【作者】 张万宏；

【导师】 聂绍发；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2009， 博士

【摘要】 研究背景我国自2004年启动艾滋病自愿咨询检测(HIV Voluntary Counseling & Testing，VCT)工作以来，一直处于低效运转状态。为充分发挥VCT在艾滋病预防干预工作中的作用，迫切需要对我国VCT现状及其影响因素进行全面评价，以期为VCT策略调整提供科学依据。研究目的评价我国VCT工作现状及目标人群对VCT的需求，研究影响VCT高效运转的各种因素；尝试建立VCT工作示范县，在实践中探索适合我国国情的VCT工作方法和策略。研究方法1、采用典型抽样法，抽取我国9个代表性地区作为研究区域，收集最近3年各地VCT现况资料；抽取43家VCT门诊，通过现场观察和查阅资料，了解VCT门诊运转情况。采用配额抽样法，抽取838名暗娼、312名男男同性恋、282名性病患者、711名吸毒者、951名青年学生，进行匿名问卷调查，对相关资料进行定性和定量的分析。2、选择湖北省蕲春县作为实践研究区域，指导当地重建VCT服务体系，不断调整和优化工作方法；通过前后对照，评价活动效果，形成经验性总结。主要研究结果1、9个地区每百万人口VCT门诊平均配置密度为5.48个；322名VCT专业人员中，专职仅占9.94％；2004年～2006年，VCT服务人次年均增长率751.67％。2、2006年，43家抽样VCT门诊中，年服务量不足100人次的占51.17％。3、对43个咨询电话接答质量进行评估，“差”的占51.16％。4、60名咨询员艾滋病知识水平测试，平均得分为(74.07±23.42)分，不及格率为26.67％；仅有3.33％的咨询员对待遇满意。5、3094名接受调查者中，67.16％既往未利用过VCT服务，43.37％不知晓VCT服务信息，81.97％认为开展VCT服务有必要，50.78％从不担心自己会感染艾滋病，39.88％的人认为自己没有必要做艾滋病检测；Logistc回归分析结果显示：对HIV感染风险的不恰当的认识、不知晓VCT服务信息、艾滋病知识水平低等是阻碍目标人群主动利用VCT服务的主要因素。6、蕲春县实践研究项目实施后与实施前比较，VCT工作规范性和效率显著提高。结论与政策建议1、我国VCT体系多个环节仍不完善，主要表现为：VCT网络建设资源浪费严重，多数VCT门诊服务效率低下；宣传工作针对性不强，无法促进重点人群充分利用VCT服务；对VCT门诊经费支持不够，影响了基层VCT服务承担机构和工作人员的积极性；缺乏有效的制约机制，督导工作欠缺力度；专业人员素质参差不齐，VCT服务规范性不够。2、政策建议：为促进VCT工作高效运转，政府应充分发挥主导作用，加强工作协调；VCT网络建设应开展需求评估和成本效益分析，减少资源浪费；防艾经费的二次分配应向基层VCT服务承担机构和工作人员倾斜；积极开展有针对性的宣传，促进知识信息的传播，提高重点人群利用VCT服务的意识和主动性；加强基层工作人员培训，深入开展工作督导和评估，提高VCT服务规范性。更多还原

【Abstract】 Research BackgroundIt had been getting along with the state of low-efficiency while the work of HIV voluntarycounseling and testing(VCT) being put into practice in China since 2004. In order to renderscience foundation for policy adjusting, and improve the role of VCT playing in AIDS control,it’s urgent to give an evaluation to present status and influence factors of VCT on the whole.Research Purposes1. To assess the current situation of VCT in China and the requirement of VCT among thetarget groups, and study the factors influencing on efficient operation of VCT.2. Try to set up a model county, and explore the strategies and methods of VCT work fittingChina in practice.Research Methods1. Using the method of type sampling, nine representative areas were abstracted as theresearch regions from China. The present situation data of VCT in the last three years wascollected. By way of field observation and material inspection, the operation informations of43 VCT clinics selected were gathered. Through quota sampling, 838 demimondaines, 312MSMs, 282 patients suffering STD, 711 drug users and 951 young students were abstracted toaccept anonymous questionnaire survey. The above data collected was analyzed qualitativelyand quantitatively.2. Qichun county Hubei province was selected as the region of practice research. By guidingthe rebuilding of the local VCT service system, the work methods and strategies wereadjusted and optimized constantly. By way of contrasting the pre and the post, the projecteffects were assessed on the whole, and the experience was summarized.Research Results1. In nine sampling districts, the average density of VCT clinics was 5.48 per millionpopulation. Among 322 professionals dealing with VCT, only 9.94% were full-time. During 2004 to 2006, the growth rate of service person-time yearly achieved 751.67%.2. In 2006, 51.16% of 43 VCT clinics sampled had served less than 100 person-times per year.3. Evaluating the answer quality of 43 counseling telephones, 51.16% were "poor".4. Testing to 60 counsellors about AIDS knowledge, the average score was (74.07±23.42),and 26.67% of them failed it. Only 3.33% of Counsellors were satisfied by the pay.5. Among 3094 respondents, 67.16% had not even made use of VCT before, 43.37% didn’tknow VCT information, 81.97% thought VCT being necessary, 50.78% never worried aboutthemselves to be infected by HIV, and 39.88% thought it being unnecessary for themselves toaccept HIV testing. Logistic regression model shew that improper realization to HIV infectionrisk, not knowing VCT information, lower level of AIDS knowledge, etc, were main factorsobstructing voluntary utilization of VCT service among the target groups.6. Compared with the prior year, the specification and efficiency of VCT work in Qichuncounty had been improved greatly aider implementing project activities.Conclusion and Suggestion1. Many links of VCT system in our country were still imperfect, mainly as follows: Seriouswaste of resources existed in VCT network’s construction, and the efficiency in most of VCTclinics was very low. The propagandas were lack of direction and couldn’t promote targetgroups to make full use of VCT service. The fund supporting was not enough for most of theVCT clinics, which affecting the motivation of staffs and institutions. Due to lack of effectiverestrict mechanisms, the supervision was short of power. The uneven quality of professionalstaff resulted in VCT service non-normative.2. To promote VCT work effectively, the policy suggestions are given as below. The first, thegovernment should play a leading role and strengthen the coordination work in VCT.Secondly, the construction of VCT network should be based on scientific evaluation and fullcost benefit analysis so as to reduce resource waste. The third, the secondly assignment offund for AIDS prevention and control should be inclined to the basic level personnel andinstitutions of VCT service. Furthermore, diverse VCT propagandas should be positivelydeveloped to promote the spread of knowledge and information and enhance theconsciousness and initiative of the target groups using VCT service. Finally, training work forbasic level staffs should be strengthened, and the work of supervision and evaluation shouldbe carried out in a deep-going way, so as to improve the specification of VCT service.更多还原