云南省HIV/AIDS病人告知和随访工作模式初探

A preliminary study of the model of PLWHA notification and follow up in Yunnan province

目的分析2006-2008年云南省艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(HIV/AIDS病人)告知、随访工作成效及主要措施,为其他地区开展相关工作提供参考。方法对新报告的HIV/AIDS病人进行结果告知、个案流调和转介,对现住址在云南的HIV/AIDS病人开展随访,用全国"艾滋病综合防治信息系统"和专报系统数据统计个案流调、随访、CD4检测、抗病毒治疗转介、治疗和配偶检测相关指标,分析采取的主要措施。结果 2008年云南省新报告的HIV/AIDS病人的个案流调率达到93.7%,累计HIV/AIDS病人的随访率达到61.4%,CD4检测率为32.7%,较2006年和2007年分别提高了69%和41%、30%和10.6%、26%和22%,配偶检测率为63.2%,较2007年提高了24%,抗病毒治疗转介及治疗工作逐年推进。结论落实首诊负责制,提高县疾病预防控制中心的信息化管理水平,把随访工作分解和下移到社区和艾滋病相关服务平台,优化社区卫生服务机构的资源配置,在经费使用中实行目标管理,是确保告知和随访工作长期有效运转的基础。

Objective To analyze the main approaches adopted to the model of PLWHA notification and follow up in 2006-2008 in Yunnan province and its effectiveness so as to provide information for other regions.Methods The newly reported people living with HIV/AIDS（PLWHA）who were distributed in 16 prefectures of the province were notified of the test results and followed up.Epidemiological case surveys were conducted among them according to the indictors established by the China National AIDS Integrated Prevention and Treatment Information System.They were tested for CD4 count and treated with ARV drugs,and their spouses were also tested.The outcomes of the intervention adopted were analyzed.Results In the year of 2008,the rate of case survey among PLWHA reached 93.7%,the cumulative follow up rate was 61.4% and the CD4 test rate was 32.7%,a respective increase by 69%,30% and 2.6% as compared with those in 2006 and a respective increase by 41%,10.6% and 22% as compared with those in 2007.The rate of spouse testing was 63.2%,an increase by 24% in comparison with that in 2007.The case referral and HAART service made steady progress in the past 3 years.Conclusion A system of responsibility by the health provider who first see the HIV/AIDS case,improvement of the information management in county-level CDCs,transferring the follow up visits to the township and village health centers and related service units,optimization of community health resource distribution and practicing a target management in fund allocation are key to an effective operation of PLWHA notification and follow up.