江西省HIV/AIDS病人对随访管理下沉模式的接受状况
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摘要
目的了解江西省艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)对艾滋病随访下沉管理模式的接受意愿性。方法采用横断面研究设计,于2017年5—11月以在11个设区市接受随访管理的HIV/AIDS病人为调查对象,调查内容包括社会人口学特征、确诊年份、是否愿意接受随访下沉及不愿意接受的原因等。结果本次共调查147人,其中有68人愿意接受随访下沉,占46.26%。单因素分析显示,不同年龄组(χ~2=10.84,P=0.01)、不同收入群体(χ~2=14.05,P<0.01)与不同确诊年份(χ~2=5.61,P=0.02)对是否愿意接受下沉差异有统计学意义,已下沉的HIV/AIDS病人更愿意接受随访下沉。多因素Logistics回归分析显示,未随访下沉的[比值比(OR)=3.427,95%可信区间(CI):1.508～6.992]及确诊年份在2014年及之前的(OR=0.453,95%CI:0.228～0.897)HIV/AIDS病人更不愿意接受随访下沉。结论多数HIV/AIDS病人不愿意接受随访下沉,在新病例中开展随访下沉工作更易被接受,在开展随访下沉工作前应考虑HIV/AIDS病人本人意愿,同时应注重患者隐私保护及提高随访工作人员工作能力。
Objective To understand the acceptance of HIV/AIDS patients for the task-shifting of follow-up management from CDC to community/township health center in Jiangxi province. Methods A cross-sectional study was conducted in 11 cities. HIV/AIDS patients followed up were investigated from May to Nov 2017. The contents of the survey included demographic characteristics, year of diagnosis, acceptance to shift the tasks and reasons. Results A total of 147 people were surveyed, of whom 68 accepted, accounting for 46.25%. Univariate analysis showed that there were significantly differences between ages(χ~2=10.84, P=0.01), incomes(χ~2=14.05, P<0.01), year of diagnosis(χ~2=5.61, P=0.02) and willingness to accept the shift. Patients already followed up by the community health centers were more likely to accept the task-shifting than those not yet. Multivariate regression analysis showed that the HIV/AIDS patients not yet managed by the community health centers(OR=3.427,95%CI:0.228-0.897) and diagnosed in 2014 and before(OR=0.453,95%CI:1.508-6.992) did not accept. Conclusion Most of HIV/AIDS patients are not willing to accept the task-shifting and the new cases after 2014 are more likely to accept. It is suggested that the willingness of HIV/AIDS patients should be taken into account before the task-shifting. Meanwhile, privacy protection and improvement of professional skills should be paid attention to.
Objective To understand the acceptance of HIV/AIDS patients for the task-shifting of follow-up management from CDC to community/township health center in Jiangxi province. Methods A cross-sectional study was conducted in 11 cities. HIV/AIDS patients followed up were investigated from May to Nov 2017. The contents of the survey included demographic characteristics, year of diagnosis, acceptance to shift the tasks and reasons. Results A total of 147 people were surveyed, of whom 68 accepted, accounting for 46.25%. Univariate analysis showed that there were significantly differences between ages(χ~2=10.84, P=0.01), incomes(χ~2=14.05, P<0.01), year of diagnosis(χ~2=5.61, P=0.02) and willingness to accept the shift. Patients already followed up by the community health centers were more likely to accept the task-shifting than those not yet. Multivariate regression analysis showed that the HIV/AIDS patients not yet managed by the community health centers(OR=3.427,95%CI:0.228-0.897) and diagnosed in 2014 and before(OR=0.453,95%CI:1.508-6.992) did not accept. Conclusion Most of HIV/AIDS patients are not willing to accept the task-shifting and the new cases after 2014 are more likely to accept. It is suggested that the willingness of HIV/AIDS patients should be taken into account before the task-shifting. Meanwhile, privacy protection and improvement of professional skills should be paid attention to.
引文
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[2] 廖清华,杨晴,卢飞豹,等.1994—2011年江西省艾滋病疫情分析[J].中华预防医学杂志,2012,46(11): 1038-1039.
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[5] Zhang Y, Lu L, Li HQ, et al. Engaging HIV-infected patients in antiretroviral therapy services: CD4 cell count testing after HIV diagnosis from 2005 to 2009 in Yunnan and Guangxi, China[J]. Chin Med J: (Engl), 2011,124(10): 1488-1492.
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[7] 张曼华,徐勤,张辉,等.艾滋病相关老年人群心理健康状况调查[J].中国公共卫生,2007, 23(9): 1069-1070.
[8] Yoshioka MR, Schustack A. Disclosure of HIV status: Cultural issues of Asian patients[J]. AIDS Patient Care and STD's, 2001,15(2):77-82.
[9] 徐钟渭,徐红,项珍.浅谈我国新发现HIV/AIDS患者的失访问题[J].中国艾滋病性病,2008,14(4): 396-398.
[10] 李杰,徐鹏,王桂英,等.艾滋病病毒感染者和艾滋病病人信息保密工作面临的问题及对策[J].中国医学伦理学,2012,25(5):596-598.
[11] Wu S, Li L, Wu ZY, et al. A brief HIV stigma reduction intervention for service providers in China[J]. AIDS Patient Care STDS, 2008, 22(6):513-520.
[12] Chan KY, Yang Y, Zhang KL, et al. Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation-a factorial survey of medical students in China[J]. BMC Public Health, 2007(7):280.
[13] 王朝才,刘燕,马永成,等.HIV感染者/AIDS病人在低流行区的管理[J].中国艾滋病性病, 2010,16(4): 415-416.
[14] 李小英.上栗县艾滋病病毒感染者随访管理下沉项目经验交流[J].安徽卫生职业技术学院学报,2016,15(4):3-4.
[15] Ma F, Lyu F, Xu P, et al. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis[J]. BMC Health Services Research, 2015,15(1):253.
[2] 廖清华,杨晴,卢飞豹,等.1994—2011年江西省艾滋病疫情分析[J].中华预防医学杂志,2012,46(11): 1038-1039.
[3] 付思云,陈庆玲,李惠琴. 艾滋病病毒感染者和艾滋病病人管理模式展望[J]. 中国热带医学,2015, 15(3):380-383.
[4] 江西省卫生和计划生育委员会.江西省艾滋病病毒感染者及病人随访管理下沉指导意见(赣卫疾控字[2015]31号)[Z]. 2015.
[5] Zhang Y, Lu L, Li HQ, et al. Engaging HIV-infected patients in antiretroviral therapy services: CD4 cell count testing after HIV diagnosis from 2005 to 2009 in Yunnan and Guangxi, China[J]. Chin Med J: (Engl), 2011,124(10): 1488-1492.
[6] 黄凌,杨晴,胡强,等.江西省艾滋病随访管理下沉工作现况分析与探讨[J]. 中华疾病控制杂志,2017, 21(12):1298-1300.
[7] 张曼华,徐勤,张辉,等.艾滋病相关老年人群心理健康状况调查[J].中国公共卫生,2007, 23(9): 1069-1070.
[8] Yoshioka MR, Schustack A. Disclosure of HIV status: Cultural issues of Asian patients[J]. AIDS Patient Care and STD's, 2001,15(2):77-82.
[9] 徐钟渭,徐红,项珍.浅谈我国新发现HIV/AIDS患者的失访问题[J].中国艾滋病性病,2008,14(4): 396-398.
[10] 李杰,徐鹏,王桂英,等.艾滋病病毒感染者和艾滋病病人信息保密工作面临的问题及对策[J].中国医学伦理学,2012,25(5):596-598.
[11] Wu S, Li L, Wu ZY, et al. A brief HIV stigma reduction intervention for service providers in China[J]. AIDS Patient Care STDS, 2008, 22(6):513-520.
[12] Chan KY, Yang Y, Zhang KL, et al. Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation-a factorial survey of medical students in China[J]. BMC Public Health, 2007(7):280.
[13] 王朝才,刘燕,马永成,等.HIV感染者/AIDS病人在低流行区的管理[J].中国艾滋病性病, 2010,16(4): 415-416.
[14] 李小英.上栗县艾滋病病毒感染者随访管理下沉项目经验交流[J].安徽卫生职业技术学院学报,2016,15(4):3-4.
[15] Ma F, Lyu F, Xu P, et al. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis[J]. BMC Health Services Research, 2015,15(1):253.