目的:探讨在计划生育门诊中开展医务人员主动提供HIV检测咨询(provider-initiated testing and counse-ling,PITC)服务的必要性和可行性及影响因素。方法:随机抽取计划生育门诊就诊者800人进行问卷凋查。结果:就诊者艾滋病总知识知晓率...目的:探讨在计划生育门诊中开展医务人员主动提供HIV检测咨询(provider-initiated testing and counse-ling,PITC)服务的必要性和可行性及影响因素。方法:随机抽取计划生育门诊就诊者800人进行问卷凋查。结果:就诊者艾滋病总知识知晓率为85.27%,各知识点知晓率差距较大,12个知识点中有7项正确回答率90%以上,有3项正确回答率在70%以下;年轻、初中文化程度和无业人员、工人等人群知晓率偏低。对艾滋病病毒感染者态度有30.0%持"同情并帮助"态度,有38.00%持"同情并疏远"态度。76.75%认为HIV检测咨询可以控制艾滋病的流行和传播。"认为HIV检测的负面影响"的选择中,害怕被歧视29.73%、家庭破裂24.62%、失去工作24.44%、暴露隐私21.21%。在不愿接受HIV检测的就诊者中,81.90%认为没必要。25.62%(人.项)的就诊者知道计生门诊可以提供艾滋病检测咨询服务;35.22%的就诊者会首选到计生门诊检测。分别有86.88%和94.63%的人表示,在计生门诊就诊时,愿意接受医务人员提供HIV检测和HIV方面的知识信息咨询。开展PITC服务1年,门诊检测率从11.64%提高到23.15%,有显著性差异(P<0.01)。结论:计划生育门诊医务人员开展PITC服务是必要的和可行的,能明显提高就诊者的HIV检测率。艾滋病综合知识知晓率低、HIV检测重要性认识不足、社会歧视是阻碍就诊者接受PITC服务的重要影响因素。展开更多
Background:Provider-initiated HIV testing and counseling(PITC)is offered as part of the normal standard of care to increase access to treatment for HIV-infected children.In practice,HIV diagnosis occurs in late childh...Background:Provider-initiated HIV testing and counseling(PITC)is offered as part of the normal standard of care to increase access to treatment for HIV-infected children.In practice,HIV diagnosis occurs in late childhood following recurrent and chronic infections.We investigated primary caregivers’reported reasons for seeking HIV testing for children aged 5–18 years,determined the orphan status of the children,and compared the clinical profile and disease burden of orphans and non-orphans.Methods:This was a cross-sectional survey of primary caregivers of HIV-infected children accessing antiretroviral treatment(ART)from two community hospitals and 34 primary healthcare facilities in a rural district in Mpumalanga province,South Africa.Results:The sample consisted of 406 primary caregivers:319(78.6%)brought the child to the health facility for HIV testing because of chronic and recurrent infections.Almost half(n=183,45.1%)of the children were maternal orphans,128(31.5%)were paternal orphans,and 73(39.9%)were double orphans.A univariate analysis showed that maternal orphans were significantly more likely to be older(OR=2.57,p=0.000,CI:1.71–3.84),diagnosed late(OR=2.48,p=0.009,CI:1.26–4.88),and to start ART later(OR=2.5,p=0.007,CI:1.28–4.89)than non-orphans.There was a high burden of infection among the children prior to HIV diagnosis;274(69.4%)presented with multiple infections.Multiple logistic regression showed that ART start age(aOR=1.19,p=0.000,CI:1.10–1.29)and time on ART(aOR=2.30,p=0.000,CI:1.45–3.64)were significantly associated with orphanhood status.Half(n=203,(50.2%)of the children were admitted to hospital prior to start of ART,and hospitalization was associated with multiple infections(OR=1.27,p=0.004,CI:1.07–1.51).Conclusions:The study found late presentation with undiagnosed perinatal HIV infection and high prevalence of orphanhood among the children.The health of maternal orphans was more compromised than non-orphans.Routine PICT should be strengthened to increase community awareness about undiagnosed HIV among older children and to encourage primary caregivers to accept HIV testing for children.展开更多
文摘目的:探讨在计划生育门诊中开展医务人员主动提供HIV检测咨询(provider-initiated testing and counse-ling,PITC)服务的必要性和可行性及影响因素。方法:随机抽取计划生育门诊就诊者800人进行问卷凋查。结果:就诊者艾滋病总知识知晓率为85.27%,各知识点知晓率差距较大,12个知识点中有7项正确回答率90%以上,有3项正确回答率在70%以下;年轻、初中文化程度和无业人员、工人等人群知晓率偏低。对艾滋病病毒感染者态度有30.0%持"同情并帮助"态度,有38.00%持"同情并疏远"态度。76.75%认为HIV检测咨询可以控制艾滋病的流行和传播。"认为HIV检测的负面影响"的选择中,害怕被歧视29.73%、家庭破裂24.62%、失去工作24.44%、暴露隐私21.21%。在不愿接受HIV检测的就诊者中,81.90%认为没必要。25.62%(人.项)的就诊者知道计生门诊可以提供艾滋病检测咨询服务;35.22%的就诊者会首选到计生门诊检测。分别有86.88%和94.63%的人表示,在计生门诊就诊时,愿意接受医务人员提供HIV检测和HIV方面的知识信息咨询。开展PITC服务1年,门诊检测率从11.64%提高到23.15%,有显著性差异(P<0.01)。结论:计划生育门诊医务人员开展PITC服务是必要的和可行的,能明显提高就诊者的HIV检测率。艾滋病综合知识知晓率低、HIV检测重要性认识不足、社会歧视是阻碍就诊者接受PITC服务的重要影响因素。
基金This study was funded by the University of Limpopo.The authors would also like to thank the field workers and all the caregivers who participated and shared their time and experiences with us.We also acknowledge the healthcare workers who supported the data collection process.
文摘Background:Provider-initiated HIV testing and counseling(PITC)is offered as part of the normal standard of care to increase access to treatment for HIV-infected children.In practice,HIV diagnosis occurs in late childhood following recurrent and chronic infections.We investigated primary caregivers’reported reasons for seeking HIV testing for children aged 5–18 years,determined the orphan status of the children,and compared the clinical profile and disease burden of orphans and non-orphans.Methods:This was a cross-sectional survey of primary caregivers of HIV-infected children accessing antiretroviral treatment(ART)from two community hospitals and 34 primary healthcare facilities in a rural district in Mpumalanga province,South Africa.Results:The sample consisted of 406 primary caregivers:319(78.6%)brought the child to the health facility for HIV testing because of chronic and recurrent infections.Almost half(n=183,45.1%)of the children were maternal orphans,128(31.5%)were paternal orphans,and 73(39.9%)were double orphans.A univariate analysis showed that maternal orphans were significantly more likely to be older(OR=2.57,p=0.000,CI:1.71–3.84),diagnosed late(OR=2.48,p=0.009,CI:1.26–4.88),and to start ART later(OR=2.5,p=0.007,CI:1.28–4.89)than non-orphans.There was a high burden of infection among the children prior to HIV diagnosis;274(69.4%)presented with multiple infections.Multiple logistic regression showed that ART start age(aOR=1.19,p=0.000,CI:1.10–1.29)and time on ART(aOR=2.30,p=0.000,CI:1.45–3.64)were significantly associated with orphanhood status.Half(n=203,(50.2%)of the children were admitted to hospital prior to start of ART,and hospitalization was associated with multiple infections(OR=1.27,p=0.004,CI:1.07–1.51).Conclusions:The study found late presentation with undiagnosed perinatal HIV infection and high prevalence of orphanhood among the children.The health of maternal orphans was more compromised than non-orphans.Routine PICT should be strengthened to increase community awareness about undiagnosed HIV among older children and to encourage primary caregivers to accept HIV testing for children.
