中缅边境在华外国HIV感染者和AIDS病人综合服务模式评估

Evaluation on comprehensive service mode for foreign HIV/AIDS patients in Sino-Burmese border areas in China

目的评估中缅边境在华外国艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称外籍HIV感染者和AIDS病人)综合服务模式有效性,为制定外籍HIV感染者和AIDS病人综合服务模式提供科学依据。方法于2013年9月—2014年6月,选择云南省瑞丽市开展服务模式探索,根据外籍HIV感染者和AIDS病人境内居留时间长短、合法性和个人服务意愿等因素分群分层设计跨境婚姻、监管场所、其他人群三类服务模式。项目前后对该市随访到的、年龄≥15岁、可进行有效沟通的所有外籍HIV感染者和AIDS病人分别开展基线调查和评估调查。通过比较项目前后综合服务、高危行为信息进行模式评估。结果项目前基线调查151例,项目后评估调查131例。通过综合服务模式探索,外籍HIV感染者和AIDS病人获得HIV抗体检测咨询告知、随访、CD4+T淋巴细胞检测、抗病毒治疗、结核病检查分别从项目前的74.2%、25.8%、66.9%、44.4%和9.3%上升到项目后的100.0%、99.2%、98.5%、69.5%和87.0%(P均<0.05)。与中国人的配偶性行为每次使用安全套的比例分别从项目前的26.1%(12/46)上升到项目后的50.0%(22/44)(P<0.05)。最近6个月与中国人注射吸毒从未共用针具的比例从项目前的1.3%(1/78)上升到项目后的15.5%(9/58)(P<0.05)。结论外籍HIV感染者和AIDS病人综合服务模式促进了外籍HIV感染者和AIDS病人获得综合服务改变了高危行为。

Objective To evaluate the effectiveness of comprehensive service mode for foreign people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome （HIV/AIDS） in Sino-Burmese border areas in China, and to provide a basis for developing comprehensive service mode for foreign HIV/AIDS patients. Methods Surveys were conducted among 151 and 131 foreign HIV/AIDS patients who were aged ≥ 15 years and had effective communication ability before and after the implementation of the comprehensive service between September 2013 and June 2014 in Ruili city of Yunnan province. The comprehensive service of different manners were provided to the patients with cross-country marriage, visiting surveillance and supervision institutions and other foreign groups according to the duration staying in China, legality of the service procedure, and the willingness of the patients. The utilization and the quality of the comprehensive service and changes in high risk behavior of the patients after the implementation of the service were assessed. Results There were significant increases in the ratio of receiving notification of HIV antibody detection result （74. 2% to 100% ） ,follow-up health care （25.8% to 99. 2% ） ,CD4＋ T detection （66. 9% to 98.5% ）, anti-HIV virus therapy （44. 4% to 69.5% ） ,checkup for tuberculosis （9. 3% to 87.0% ） ,and psychological counseling during follow-up health care （ 18.5% to 91.6% ） among the patients 10 months after the implementation of the comprehensive service （ P 〈 0.05 for all）. Among the foreign HIV/AIDS patients, the condom usage rate during every sex with their Chinese sexual partners increased significantly from 26. 1% to 50.0% （ P 〈 0. 05 ） after the implementation of the comprehensive service. The ratio of never sharing syring needle with a Chinese drug user when uing drugs during the latest 6 months dereased from 15. 5% to 1.3 % after the implementation of the service mode（ P 〈 0. 05 ）. Conclusion The comprehensive service mode for foreign HIV/AIDS patients can help to promote relevant health care utilization and to decrease high risk behavior among the patients.