基于卫生策略三角形框架的艾滋病随访管理下沉政策分析

Analysis of task shifting of HIV/AIDS follow-up management based on health triangle framework

目的了解艾滋病随访管理下沉的现状及发现问题,为政策调整及推广提供依据。方法以江西省为例,采用基于卫生策略三角(HPT)框架的定性方法对随访管理下沉的4个要素进行深入研究。在知网、万方、维普三个数据库中检索了56篇文献,国家及省级检索了11份政策文件,并对其进行综述。半结构化面对面访谈探讨艾滋病随访管理服务的主要参与者的观点。结果本次调查了来自5个城市的161名参与者,其中卫生与计划生育委员会及疾病预防控制中心分管艾滋病的领导各4人,各级疾病预防控制中心从事艾滋病防治的专业人员29人,社区卫生服务中心、乡镇卫生院或防保站从事艾滋病防治的专业人员89人;接受艾滋病随访管理的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)35人。HIV/AIDS病人的不断增加使得某些地区下沉工作势在必行、而国家及省内对基层卫生服务机构的支持及倡导"零歧视"的环境也促进了该政策的实行。但下沉应从当地疫情、人员配备及基层卫生服务机构情况上考虑。在下沉过程中也存在一定的问题,包括行政与财政方面,以及病人隐私的保障上及下沉单位负责人业务能力方面。结论随访管理下沉服务在疫情严重而疾病控制预防中心人力不足的地区具有可行性和必要性。建议在开展下沉的地区需保障行政及财政经费的落实,提高基层卫生服务机构工作人员的业务能力、有效保障病人隐私,使这一政策具有有效性和可持续性。

Objective To understand the current situation and problems of HIV/AIDS follow-up management and to provide evidence for policy development.Methods Taking Jiangxi province as an example,we used the qualitative method based on the health policy triangle (HPT)framework to study the four factors of follow-up management from Nov 2016to Dec 2017.56 literatures were retrieved from the three databases of CNKI,Wanfang and Weip,and 11national and provin- cial policy documents were collected.Semi-structured face-to-face interviews were conducted to explore the views of key people in HIV/AIDS follow-up management.Results 161people were investigated in five cities,including 4 leaders from the local health and family planning commission and 4 leaders from CDCs,29 professionals from CDC at all levels,89 pro- fessionals from township health centers or prevention stations,and 35 patients living with HIV/AIDS who received follow up services.The increase of HIV/AIDS patients made the follow-up task-shifting imperative.The national and provincial support for primary health services and promotion of "zero discrimination"environment also promoted the policy implementation.However,the task-shifting should consider the situation of local epidemic,manpower and the conditions of primary health service institutions.Some problems still remained in the task-shifting process,in the aspects of administration and finance,privacy protection and capacity building of the people in primary health service institutions.Conclusion Task-shift-ing of HIV/AIDS follow-up management should be adapted to local situation.It is feasible and necessary to do so especially in the areas with severe epidemic and shortage of CDC staffs.However,it must ensure the administrative implementation,financial support and capacity building of the staff of primary health service institutions,as well as privacy protection of the patients in order to make the task-shifting policy effective and sustainable.