长沙市免费艾滋病自愿咨询检测服务现状及影响因素研究

发布时间：2018-07-03 15:32

本文选题：自愿咨询检测 + 高危人群　；参考：《中南大学》2014年硕士论文

【摘要】：目的：从卫生服务利用方、卫生服务提供方以及卫生服务的成本效果三个角度,全面评估长沙市免费艾滋病自愿咨询检测服务(Voluntary Counseling and Testing, VCT)的工作现状及其主要影响因素,为更有效地利用艾滋病自愿咨询检测服务、降低艾滋病病毒(Human Immunodeficiency Virus, HIV)感染率、有效防治艾滋病提供参考资料。方法：以长沙市作为研究现场,①通过方便抽样选取200名HIR感染高危人群作为自愿咨询检测服务利用方样本,分别为美沙酮门诊静脉吸毒者、门诊性传播疾病患者、娱乐服务场所女性性服务工作者和高校男男性行为者各50名,采用自编“一般情况调查问卷”、“艾滋病相关知识问卷”、“艾滋病自愿咨询检测利用情况调查问卷”以及标准化“情绪问题量表”调查了解四类HIV感染高危人群利用自愿咨询检测服务情况及其相关影响因素；②将长沙市提供免费艾滋病自愿咨询检测服务的专业工作人员作为卫生服务提供方样本,采用自编一般情况调查问卷了解其基本人口学特征,采用标准化明尼苏达工作满意度问卷(短式量表)和医务人员艾滋病歧视量表对VCT专业工作人员的工作满意和艾滋病歧视态度进行调查,并与CDC其他专业工作人员进行比较；③利用长沙市疾病预防控制机构工作报表中的数据资料,对全市所有开展免费艾滋病咨询检测服务的10所门诊,在2008～2013年期间所提供的检测服务进行成本效果分析。结果：①四类HIV感染高危人群样本中,VCT服务的总利用率为38.5%(77/200),VCT服务的总知晓率为36.5%(73/200)。样本中高校男男性行为样本VCT服务利用率和知晓率最高,分别为68.0%(34/50)和60.0%(30/50),最低的为娱乐服务场所女性性服务工作者样本分别为10.0%(5/50)和8.0%(4/50)。70.0%的样本(140/200)艾滋病相关知识知晓率高(≥12分)。在调查未利用VCT服务的原因中,129人(64.5%)报告为“认为自己不会感染”。调查样本中,抑郁症状阳性率(PHQ-9≥10分)为39%(78/200),焦虑症状阳性率(GAD-7≥10分)为48.5%(97/200)。与未利用过VCT服务的样本组比较,曾利用过VCT服务组的艾滋病相关知识得分高(χ2=14.723,P0.01)、有阳性抑郁症状(χ2=10.628,P0.01)和有阳性焦虑症状者(χ2=15.764,P0.01)的比例更高。多因素logistic分析显示,四类HIV感染高危人群样本利用VCT服务的影响因素为：有稳定婚姻状况(OR=2.320,95%CI:1.061～5.067)、性取向为同性(OR=0.379,95%CI:0.164～0.871)和艾滋病相关知识知晓率高(OR=2.342,95%CI:1.072～5.116)的样本更可能利用VCT服务。②长沙市区范围内,共有22名提供VCT服务的专业工作人员,专业工作人员的明尼苏达工作满意度总分为76.1分,处于“一般满意”水平,与其他专业工作人员的满意度得分无差异(χ2=3.513,P0.05)；“医务人员艾滋病歧视量表”的总分为39.6分,处于“中等歧视”水平,VCT服务专业工作人员对待AIDS歧视低于其他业务科室工作人员,差异有统计学意义(χ2=7.183,P0.05)。③10个免费VCT门诊每百万人口的平均配置密度为1.51个,2008年至2013年成本投入从69.70万元上升到95.37万元。VCT服务例均检测成本由2008年125.5元上升到2010年197.8元,再下降到2013年的143.4元；完整VCT服务成本由2008年126.2元上升到2010年198.3元,再下降到2013年的145.1元：阳性检测成本由2008年43562.5元下降到2013年8082.2元。结论：①被调查的四类HIV感染高危人群样本VCT服务知晓率和利用率低,分别为36.5%和38.5%；其中高校男男性行为者样本的知晓率和利用率均为最高,娱乐场所女性性工作者样本均列最低。有稳定的婚姻状况、性取向为同性和艾滋病相关知识知晓率高更可能利用VCT服务。②提供VCT服务专业工作人员工作满意度总体处于“一般满意”水平,对AIDS歧视态度处于中等水平,VCT服务专业工作人员对待AIDS歧视低于其他业务科室工作人员。③10个免费VCT门诊2008年至2013年的例均检测成本、完整VCT服务例均成本呈现先上升后下降逐渐趋于平稳的趋势,发现并确认阳性检测成本基本呈现下降趋势。
[Abstract]:Objective: To evaluate the status of the free AIDS voluntary counseling and testing service (Voluntary Counseling and Testing, VCT) and its main influencing factors from the three angles of health service utilization, health service providers and the cost effect of health services, in order to make more effective use of AIDS voluntary counseling and testing services and reduce the effective use of AIDS. Human Immunodeficiency Virus (HIV) infection rate, effective prevention and treatment of AIDS to provide reference materials.
Methods: taking Changsha as the research site, 200 high risk population of HIR infection were selected as voluntary counseling and testing services by convenient sampling, which were divided into 50 cases of methadone outpatient drug addicts, outpatient sexually transmitted diseases, female sex service workers in entertainment services and male male actors in Colleges and universities. "General situation questionnaire", "AIDS related knowledge questionnaire", "AIDS voluntary counseling and testing utilization questionnaire" and standardized "emotional problem scale" survey to understand the use of voluntary counseling and testing services of four types of high-risk groups of HIV infection and related factors; (2) to provide free AIDS in Changsha City The professional staff of voluntary counseling and testing service, as a sample of health service providers, use the self-made general situation questionnaire to understand their basic demographic characteristics, and adopt the standardized Minnesota job satisfaction questionnaire (short scale scale) and the AIDS discrimination scale of medical staff to the work satisfaction of VCT professional staff and AIDS disproportionate. Investigate the attitude and compare with other professional staff of CDC. (3) using data from the report of the Changsha disease prevention and control agency, 10 outpatients of all free AIDS counseling and testing services in the city were used to analyze the cost effectiveness of the inspection services provided during the 2008~2013 year period.
Results: (1) the total utilization rate of VCT service was 38.5% (77/200), and the total awareness rate of VCT service was 36.5% (73/200) in the samples of four types of high risk people with high risk of HIV infection. The highest utilization rate and awareness rate of VCT service in the samples of male male behavior in Colleges and universities were 68% (34/50) and 60% (30/50) respectively, and the lowest was the female sex service workers in the entertainment service place. The awareness rate of AIDS related knowledge of 10% (5/50) and 8% (4/50).70.0% (140/200) was higher (> 12). Among the reasons for unused VCT service, 129 people (64.5%) reported that they were "not infected". The positive rate of depressive symptoms (PHQ-9 > 10) was 39% (78/200), and the positive rate of anxiety (GAD-7 > 10) was found in the survey samples. ) for 48.5% (97/200). Compared with the sample group that had not used VCT services, Zeng had a higher score on AIDS related knowledge in the VCT service group (x 2=14.723, P0.01), with positive depressive symptoms (chi 2=10.628, P0.01) and those with positive anxiety symptoms (chi 2=15.764, P0.01) higher than that of the cases. Multifactor logistic analysis showed that the four class HIV infection high risk population samples The factors affecting the use of VCT services are: stable marital status (OR=2.320,95%CI:1.061 to 5.067), sex orientation (OR=0.379,95%CI:0.164 ~ 0.871) and AIDS related knowledge (OR=2.342,95%CI:1.072 ~ 5.116) are more likely to use VCT services. (2) there are 22 professional VCT services in Changsha urban area The total score of job satisfaction of staff and professional staff in Minnesota was 76.1 points, at the level of "general satisfaction", and there was no difference from other professional staff (x 2=3.513, P0.05); the total score of "AIDS discrimination scale for medical staff" was 39.6 points, at the level of "medium discrimination", and VCT service professional workers. The discrimination against AIDS was lower than those of other business department staff, the difference was statistically significant (x 2=7.183, P0.05). (3) the average distribution density of 10 free VCT outpatients per million population was 1.51, and the cost input from 2008 to 2013 increased from 697 thousand yuan to 953 thousand and 700 yuan.VCT service and the cost increased from 125.5 yuan in 2008 to 197.8 in 2010. Yuan, then down to 143.4 yuan in 2013, the total cost of VCT services rose from 126.2 yuan in 2008 to 198.3 yuan in 2010 and then down to 145.1 yuan in 2013: the cost of positive detection decreased from 43562.5 yuan in 2008 to 8082.2 yuan in 2013.
Conclusion: (1) the awareness rate and utilization rate of VCT services in the four types of high-risk group of HIV infection were low, 36.5% and 38.5%, respectively. The rate of awareness and utilization of male male sex workers in Colleges and universities were the highest, and the sample of female sex workers in the entertainment places were the lowest. The knowledge awareness rate is more likely to use VCT services. (2) the job satisfaction of the VCT service professional staff is generally at the "general satisfaction" level, the AIDS discriminatory attitude is at the middle level, and the VCT service professionals treat AIDS discrimination lower than the other business department staff. (3) 10 free VCT outpatients from 2008 to 2013 In terms of testing cost, the cost of VCT service shows a trend of rising first and then decreasing steadily. It is found and confirmed that the cost of positive detection basically shows a downward trend.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

【共引文献】