009-2015年医疗机构PITC结果分析[J].中国艾滋病性病,2017,23(10):959-961.Huo JL,Shi YH,Han Y,et al. Result analysis of providerinitiated HIV testing and counseling for clients to medical institutions from 2009 to 2015 in Yunnan province[J]. Chin J AIDS STD,2017,23(10):959-961.
[7]赵晓燕,奚静,王德伟,等.成都市成华区艾滋病PITC工作模式及效果分析[J].中国初级卫生保健,2016,30(10):55-57,60.Zhao XY,Xi J,Wang DW,et al. PITC working mode and effect analysis of AIDS in Chenghua district,Chengdu[J]. Chinese Primary Health Care,2016,30(10):55-57,60.
[8]胡强,李艳春,罗雅凌. 2014-2016年江西省医疗机构主动提供艾滋病检测咨询工作情况分析[J].应用预防医学,2017,23(5):374-376.Hu Q,Li YC,Luo YL. Analysis of AIDS testing and consulting work in Jiangxi medical institutions from 2014 to 2016[J]. J Applied Prev Med,2017,23(5):374-376.
[9]罗珍胄,李岚,李真,等.深圳市医务人员艾滋病检测咨询效果分析[J].中国热带医学,2012,12(5):556-558.Luo ZZ,Li L,Li Z,et al. Results of provider-initiated HIV testing and counselling in health facility in Nanshan District of Shenzhen[J]. China Tropical Medicine,2012,12(5):556-558.
[10]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.Shan D,Duan S,Gao J,et al. Analysis of early detection of HIV infections by provider initiated HIV testing and counselling in regions with high HIV/AIDS epidemic in China[J]. Chin J Prev Med,2015,49(11):962-966.
[11]高洁,项丽芬,沈勤丰,等.德宏州乡镇卫生院2013年免费主动提供艾滋病咨询检测服务人群HIV感染率及其影响因素[J].中国艾滋病性病,2016,22(1):29-31.Gao J,Xiang LF,Shen QF,et al. HIV infection and influencing factors of the patients receiving PITC in township hospitals in Dehong Prefecture[J]. Chin J AIDS STD,2016,22(1):29-31.
[12]朱艳文,金燕,杨慧,等. 2008-2016年济南市医疗机构检测发现的艾滋病病例情况分析[J].中国艾滋病性病,2017,23(9):859-860.Zhu YW,Jin Y,Yang H,et al. Analysis of AIDS cases detected by medical institutions in Ji'nan from 2008 to 2016[J]. Chin J AIDS STD,2017,23(9):859-860.
[13]董玉梅,靳桂明,祝松,等.综合性医院扩大HIV检测咨询服务模式运行与实施[J].中国艾滋病性病,2014,20(10):784-785.Dong YM,Jin GM,Zhu S,et al. Operation and implementation of expanded HIV testing and consultation service mode in general hospitals[J]. Chin J AIDS STD,2014,20(10):784-785.
[14]黄胜萍,王建梅,姚在节,等.以性病诊疗为依托的预防艾滋病行为干预模式研究[J].右江医学,2017,45(2):180-183.Huang SP,Wang JM,Yao ZJ,et al. A study on intervention mode of HIV/AIDS prevention based on clinical service of sexually transmitted disease[J]. Chinese Youjiang Medical Journal,2017,45(2):180-183.
[15]左桐,庞作章,齐秀英.性病门诊男性就诊者HIV/TP感染状况及影响因素[J].中国公共卫生,2017,33(3):361-364.Zuo T,Pang ZZ,Qi XY. HIV/TP infection and related factors of among male attendees of STD clinic[J]. Chin J Public Health,2017,33(3):361-364.
[16]杨晓华,朱鑫,刘英,等.洛阳市艾滋病扩大检测效果评价[J].中国医学创新,2016,13(25):59-62.Yang XH,Zhu X,Liu Y,et al. Evaluation on the effect of AIDS extended detection in Luoyang city[J]. Medical Innovation of China,2016,13(25):59-62.
[17]金霞,熊燃,毛宇嵘. 2008-2013年我国医疗机构检测发现艾滋病病例情况分析[J].中华流行病学杂志,2015,36(4):323-326.Jin X,Xiong R,Mao YR. HIV/AIDS cases detection in medical institutions from 2008 to 2013 in China[J]. Chin J Epidemiol,2015,36(4):323-326.
[18]张娜娜,宋明明,刘冬莹,等.潍坊市2005-2015年HIV/AIDS病例晚发现情况分析[J].中国艾滋病性病,2017,23(7):609-612.`Zhang NN,Song MM,Liu DY,et al. Analysis on the diagnosed HIV/AIDS cases reported during 2005-2015 in Weifang city[J].Chin J AIDS STD,2017,23(7):609-612.
[19]金霞,熊燃,王丽艳,等. 2010-2014年我国HIV感染病例的晚发现情况分析[J].中华流行病学杂志,2016,37(2):218-221.Jin X, Xiong R, Wang LY, et al. Analysis on the ‘late diagnosis’(LD)phenomena among newly identified HIV/AIDS cases in China,2010-2014[J]. Chin J Epidemiol,2016,37(2):218-221.
[20]赵秀萍,傅卓华,赵艳秋,等.苏州市扩大艾滋病检测措施实施效果评价[J].中国艾滋病性病,2013,19(11):823-825.Zhao XP,Fu ZH,Zhao YQ,et al. Evaluation on strategy of scaling-up HIV testing in Suzhou,Jiangsu Province[J]. Chin J AIDS STD,2013,19(11):823-825.