江西省HIV/AIDS病人对随访管理下沉模式的接受状况

Acceptance of task-shifting of HIV/AIDS patients follow-up management from CDC to community/township health center in Jiangxi province

目的了解江西省艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)对艾滋病随访下沉管理模式的接受意愿性。方法采用横断面研究设计,于2017年5—11月以在11个设区市接受随访管理的HIV/AIDS病人为调查对象,调查内容包括社会人口学特征、确诊年份、是否愿意接受随访下沉及不愿意接受的原因等。结果本次共调查147人,其中有68人愿意接受随访下沉,占46.26%。单因素分析显示,不同年龄组(χ~2=10.84,P=0.01)、不同收入群体(χ~2=14.05,P<0.01)与不同确诊年份(χ~2=5.61,P=0.02)对是否愿意接受下沉差异有统计学意义,已下沉的HIV/AIDS病人更愿意接受随访下沉。多因素Logistics回归分析显示,未随访下沉的[比值比(OR)=3.427,95%可信区间(CI):1.508～6.992]及确诊年份在2014年及之前的(OR=0.453,95%CI:0.228～0.897)HIV/AIDS病人更不愿意接受随访下沉。结论多数HIV/AIDS病人不愿意接受随访下沉,在新病例中开展随访下沉工作更易被接受,在开展随访下沉工作前应考虑HIV/AIDS病人本人意愿,同时应注重患者隐私保护及提高随访工作人员工作能力。

Objective To understand the acceptance of HIV/AIDS patients for the task-shifting of follow-up management from CDC to community/township health center in Jiangxi province. Methods A cross-sectional study was conducted in 11 cities. HIV/AIDS patients followed up were investigated from May to Nov 2017. The contents of the survey included demographic characteristics, year of diagnosis, acceptance to shift the tasks and reasons. Results A total of 147 people were surveyed, of whom 68 accepted, accounting for 46.25%. Univariate analysis showed that there were significantly differences between ages(χ~2=10.84, P=0.01), incomes(χ~2=14.05, P<0.01), year of diagnosis(χ~2=5.61, P=0.02) and willingness to accept the shift. Patients already followed up by the community health centers were more likely to accept the task-shifting than those not yet. Multivariate regression analysis showed that the HIV/AIDS patients not yet managed by the community health centers(OR=3.427,95%CI:0.228-0.897) and diagnosed in 2014 and before(OR=0.453,95%CI:1.508-6.992) did not accept. Conclusion Most of HIV/AIDS patients are not willing to accept the task-shifting and the new cases after 2014 are more likely to accept. It is suggested that the willingness of HIV/AIDS patients should be taken into account before the task-shifting. Meanwhile, privacy protection and improvement of professional skills should be paid attention to.