三城市男男性行为人群艾滋病防治经费实际支出及利用研究

发布时间：2018-11-22 10:52

【摘要】：背景：男男性行为人群(MSM)是我国艾滋病防治工作的重点人群之一。为保障该项工作的顺利实施,我国政府积极探索有效防治策略并不断加大对该人群经费投入,同时积极扶持、推动社区组织参与MSM人群艾滋病防治工作。虽然艾滋病防治项目的资源越来越多,防治经费的投入呈逐年上升趋势,但是目前缺少科学的方法对MSM人群艾滋病防治工作经费进行梳理和测算,以及对该领域经费使用效率进行分析,这项工作是艾滋病资源配置分析的关键点,也是艾滋病防治经费测算和评估的核心内容,对我国艾滋病资源合理配置具有重要意义,同时也为今后政策制定提供可靠依据。目的：1.利用NASA方法对MSM人群艾滋病防治经费实际支出进行追踪和测算,从多个维度多领域全面掌握经费使用各个环节的实际支出情况；2.结合具体工作产出,分析经费实际支出和产出之间关系,探讨经费使用效率；并以重庆市为例,分析不同服务提供机构在MSM人群艾滋病防治活动领域具体经费支出,重点分析该地区社区组织参与MSM人群艾滋病防治工作情况及HIV感染者/病人发现单位成本变化情况。方法：根据NASA方法分类体系与当地实际工作情况,建立适用于MSM人群的NASA方法分类体系；通过问卷调查、定性访谈、财务及痕迹资料翻阅等方法合理测算2010-2013年上海市、重庆市和杭州市MSM人群艾滋病防治经费实际支出；利用经济学理论测算2010-2013年三个城市MSM人群动员检测和阳性发现单位成本。数据以描述性统计分析为主,图表制作使用MS Excel2010软件。结果：上海市、重庆市、浙江省杭州市的MSM人群艾滋病防治经费筹资来源主要分为三部分：财政经费、国际合作项目经费、国内科研课题经费。2010-2013年上海市MSM人群艾滋病防治经费实际支出经费共计2152.9万元,每年防治经费分别为409.0万元、488.4万元、651.41万元和604.1万元；重庆市总经费为2147.8万元,每年分别为364.7万元、432.0万元、628.8万元和722.3万元；杭州市总经费为1038.2万元,每年分别为182.4万元、229.4万元、346.4万元和279.9万元。三个城市财政经费数量和所占总经费比重均逐年增加。经费管理机构主要涉及当地卫生行政部门、疾控系统和预防医学会。三个城市MSM人群艾滋病防治活动服务提供机构主要为CDC系统、医疗卫生系统、社会组织,其中CDC系统支出最多,其次是社会组织,不同地区各个机构实际支出经费比例明显不同。MSM人群艾滋病防治工作主要活动领域包括：预防领域、项目管理、人力资源、科研领域和政策倡导领域。不同经费来源重点投入的领域不完全相同。财政经费支持上述所有领域工作；国际合作项目在预防领域、治疗及随访关怀领域、项目管理和人力资源均有投入；科研经费主要用于应用性研究。上海市MSM人群HIV动员检测单位成本分别为1085.0元/人次、388.3元/人次、664.8元/人次、390.2元/人次,阳性发现单位成本分别为4773.4元/例、3082.4元/例、4896.6元/例、3075.7元/例；重庆市MSM人群HIV动员检测单位成本分别为162.3元/人次、139.6元/人次、210.8元/人次、132.8元/人次,阳性发现单位成本分别为1851.4元/例、1496.3元/列、1995.0元/例、1232.5元/例；杭州市MSM人群HIV动员检测单位成本分别为448.2元/人次、342.4元/人次、342.9元/人次、183.0元/人次,阳性发现单位成本分别为3479.5元/例、2403.6元/例、3526.4元/例、1792.3元/例。社区组织每年的阳性发现贡献率逐年提高,从2010年的37.5%,上升至2013年的50.5%,其阳性发现单位成本也大致呈下降趋势,2010-2013年社区组织直接单位成本分别为3645.6元/例、1674.2元/例、2436.4元/例、1880.0元/例。结论：利用NASA方法对单一人群的艾滋病防治经费测算,按照方法中的不同维度及其分类能掌握经费的使用和流向,充分发挥该方法在成本梳理和测算的优势。MSM人群艾滋病防治经费以财政经费为主,不同经费来源重点投入领域不同。财政经费重点是在治疗及关怀领域的抗病毒治疗及HIV相关实验室检测工作；国际合作项目重点支持预防领域的行为干预和HIV动员检测工作和治疗领域的随访关怀工作；科研经费主要用于应用性研究。三个城市MSM人群HIV动员检测及HIV感染者/病人发现的单位成本均逐年降低,提示MSM人群艾滋病预防领域经费使用效率不断提高。社区组织MSM人群HIV阳性发现的单位成本也呈下降趋势,应加强与社区组织紧密合作。
[Abstract]:BACKGROUND: The MSM is one of the key people in the prevention and control of AIDS in China. In order to guarantee the smooth implementation of the work, our Government actively explores effective control strategies and continuously increases the input to the population, while actively supporting and promoting the participation of community organizations in the prevention and treatment of HIV/ AIDS in the MSM population. Although the resources of the AIDS prevention and control project are increasing, the input of prevention and control is increasing year by year, but there is a lack of scientific methods to comb and measure the HIV/ AIDS prevention and control work of the MSM population, and to analyze the use efficiency of the funds in this field. This work is the key point of the analysis of the resource allocation of AIDS. It is also the core of the measurement and evaluation of AIDS prevention and control, which is of great significance to the rational allocation of AIDS resources in China, and also provides a reliable basis for future policy development. Objective: 1. The actual expenditure of HIV/ AIDS prevention and control is tracked and measured by the NASA method, and the actual expenditure of each link is comprehensively grasped from the multi-dimension multi-domain; and 2. in combination with that specific work output, the relationship between the actual expenditure and the output of the fund is analyzed, and the use efficiency of the fund is explored; and in the case of the Chongqing as a case, the specific expenditure of the different service providers in the field of AIDS prevention and control activities of the MSM population is analyzed, Focus on the participation of community organizations in the region in the prevention and treatment of HIV/ AIDS in the MSM population and the change of the unit cost of HIV/ AIDS patients/ patients. Method: According to the classification system of the NASA method and the local practical work, the NASA method classification system applicable to the MSM population is established; through the methods of questionnaire survey, qualitative interview, financial and trace data reading and the like, Shanghai is reasonably measured in 2010-2013, The actual expenditure of AIDS prevention and control in the MSM population in Chongqing and Hangzhou is estimated, and the unit cost of the mobilization and detection of the MSM in the three cities in 2010-2013 is calculated by using the economic theory. The data is based on descriptive statistics and the MS Excel2010 software is used for graph production. Results: The funding sources for AIDS prevention and control of MSM in Shanghai, Chongqing and Hangzhou are divided into three parts: financial resources, international cooperation projects and domestic scientific research projects. In 2010-2013, the actual expenditures for AIDS prevention and control of MSM in Shanghai totaled 2152 million yuan, The annual prevention and control expenses are 40.9 million yuan, 488 million yuan, 651. 41 million yuan and 604. 100 million yuan, respectively. The total resources of Chongqing are 2147 million yuan, the annual rate of which is 364 million yuan, 432 million yuan, 628. 800 million yuan and 722. 300 million yuan, respectively. The total cost of Hangzhou is 1038 million yuan, which is 182.40 million yuan, 229,400 million yuan, 346 million yuan and 279,900 yuan each year. The number of financial resources and the proportion of the total funds in the three cities are increasing year by year. The fund management body is mainly concerned with the local health administrative department, the disease control system and the prevention medical association. The three urban MSM population AIDS prevention and control activities service providers are mainly the CDC system, the medical and health system and the social organization, among which the CDC system expenditure is the most, the second is the social organization, the proportion of the actual expenditure of each institution in different regions is obviously different. The main areas of HIV/ AIDS prevention and control in the MSM population include areas of prevention, project management, human resources, scientific research and policy advocacy. The areas of different sources of funding are not exactly the same. The financial resources support all of the above-mentioned areas; international cooperation projects have been invested in the areas of prevention, treatment and follow-up care, project management and human resources; and research funding is mainly used for application research. The unit cost of HIV mobilization in MSM population in Shanghai was 1085. 0 yuan/ person, 388,3 yuan/ person-person, 664. 8 yuan/ person-time, 33.9 yuan/ person-time, and the unit cost of positive discovery was 4773.4 yuan/ case, 3082.4 yuan/ case, 4896. 6 yuan/ case, 3075.7 yuan/ case; The unit cost of HIV mobilization in the MSM population of Chongqing is 162.3yuan/ person-time, 139.6yuan/ person-time, 210.8yuan/ person-time, 132.8yuan/ person-time, the unit cost of positive discovery is 1851.4 yuan/ case, 1496.3 yuan/ column, 1995. 0 yuan/ case, 1232. 5 yuan/ case; The unit cost of HIV mobilization in MSM in Hangzhou was 448. 2 yuan/ person, 342. 4 yuan/ person, 342. 9 yuan/ person, 183. 0 yuan/ person. The unit cost of positive discovery was 3479.5 yuan/ case, 2403. 6 yuan/ case, 3526. 4 yuan/ case, 1792.3 yuan/ case. The annual positive rate of the community organization increased year by year, from 37. 5% in 2010 to 53.5% in 2013, and the positive discovery unit cost of the community was also roughly decreasing. The direct unit cost of the community organizations in 2010-2013 was 3645. 6 yuan/ case, 1674.2 yuan/ case, 2436. 4 yuan/ case, 1880. 0 yuan/ case. Conclusion: Using the method of NASA to measure the cost of AIDS prevention and control in a single population, the use and the flow direction of the funds can be grasped according to the different dimensions and their classification in the method, and the advantages of the method in cost-carding and measurement can be given full play. The funds for AIDS prevention and control in the MSM population are mainly funded by the financial resources, and the different sources of funds are different in the input field. The financial resources focus on anti-viral treatment in the field of treatment and care and HIV-related laboratory testing; international cooperation projects focus on support for behavioral intervention in the field of prevention and follow-up care in the field of HIV-mobilization detection and treatment; and research funding is mainly used in the application study. In the three urban MSM, the cost of HIV mobilization and the unit cost of HIV-infected people/ patients decreased year by year, suggesting that the efficiency of HIV prevention in MSM population was increasing. The unit cost of HIV-positive findings in the community-based MSM population is also declining and should be strengthened in close cooperation with community-based organizations.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R512.91

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