中国14个城市社区组织参与艾滋病防治的效果研究

Effect of community based organizations' participation in HIV/AIDS prevention and control among 14 cities in China

目的分析中国14个城市的社区组织(CBO)参与艾滋病防治服务的效果,为今后CBO更好地参与艾滋病防治工作提供参考。方法基于中盖艾滋病项目指标的报表数据、艾滋病病毒(HIV)动员检测卡信息库和产出及评估数据资料,分析CBO完成相关预防干预指标的情况及其趋势。结果2008-2012年,参与艾滋病项目的CBO数量由74个上升至203个;干预领域不断扩展,实施综合干预的CBO数量由2008年的3个增至2012年的60个;社区组织的经费占项目经费总支出的比例,由2009年的41.6%上升为2012年的53.4%。2008-2012年,项目支持CBO动员男男性行为人群(MSM)进行HIV筛查,其阳性检出率分别为5.3%(886/16 585)、5.8%(2562/44 532)、6.1%(3590/58 928)、6.0%(4563/76 628)和6.2%(6531/105 680),HIV感染者的发现率分别为2.4%(646/27 407)、6.4%(1745/27 407)、8.7%(2382/27 407)、11.0%(3024/27 407)和16.6%(4536/27 407),各指标的逐年上升趋势均具有统计学意义(P<0.001)。MSM检测量的贡献主要来自于前50名的社区组织。但社区组织数量的持续增加并未显著增加MSM中HIV阳性发现的效率。结论 CBO推动艾滋病预防干预工作的效果较为显著,但单纯增加社区组织数量并不能显著提高MSM中HIV阳性发现能力。建议平衡每个地区社区组织的数量,探索优秀CBO的长期可持续性,使它们为政府主导的艾滋病防治工作做出更大贡献。

Objective To analyze the effect of Community Based Organizations （CBO）＇ participation in promo- ting HIV/AIDS control and prevention service in 14 cities in China. Methods Based on the CBO indicators reports, HIV testing cards, and the output and evaluation data, the effect of CBOs＇ participation of AIDS response was eval- uated. Results From 2008 to 2012, the number of CBOs increased from 74 to 203. The work content has been ex- panded. The proportion of CBO funds in total expenditure increased from 41.6 % to 53.4%. Proportion of screened HIV-positive people were 5.3% （886/16585）, 5.8% （2562/44532）, 6.1% （3590/58928）, 6.0% （4563/76628） and 6.2% （6531/105680）, the proportion of case finding by CBO mobilization were 2.4% （646/27407）, 6.4% （1745/27407）, 8.7% （2382/27407）, 11.0% （3024/27407） and 16.6% （4536/27407）, respectively. These increa- ses all have statistical significance （P〈0. 001）. The increase in the number of CBOs could not correspondingly in- crease the HIV testing among MSM, and the main contribution to the testing is due to the first 50 CBOs. Conclusion The effect of CBOs＇ participation in AIDS response is obvious, but the testing work could not be improved by simply increasing the number of CBOs, which suggests the necessity of balancing the CBOs and the strengthening of good CBOs to enable them to make greater contribution to AIDS response.