【作者】 庞勇；

【导师】 李自钊；

【作者基本信息】 河南大学 ， 社会医学与卫生事业管理， 2012， 硕士

【摘要】 目的：在新医改背景下，调查了解河南省艾滋病防治工作现状及存在的问题，寻找艾滋病防治工作与新医改方案的结合点，为进一步完善河南省艾滋病防治工作提供政策建议。方法：采用分层随机抽样选取河南省艾滋病疫情分别为高、中、低的上蔡县、确山县和濮阳县作为样本县。采用访谈法与样本县卫生、教育、妇联等有关部门领导和工作人员进行深入访谈，了解艾滋病政策落实情况，医疗救治、帮扶救助活动开展情况以及开展工作时遇到的困难和问题，讨论相关的解决办法。通过问卷调查收集样本县基本信息，医疗救治队伍人员个人能力水平，高危人群艾滋病知识知晓情况、安全套使用情况等信息。利用SPSS11.5统计分析软件建立数据库，进行统计分析。对全体调查人员进行调查程序和数据收集方法的培训，确保收集资料的准确性、完整性。在现场调查中严格按照要求进行调查，确保调查环境符合工作要求。对每天完成的调查问卷进行及时核实，以便及时补充调查。对完成的数据库有专人进行核查。结果：1.样本县基本情况从样本县近三年的艾滋病感染情况可以看出，艾滋病疫情仍处于上升阶段，但增幅正在逐渐下降；经血液传播、母婴传播的感染情况正在减少，但经性传播上升趋势明显；艾滋病感染者及病人流出人数在逐年递增；单阳家庭安全套使用率逐年升高，单阳配偶阳转率逐年下降。2.预防控制工作（1）在以社区为依托的艾滋病综合管理模式下，疾控部门及治疗单位对流动病人及感染者的服药督导和随访管理多依靠电话进行。疾病预防控制机构与医疗救治机构缺乏信息沟通。（2）专门的艾滋病检验监测机构设置，导致部分人群碍于情面，害怕暴露，不愿去做检查。（3）艾滋病预防控制及医疗救治人员中，初级职称人员占一半以上，中级职称较少，高级职称人员仅占6.6%。本科学历者仅为5.3%，专科学历者占85.1%，高中及以下学历人员占9.6%。（4）高危人群艾滋病单项知识答对率59.5%－98.6%，答错率0－19.6%，不知道率0.7%－25.7%。高危人群百分制综合得分60分以下者占4.7%；60－80分者占27.1%；80分以上者68.2%。满分者41人，占27.7%。（5）高危人群在发生性行为时，每次都使用安全套的占61.5％，没有用过安全套的人数占18.2％。在阳性孕龄妇女中每次性行为都使用安全套的仅占53.6％，34.8％的阳性妇女没有用过安全套。3.医疗救治工作（1）2010年度上蔡县累计抗机会性感染治疗人数5786人，个人账户人均月支出209.15元，个人账户及大病统筹透支人数各1511人，个人账户超支671万元，大病统筹超支总金额517万元；确山县抗机会性感染治疗总人数752人，个人账户人均月支出139元；使用个人账户87人，透支总金额108.9818万元，其中支出1万元以上31人，支出金额71.4182万元，占支出总金额的65.53％，支出最高者金额56766元。（2）两性霉素B与红霉素对真菌感染治疗均有一定的效果，但二者产生的副作用和不良反应较多，在抗机会性感染治疗的实际工作中使用率较低。（3）上蔡县2009年纳入二线药物治疗444人，2010年516人，截至2010年底960人中803人是因治疗效果不佳纳入。确山县2009年纳入二线药物治疗26人，2010年24人，截至2010年底，确山县接受抗病毒治疗的743人中有43人是由于治疗效果不佳纳入二线药物，占纳入二线药物治疗人数的86%。4.帮扶救助工作在被调查的民政、教育、团委等15个部门中，有9个部门提到经费短缺、人力不足问题。有6个部门有专职艾防人员，其中疫情较低的濮阳县各部门均无专职艾防人员。确山县妇联、团县委等部门2010年均无艾滋病防治工作专项经费。濮阳县除民政部门每年有1000余元的专项经费外，其余部门均无专项经费。结论1.艾滋病病人及感染者信息管理系统有待进一步健全,专门的艾滋病筛查检测机构存在弊端；2.艾滋病预防控制及医疗救治队伍，个人能力整体水平较低；3.高危人群艾滋病知识知晓率总体较高，但认识与行为存在偏差，存在传播隐患，安全套使用率较低，特别是双阳家庭；4.抗机会性感染治疗费用逐渐增高，病人用药种类有限。抗机会性感染治疗药物目录有待进一步调整；5.抗病毒治疗耐药问题日益突出，中医药的作用未得到充分发挥；6.经费短缺、人力不足是影响基层多部门合作开展艾滋病防治工作效果的重要因素。更多还原

【Abstract】 Objective:Henan Province AIDS prevention and control current situation and existing problems in the context ofthe new medical reform, the investigation, find the point of integration of AIDS prevention and controlmode and the new medical reform program, and provide policy recommendations to further improve theHenan AIDS prevention mode.Methods:Using stratified random sampling to select the AIDS epidemic in Henan Province were high, lowShangcai, Queshan and Puyang County as samples of counties. Interviews with samples County health,education, women’s federations and other leaders of relevant departments and staff to conduct in-depthinterviews about AIDS policy to the implementation of medical care, helping rescue activities, as well asthe difficulties encountered in the work and problems, discuss solution. Through a questionnaire survey tocollect the basic information of the sample counties, the level of individual ability of the medical treatmentteam personnel at high risk of AIDS knowledge, condom use and other information. SPSS11.5statisticalanalysis software to establish a database for statistical analysis. Training in survey procedures and datacollection methods for all the investigating officers to ensure the accuracy of data collection and integrity.In the field investigation in strict accordance with the requirements of the investigation to ensure thatinvestigations meet the job requirements to the environment. Timely verification of the questionnairecompleted every day, in order to replenish the investigation. Staff for verification of the completeddatabase.Results:1A sample County situationIt can be seen from the samples County nearly three years of HIV infection, the AIDS epidemic inHenan Province is still on the upswing, but the growth rate is gradually declining; transmitted throughblood, mother to child transmission of infection is declining, but obvious by the sexually transmittedupward trend; AIDS and the patient outflow of the number increase every year; families in single-positive rate of condom use increased year by year, the spouse of a single positive seroconversion rates declining.2Prevention and control(1) In the AIDS community-based integrated management model, disease control department, andtreatment units for medication supervision and follow-up management of the flow of patients and infectedpersons to rely more on the phone. Disease control and prevention and medical treatment institutions is thelack of information communication..(2) Set of specialized AIDS inspection and monitoring bodies, causing part of the population becauseof the feelings, fear of exposure, do not want to do the check.(3) AIDS Control and Prevention and medical treatment personnel in the junior titles more than halfless, intermediate grade, and senior professional titles account for only6.6%. Undergraduate degree, only5.3percent, specialist education, accounting for85.1%, accounted for9.6percent of high school thefollowing academic staff.(4) At high risk of AIDS individual knowledge correct rate of59.5%-98.6%, got it wrong rate of0-19.6%, do not know the rate of0.7%-25.7%. High-risk groups percentile score60points or lessaccounted for4.7%;60-80points accounted for27.1%;80points or above68.2%. Out of41, accountingfor27.7%.(5) High-risk groups, and each time use a condom during sex accounted for61.5%,18.2%never usedcondoms. Positive women of childbearing age in each sex use condoms, only53.6%,34.8%of positivewomen have not used a condom.3Medical treatment(1)2010Shangcai cumulative anti-opportunistic infection treatment the number of5786,209.15yuanper capita monthly expenditure of personal accounts, personal accounts and serious co-ordination overdraftnumber1511, the personal account of overspending671million, serious co-ordination overrun the totalamount of517million; county used anti-opportunistic infection treatment and the total number of752,139yuan per capita monthly expenditure of personal accounts;87personal accounts, overdrafts, the totalamount of108.9818million yuan,31people spent10,000yuan or more, spending the amount of71.4182million yuan, accounted for65.53%of the total amount of expenditures, spending the highest amount of56,766yuan. (2) Of amphotericin B and erythromycin treatment to have a certain effect, but in view of the twoside-effects and adverse reactions are more low usage in the actual work of the anti-opportunistic infectionsfungal infections.(3) Shangcai2009into the second-line drug therapy444，516people in2010，803of960people atthe end of2010into the treatment ineffective. The county used in2009into the second-line drug therapy26201024, the end of2010, the county used to accept743out of antiretroviral therapy43into the second-linedrugs due to poor treatment, accounting into the second-line drug therapy the number of86%.(4) Helping rescue workIn the15sectors surveyed, nine departments mentioned the shortage of funds, lack of manpowerproblems. Six departments have full-time HIV Prevention staff, which the epidemic lower Puyang Countydepartments were not full-time HIV Prevention staff. Queshan County Women’s Federation, the regimentcounty departments average annual AIDS prevention and control of special funds. Puyang County inaddition to the civil affairs departments in each of1000yuan of special funds, the rest of the departmenthad no special funding.Conclusion：Pending further improve the information management system for AIDS patients and infected persons;specialized HIV screening testing organizations disadvantages; AIDS Control and Prevention and medicaltreatment team, personal ability and lower the overall level; high-risk groups Knowledge about AIDS isgenerally high, but awareness and biased behavior, there is spread hidden; low rate of condom use ofhigh-risk groups, the Shuangyang family; anti-opportunistic infection treatment costs gradually increased, alimited range of patient medication; anti-opportunistic infection therapy directory is subject to furtheradjustment; drug resistance to antiviral therapy have become increasingly prominent role of traditionalmedicine has not been fully realized; multisectoral cooperation AIDS and there are limits.更多还原