凉山地区预防艾滋病母婴传播相关资源整合的分析

Analysis of financial resources on prevention of mother-to-child transmission of HIV in Liangshan

目的通过收集四川省凉山地区与预防艾滋病母婴传播相关的妇女保健和儿童保健各环节上现有资源的投入和支持，探索凉山地区整合相关卫生资源促进预防艾滋病母婴传播工作开展的可行性和有效性。方法通过定量调查的方法了解艾滋病感染孕产妇分娩所需费用，通过深入访谈和小组讨论等定性方法，获取目前预防艾滋病母婴传播工作资金和其他相关卫生资源的投入等信息，以及整合与利用情况。结果目前凉山地区预防艾滋病母婴传播的经费支持来源于中央财政转移支付和默沙东艾滋病防治项目。与预防艾滋病母婴传播有关的支持分别来自新型农村合作医疗、降低孕产妇死亡率和消除新生儿破伤风项目、农村孕产妇住院分娩补助、民政医疗救助等项目。某县艾滋病感染孕产妇住院分娩的费用57．12％来源于预防艾滋病母婴传播项目，新农合占34．21％，降消项目占5．22％，个人负担3．45％。结论预防艾滋病母婴传播项目以及妇幼卫生相关项目和政策均对孕产妇艾滋病检测及住院分娩予以经费支持；而其他与预防艾滋病母婴传播相关的服务环节，如婚前保健、孕期保健、产褥期保健、儿童保健等服务得到支持和关注较少。建议在凉山的贫困边远和少数民族地区合理调配现有资源，关注和强调孕期保健、儿童保健，加大对发现孕产妇、艾滋病感染儿童的随访和指导服务中人力和物力的投入。

Objective To explore the feasibility and effectiveness of prevention of mother-to-child transmission （PMTCT） of .HIV with integrated health resources in Liangshan by analyzing the present financial supports for women and child health care related with preventing AIDS spread. Methods The expenses for delivery of HIV infected women were investigated with quantitative survey, and qualitative methods of in-depth interviews and group discussion were used to understand the funds for PMTCT and support of other related health resources as well as their integration and utilization. Results The fund supports of PMTCT were central financial transfer payment and C- MAP program. Related supports of PMTCT included new rural cooperative medical system, program for reduction of mortality of pregnant and lying-in women and elimination of neonatal tetanus, allowance for hospital delivery of rural pregnant women and civil medical assistance. For the expenses for hospital delivery of HIV infected women in the county, 57.12% were from PMTCT program, 34.21% were from new rural cooperative medical system, 5.22% were from program for reduction of mortality of pregnant and lying-in women and elimination of neonatal tetanus and the rest 3.45% were paid by themselves. Conclusion The detection of HIV and expenses for hospital delivery of pregnant women are financially supported by PMTCT program and related programs and policies for maternal and child health, but the support and focus on service links such as premarital care, antenatal care, puerperium health care and child health care are insufficient. It is suggested that present resources should be allocated reasonably in poverty-stricken areas and minority areas and close attention should be paid to puerperium health care and child health care. Meanwhile, the follow-up of pregnant women and infected children and investment on human and material resources should be strengthened.