【作者】 薛珲；

【导师】 孙江平；

【作者基本信息】 中国疾病预防控制中心 ， 流行病与卫生统计学， 2011， 博士

【摘要】 目的：分析重庆市主城区不同场所MSM人群行为干预工作的主要内容,并对MSM人群干预工作的经费花费情况和实际支出成本进行分析,为有效开展MSM人群干预工作提供科学依据。方法：利用定量和定性研究相结合的方法对重庆市主城区2006-2009年的MSM人群干预相关情况进行研究。利用定量研究方法通过收集历年病例报告、哨点监测、专项调查、经费使用分配问卷等数据,分析重庆市MSM人群干预工作取得的效果及存在的问题,并分析重庆市MSM人群干预经费的来源和使用情况。利用作业成本法对不同场所MSM人群干预工作的实际支出成本进行分析。通过定性访谈分析了解目前不同场所MSM人群干预工作的具体内容和经费使用与分配过程中存在的问题。应用Excel建立数据库,利用SPSS15.0统计软件进行统计分析。结果：重庆市MSM人群在寻找性伴时,通过网络、酒吧和浴池途径的比例分别为65%、18%和7%,因此重庆市针对MSM人群主要开展了网络类干预、酒吧类干预和浴池类干预三种不同场所和渠道的干预工作。网络类干预主要工作内容是宣传性病艾滋病相关的知识信息、服务转介和招募目标对象等,酒吧类干预主要工作内容是宣传介绍相关艾滋病的知识信息和发放安全套及润滑剂等,浴池类干预主要的工作内容是减少浴池中MSM人员间高危性行为的发生、发放安全套和润滑剂以及宣传艾滋病的相关知识等。2006-2009年重庆市主城区用于MSM人群干预工作的经费为444.8万元,其中中盖项目支持经费最多,占48.1%。MSM人群干预工作的支出成本分为直接支出和间接支出,其中直接支出领域主要包括MSM人群聚集场所的现场外展干预和通过网络渠道开展MSM人群干预,占总支出的50.6%,间接支出领域主要包括创造支持性环境、能力建设、和督导评估,占总支出的49.4%。重庆市主城区网络类干预每干预1人次的实际花费成本从2006年的68.7元降到2009年的40.9元,每检出1例HIV阳性MSM的实际花费成本从2006年的51887.5元降到2009年的14052.5元；酒吧类干预每干预1人次的实际花费成本从2006年的67.3元降到2009年的30.2元,每检出1例HIV阳性MSM的实际花费成本从2006年的36787.3元降到2009年的4672.1元；浴池类干预每干预1人次的实际花费成本从2006年的67.9元降到2009年的17.5元,每检出1例HIV阳性MSM的实际花费成本从2006年的4393.3元降到2009年的1155.6元。结论：重庆市主城区主要采取了网络类干预、酒吧类干预和浴池类干预三种不同场所和渠道的干预对MSM人群进行高危行为干预,且根据各自场所的实际情况包括了不同的工作内容和方式。MSM人群干预工作的经费主要来源于政府财政投入和国际合作项目经费支持。不同场所的干预工作直接支出所占比重因工作所包含内容不同而不同。三类场所干预MSM每人次的成本、通过开展干预活动促使MSM人群接受HIV检测的成本和每检出1例HIV阳性MSM的成本均有下降趋势。更多还原

【Abstract】 Objectives:To analyse the main contents of MSM intervention in different places in the central regions of Chongqing, analyse the fund investment and the actual expenditure cost to provide related evidences for carrying out the intervention effectively among MSM.Methods:Quantitative and qualitative methods were both used to study the related information about the MSM intervention in the central regions of Chongqing between2006and2009. Analyse the quantitative data from case reports, sentinel surveillance, special surveys and questionnaires to describe the effectiveness and problems of the MSM intervention in Chongqing. Collect and analyse the information about the fund source, allocation and working areas investment of the resource invested for the MSM intervention. The actual expenditure cost of intervention was calculated with activity-based costing The intervention contents, difficulties and problems about the resource utilization and allocation were provided through qualitative interviews. A Data-base was established using Microsoft Office Excel2003. SPSS15.0was used for statistics analysis.Results:The percentage of finding sexual partners of MSM in Chongqing through Internet, bar and bathhouse were65%,18%,7%respectively, and interventions through internet and in bar and bathhouse were conducted accordingly. The main contents of intervention through internet were referral and target population recruitment. The contents of intervention in bar were delivering the HIV/AIDS information, condoms and lubricants. The contents of intervention in bathhouse were preventing the high risk behaviours and delivering the HIV/AIDS information, condoms and lubricants. Total resources allocated for MSM intervention in central regions of Chongqing between2006and2009were4.448million, of which the biggest (48.1%) is from Gates. The expenditure of intervention was divided into direct and indirect expenditure. The direct expenditure was mainly used to conduct outreach and internet intervention, counting for50.6%of the total expenditure. The indirect expenditure was mainly used for creating supporting environment, capacity building and M&E, which counting for49.4%. The cost of MSM covered by intervention through internt and in bar and bathhouse decreased from68.7,67.3,67.9yuan per person times in2006to40.9,30.2,17.5yuan in2009resectively, and the cost of HIV positive case finding dercreased from51877.5,36787.3,16287.3yuan per person to14052.5,4672.1,1950.2yuan respectively.Conclusions:The intervention among MSM in the central regions of Chongqing were mainly conducted through internet and in bar and bathhouse, and different contents were included according to the circumstances. The resource of MSM intervention was mostly from government investment and financial support of international cooperation program. The proportions of direct expenditure of the3interventions accounting for the total expenditure were different as a result of the different contents included. The unit costs of MSM covered by intervention, of promoting HIV testing and HIV positive case finding all had decreaing trends.更多还原