我国基层艾滋病防治服务规范研究

发布时间：2018-03-19 12:25

本文选题：基层　切入点：艾滋病防治　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:基层是我国艾防工作的落脚点和重要平台,然而基层艾滋病防治正面临诸多问题与挑战。由于流动性强,文化水平较低,艾滋病防治意识较为薄弱等特点,我国城乡居民面临着艾滋病感染的高风险,全国每年新增的艾滋病病毒感染者和病人都分布在农村。同时由于基层艾滋病防治服务平台尚处于构建阶段,体系薄弱,基层卫生机构的防艾职责尚不明确,缺乏相应的工作技术指南,工作难以做到标准和规范,基层艾滋病防治面临巨大挑战。而服务规范作为一种服务标准,能够传达服务期望,规范服务行为,进行绩效考核,同时通过规范的构建,还可以将基层艾滋病防治服务内容确定下来,保持基层工作的可持续性,推动基层艾滋病防治工作的开展。因此,构建基层艾滋病防治服务规范对于基层艾防工作具有重要指导意义。目的:本研究通过了解艾滋病防治服务受益人群的艾防服务需求,以及典型地区艾滋病防治服务形式和现有规范调查与研究的基础上,旨在构建一套具有一定科学性和可操作性的基层艾滋病防治服务规范。方法:本研究主要采用了现场调查和专家评审2种方法。现场调查中,综合考虑了全国艾滋病疫情的严重程度,选取了四川成都2个区县、湖北武汉2个区县和安徽省合肥市、亳州市的2个县进行艾滋病防治相关受益人群的需求调查,采用“一问一答”的问卷调查形式,了解受益人群需求特点。同时选取了一个基层艾滋病防治服务工作已下沉的典型样本,通过关键知情人访谈,了解已下沉地区的基层艾滋病防治服务类别,具体工作内容和考核方式等。收集的数据经过Epi Data3.1软件的双人双录入,数据分析则采用SPSS18.0。访谈调查内容通过转录音和文本分析的方式进行总结。专家评审的方法主要用于后期的基层艾滋病防治服务规范的构建,对构建的规范进行论证评议和提出修改意见与建议。结果:(1)艾滋病防治服务受益人群需求情况:(1)本次共调查艾滋病防治服务7类受益人群1204人。92.1%的一般居民和89.9%的校内青少年认为有必要接受艾滋病相关的宣传教育;92.6%的流动人口、93.2%的暗娼人群、91.7%的吸毒人群、96.1%的男同和100%的艾滋病感染者/病人认为需要接受艾滋病防治服务。(2)每类人群对艾滋病防治服务的需求程度有所不同。流动人口对于艾防服务的需求排名前三的是:“宣传教育”(87.3%)、“性病艾滋病的咨询”(27.3%)、“艾滋病检测”(23.3%);暗娼人群是:“宣传教育”(59.6%)、“安全套发放”(38.2%)和“性病防治”(37.5%);吸毒人群是:“艾滋病检测”(54.9%)、“美沙酮替代治疗”(44.4%)和“性病艾滋病咨询”(34.0%);男同人群是:“宣传教育”(59.2%)、“艾滋病检测”(57.1%)和“性病艾滋病的咨询”(45.6%)。(3)各类人群对艾防服务机构的接受情况:各类人群对于疾病预防控制机构都有良好的接受度,而对于其他服务机构的选择则有所不同。除了预防控制机构外,流动人口(56.0%)、暗娼(46.3%)和艾滋病感染者/病人(41.6%)更倾向于选择社区卫生服务中心或乡镇卫生院,吸毒人群更倾向于选择市一级设置的美沙酮替代治疗点(46.5%),社区卫生服务中心和乡镇卫生院成为吸毒人群的第三选择(43.8%),男同人群更倾向于选择社会组织(55.1%)。(2)典型地区的基层艾滋病防治服务现状:调查发现,目前基层开展的艾滋病防治服务类别主要有宣传教育、艾滋病咨询和快速检测、高危人群的干预和艾滋病病毒感染者/病人的随访管理等方面,有具体的工作内容。其激励方式与基层所获得的艾滋病防治服务经费相关,绩效考核方式和基本公共卫生服务项目的考核一致。(3)基层艾滋病防治服务规范的构建:在构建之初,确定了规范构建的基本原则是合法、合理、科学和实用。在前期资料和调查研究的基础上,依据现有规范,构建基层艾滋病防治服务规范的内容包括疫情报告、宣传教育、艾滋病咨询和快速检测、暗娼人群干预、艾滋病病毒感染者/病人的随访管理5个方面,明确了基层艾防服务机构为社区卫生服务中心和乡镇卫生院。(4)基层艾滋病防治服务规范专家评审:经过专家对各维度的评审,对初步制定的基层艾滋病防治服务规范的综合评分为90.6分。分别对评审的6个维度进行分析发现,范围与目的的标准化评分为92分,利益相关人群为94分,编写的严谨性为91分,呈现的清晰性为90.7分,显示出较好的权威性和科学性。结论:本次研究所构建的基层艾滋病防治服务规范是参照相关文献的内容,是按照一定科学的步骤构建的。本研究既充分吸纳了艾滋病防治服务对象的诉求,也借鉴了典型地区的基层艾滋病防治服务工作经验,在此基础上明确了基层艾滋病防治服务内容。同时参照了我国现有的一些服务文件和方案,构建了我国基层艾滋病防治服务规范。经相关专家评审,该“规范”具有较好的科学性、权威性和适用性。
[Abstract]:Background: China's AIDS prevention work is the basic foothold and an important platform, but the basic AIDS prevention and control is facing many problems and challenges. Due to the strong liquidity, low cultural level, AIDS prevention awareness is relatively weak and other characteristics, China's urban and rural residents face a high risk of HIV infection, HIV infection throughout the country each year. And patients are located in rural areas. At the same time as the basic AIDS prevention service platform is still in the construction phase, the weak system of AIDS prevention responsibilities of grassroots health institutions is not clear, the lack of corresponding technical guidelines, work hard to achieve standards and norms, grassroots AIDS prevention is facing enormous challenges. And the service specification as a service standard, can express service expectation, service behavior, performance appraisal, and through the construction of regulations, can also be determined under the basic AIDS prevention and control services To maintain the sustainability of the grass-roots work, promote AIDS prevention and control work to carry out grassroots. Therefore, construction of grassroots AIDS prevention service standard has important guiding significance to the grassroots AIDS prevention work. Objective: this research through the understanding of AIDS prevention service requirements service beneficiaries based AI, AIDS prevention service form and typical areas and existing norms survey with the research on the aims to construct a scientific and workable grassroots AIDS prevention service specification. Methods: This study mainly uses field survey and expert review 2 methods. In the field investigation, considering the severity of the AIDS epidemic, Sichuan selected 2 counties of Chengdu, Hubei 2 counties of Wuhan and Anhui City of Hefei Province, 2 counties of Bozhou city survey of AIDS related beneficiaries, with a question and answer" The form of a questionnaire survey, understand the beneficiaries demand characteristics. Then the typical sample of a grassroots AIDS prevention and control work has been sinking, through key informant interviews, understanding of the sinking grassroots AIDS prevention service categories, specific work contents and assessment methods. The data collected by the Epi Data3.1 software of double entry, the data were analyzed with SPSS18.0. interview summary through recording and analysis of the texts. The expert review method is mainly used for the construction of the grassroots AIDS prevention service specification, demonstration appraisal and puts forward some comments and suggestions on the construction of the standard. Results: (1) AIDS prevention service beneficiaries demand: (1) the total survey of AIDS prevention service 7 beneficiaries.92.1% 1204 general residents and 89.9% of young people in schools think it is necessary to take The publicity and education of AIDS related; 92.6% of the population, 93.2% of the 91.7% prostitutes, drug addicts, and 100% men with 96.1% HIV / AIDS patients need to accept AIDS prevention service. (2) the degree of demand for AIDS prevention and control services for each type of crowd is different. The floating population for AIDS prevention service the needs of the top three are: "education" (87.3%), "AIDS consultation" (27.3%), "AIDS test" (23.3%); prostitutes: "education" (59.6%), "condom" (38.2%) and "STD" (37.5%); drug users is: "AIDS test" (54.9%), "methadone" (44.4%) and "AIDS counseling" (34%); gay crowd: "education" (59.2%), "AIDS test" (57.1%) and "AIDS consultation" (45.6%) (3) of all types of people. For Anti AI acceptance services: all types of people are well accepted for disease prevention and control institutions, and for other services selection is different. In addition to prevention and control institutions, the floating population (56%), female sex workers (46.3%) and HIV / AIDS patients (41.6%) were more likely to choose the community health service center or township hospitals, drug users are more likely to choose a set of methadone replacement therapy (46.5% points), community health service centers and township hospitals to become drug addicts in third (43.8%), men are more likely to choose social organizations (55.1%). (2) the status quo of grassroots AIDS control service of typical areas: the survey found that at the grassroots level to carry out AIDS prevention service of the main categories of publicity and education, AIDS counseling and rapid detection of AIDS virus infection and intervention of high-risk persons / patients Follow up management, with the specific content of the work. The incentives and the grassroots AIDS prevention service funds, performance appraisal methods and basic public health service project assessment. (3) construction of grassroots AIDS prevention service specification: at the beginning of construction, to determine the basic principles of constructing the legal norms. Reasonable, scientific and practical. Based on the previous data and investigation, on the basis of the existing norms, publicity and education to build grass-roots AIDS service specification includes epidemic report, and AIDS counseling and rapid detection, CSWS interventions, 5 aspects of HIV / AIDS patient follow-up management, clear prevention services AI for grass-roots community health service centers and township hospital. (4) the grassroots AIDS prevention service specification expert review: after expert review of each dimension, for the development of the initial base Comprehensive evaluation of AIDS prevention and control layer service specifications is 90.6. 6 dimensions of the review analysis, scope and purpose of the standard score is 92 points, related to the interests of people of 94 points, writing the rigor of 91 points, 90.7 points clear of the show, authority and scientific good. Conclusion: the study of the construction of grassroots AIDS prevention service specification is referring to the related literature content, is constructed according to certain scientific steps. This research is to fully absorb the AIDS prevention and control of the demands of clients, but also from the grassroots AIDS prevention service experience in typical areas, on the basis of the basic level AIDS prevention and control services. At the same time referring to some of our existing service files and programs, the construction of China's grassroots AIDS prevention service specification. By the relevant experts, the "standard" has better It is scientific, authoritative and applicable.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.91

【参考文献】