發(fā)布時(shí)間：2018-03-19 12:25

  本文選題：基層　切入點(diǎn)：艾滋病防治　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:基層是我國(guó)艾防工作的落腳點(diǎn)和重要平臺(tái),然而基層艾滋病防治正面臨諸多問(wèn)題與挑戰(zhàn)。由于流動(dòng)性強(qiáng),文化水平較低,艾滋病防治意識(shí)較為薄弱等特點(diǎn),我國(guó)城鄉(xiāng)居民面臨著艾滋病感染的高風(fēng)險(xiǎn),全國(guó)每年新增的艾滋病病毒感染者和病人都分布在農(nóng)村。同時(shí)由于基層艾滋病防治服務(wù)平臺(tái)尚處于構(gòu)建階段,體系薄弱,基層衛(wèi)生機(jī)構(gòu)的防艾職責(zé)尚不明確,缺乏相應(yīng)的工作技術(shù)指南,工作難以做到標(biāo)準(zhǔn)和規(guī)范,基層艾滋病防治面臨巨大挑戰(zhàn)。而服務(wù)規(guī)范作為一種服務(wù)標(biāo)準(zhǔn),能夠傳達(dá)服務(wù)期望,規(guī)范服務(wù)行為,進(jìn)行績(jī)效考核,同時(shí)通過(guò)規(guī)范的構(gòu)建,還可以將基層艾滋病防治服務(wù)內(nèi)容確定下來(lái),保持基層工作的可持續(xù)性,推動(dòng)基層艾滋病防治工作的開展。因此,構(gòu)建基層艾滋病防治服務(wù)規(guī)范對(duì)于基層艾防工作具有重要指導(dǎo)意義。目的:本研究通過(guò)了解艾滋病防治服務(wù)受益人群的艾防服務(wù)需求,以及典型地區(qū)艾滋病防治服務(wù)形式和現(xiàn)有規(guī)范調(diào)查與研究的基礎(chǔ)上,旨在構(gòu)建一套具有一定科學(xué)性和可操作性的基層艾滋病防治服務(wù)規(guī)范。方法:本研究主要采用了現(xiàn)場(chǎng)調(diào)查和專家評(píng)審2種方法�，F(xiàn)場(chǎng)調(diào)查中,綜合考慮了全國(guó)艾滋病疫情的嚴(yán)重程度,選取了四川成都2個(gè)區(qū)縣、湖北武漢2個(gè)區(qū)縣和安徽省合肥市、亳州市的2個(gè)縣進(jìn)行艾滋病防治相關(guān)受益人群的需求調(diào)查,采用“一問(wèn)一答”的問(wèn)卷調(diào)查形式,了解受益人群需求特點(diǎn)。同時(shí)選取了一個(gè)基層艾滋病防治服務(wù)工作已下沉的典型樣本,通過(guò)關(guān)鍵知情人訪談,了解已下沉地區(qū)的基層艾滋病防治服務(wù)類別,具體工作內(nèi)容和考核方式等。收集的數(shù)據(jù)經(jīng)過(guò)Epi Data3.1軟件的雙人雙錄入,數(shù)據(jù)分析則采用SPSS18.0。訪談?wù){(diào)查內(nèi)容通過(guò)轉(zhuǎn)錄音和文本分析的方式進(jìn)行總結(jié)。專家評(píng)審的方法主要用于后期的基層艾滋病防治服務(wù)規(guī)范的構(gòu)建,對(duì)構(gòu)建的規(guī)范進(jìn)行論證評(píng)議和提出修改意見與建議。結(jié)果:(1)艾滋病防治服務(wù)受益人群需求情況:(1)本次共調(diào)查艾滋病防治服務(wù)7類受益人群1204人。92.1%的一般居民和89.9%的校內(nèi)青少年認(rèn)為有必要接受艾滋病相關(guān)的宣傳教育;92.6%的流動(dòng)人口、93.2%的暗娼人群、91.7%的吸毒人群、96.1%的男同和100%的艾滋病感染者/病人認(rèn)為需要接受艾滋病防治服務(wù)。(2)每類人群對(duì)艾滋病防治服務(wù)的需求程度有所不同。流動(dòng)人口對(duì)于艾防服務(wù)的需求排名前三的是:“宣傳教育”(87.3%)、“性病艾滋病的咨詢”(27.3%)、“艾滋病檢測(cè)”(23.3%);暗娼人群是:“宣傳教育”(59.6%)、“安全套發(fā)放”(38.2%)和“性病防治”(37.5%);吸毒人群是:“艾滋病檢測(cè)”(54.9%)、“美沙酮替代治療”(44.4%)和“性病艾滋病咨詢”(34.0%);男同人群是:“宣傳教育”(59.2%)、“艾滋病檢測(cè)”(57.1%)和“性病艾滋病的咨詢”(45.6%)。(3)各類人群對(duì)艾防服務(wù)機(jī)構(gòu)的接受情況:各類人群對(duì)于疾病預(yù)防控制機(jī)構(gòu)都有良好的接受度,而對(duì)于其他服務(wù)機(jī)構(gòu)的選擇則有所不同。除了預(yù)防控制機(jī)構(gòu)外,流動(dòng)人口(56.0%)、暗娼(46.3%)和艾滋病感染者/病人(41.6%)更傾向于選擇社區(qū)衛(wèi)生服務(wù)中心或鄉(xiāng)鎮(zhèn)衛(wèi)生院,吸毒人群更傾向于選擇市一級(jí)設(shè)置的美沙酮替代治療點(diǎn)(46.5%),社區(qū)衛(wèi)生服務(wù)中心和鄉(xiāng)鎮(zhèn)衛(wèi)生院成為吸毒人群的第三選擇(43.8%),男同人群更傾向于選擇社會(huì)組織(55.1%)。(2)典型地區(qū)的基層艾滋病防治服務(wù)現(xiàn)狀:調(diào)查發(fā)現(xiàn),目前基層開展的艾滋病防治服務(wù)類別主要有宣傳教育、艾滋病咨詢和快速檢測(cè)、高危人群的干預(yù)和艾滋病病毒感染者/病人的隨訪管理等方面,有具體的工作內(nèi)容。其激勵(lì)方式與基層所獲得的艾滋病防治服務(wù)經(jīng)費(fèi)相關(guān),績(jī)效考核方式和基本公共衛(wèi)生服務(wù)項(xiàng)目的考核一致。(3)基層艾滋病防治服務(wù)規(guī)范的構(gòu)建:在構(gòu)建之初,確定了規(guī)范構(gòu)建的基本原則是合法、合理、科學(xué)和實(shí)用。在前期資料和調(diào)查研究的基礎(chǔ)上,依據(jù)現(xiàn)有規(guī)范,構(gòu)建基層艾滋病防治服務(wù)規(guī)范的內(nèi)容包括疫情報(bào)告、宣傳教育、艾滋病咨詢和快速檢測(cè)、暗娼人群干預(yù)、艾滋病病毒感染者/病人的隨訪管理5個(gè)方面,明確了基層艾防服務(wù)機(jī)構(gòu)為社區(qū)衛(wèi)生服務(wù)中心和鄉(xiāng)鎮(zhèn)衛(wèi)生院。(4)基層艾滋病防治服務(wù)規(guī)范專家評(píng)審:經(jīng)過(guò)專家對(duì)各維度的評(píng)審,對(duì)初步制定的基層艾滋病防治服務(wù)規(guī)范的綜合評(píng)分為90.6分。分別對(duì)評(píng)審的6個(gè)維度進(jìn)行分析發(fā)現(xiàn),范圍與目的的標(biāo)準(zhǔn)化評(píng)分為92分,利益相關(guān)人群為94分,編寫的嚴(yán)謹(jǐn)性為91分,呈現(xiàn)的清晰性為90.7分,顯示出較好的權(quán)威性和科學(xué)性。結(jié)論:本次研究所構(gòu)建的基層艾滋病防治服務(wù)規(guī)范是參照相關(guān)文獻(xiàn)的內(nèi)容,是按照一定科學(xué)的步驟構(gòu)建的。本研究既充分吸納了艾滋病防治服務(wù)對(duì)象的訴求,也借鑒了典型地區(qū)的基層艾滋病防治服務(wù)工作經(jīng)驗(yàn),在此基礎(chǔ)上明確了基層艾滋病防治服務(wù)內(nèi)容。同時(shí)參照了我國(guó)現(xiàn)有的一些服務(wù)文件和方案,構(gòu)建了我國(guó)基層艾滋病防治服務(wù)規(guī)范。經(jīng)相關(guān)專家評(píng)審,該“規(guī)范”具有較好的科學(xué)性、權(quán)威性和適用性。
[Abstract]:Background: China's AIDS prevention work is the basic foothold and an important platform, but the basic AIDS prevention and control is facing many problems and challenges. Due to the strong liquidity, low cultural level, AIDS prevention awareness is relatively weak and other characteristics, China's urban and rural residents face a high risk of HIV infection, HIV infection throughout the country each year. And patients are located in rural areas. At the same time as the basic AIDS prevention service platform is still in the construction phase, the weak system of AIDS prevention responsibilities of grassroots health institutions is not clear, the lack of corresponding technical guidelines, work hard to achieve standards and norms, grassroots AIDS prevention is facing enormous challenges. And the service specification as a service standard, can express service expectation, service behavior, performance appraisal, and through the construction of regulations, can also be determined under the basic AIDS prevention and control services To maintain the sustainability of the grass-roots work, promote AIDS prevention and control work to carry out grassroots. Therefore, construction of grassroots AIDS prevention service standard has important guiding significance to the grassroots AIDS prevention work. Objective: this research through the understanding of AIDS prevention service requirements service beneficiaries based AI, AIDS prevention service form and typical areas and existing norms survey with the research on the aims to construct a scientific and workable grassroots AIDS prevention service specification. Methods: This study mainly uses field survey and expert review 2 methods. In the field investigation, considering the severity of the AIDS epidemic, Sichuan selected 2 counties of Chengdu, Hubei 2 counties of Wuhan and Anhui City of Hefei Province, 2 counties of Bozhou city survey of AIDS related beneficiaries, with a question and answer" The form of a questionnaire survey, understand the beneficiaries demand characteristics. Then the typical sample of a grassroots AIDS prevention and control work has been sinking, through key informant interviews, understanding of the sinking grassroots AIDS prevention service categories, specific work contents and assessment methods. The data collected by the Epi Data3.1 software of double entry, the data were analyzed with SPSS18.0. interview summary through recording and analysis of the texts. The expert review method is mainly used for the construction of the grassroots AIDS prevention service specification, demonstration appraisal and puts forward some comments and suggestions on the construction of the standard. Results: (1) AIDS prevention service beneficiaries demand: (1) the total survey of AIDS prevention service 7 beneficiaries.92.1% 1204 general residents and 89.9% of young people in schools think it is necessary to take The publicity and education of AIDS related; 92.6% of the population, 93.2% of the 91.7% prostitutes, drug addicts, and 100% men with 96.1% HIV / AIDS patients need to accept AIDS prevention service. (2) the degree of demand for AIDS prevention and control services for each type of crowd is different. The floating population for AIDS prevention service the needs of the top three are: "education" (87.3%), "AIDS consultation" (27.3%), "AIDS test" (23.3%); prostitutes: "education" (59.6%), "condom" (38.2%) and "STD" (37.5%); drug users is: "AIDS test" (54.9%), "methadone" (44.4%) and "AIDS counseling" (34%); gay crowd: "education" (59.2%), "AIDS test" (57.1%) and "AIDS consultation" (45.6%) (3) of all types of people. For Anti AI acceptance services: all types of people are well accepted for disease prevention and control institutions, and for other services selection is different. In addition to prevention and control institutions, the floating population (56%), female sex workers (46.3%) and HIV / AIDS patients (41.6%) were more likely to choose the community health service center or township hospitals, drug users are more likely to choose a set of methadone replacement therapy (46.5% points), community health service centers and township hospitals to become drug addicts in third (43.8%), men are more likely to choose social organizations (55.1%). (2) the status quo of grassroots AIDS control service of typical areas: the survey found that at the grassroots level to carry out AIDS prevention service of the main categories of publicity and education, AIDS counseling and rapid detection of AIDS virus infection and intervention of high-risk persons / patients Follow up management, with the specific content of the work. The incentives and the grassroots AIDS prevention service funds, performance appraisal methods and basic public health service project assessment. (3) construction of grassroots AIDS prevention service specification: at the beginning of construction, to determine the basic principles of constructing the legal norms. Reasonable, scientific and practical. Based on the previous data and investigation, on the basis of the existing norms, publicity and education to build grass-roots AIDS service specification includes epidemic report, and AIDS counseling and rapid detection, CSWS interventions, 5 aspects of HIV / AIDS patient follow-up management, clear prevention services AI for grass-roots community health service centers and township hospital. (4) the grassroots AIDS prevention service specification expert review: after expert review of each dimension, for the development of the initial base Comprehensive evaluation of AIDS prevention and control layer service specifications is 90.6. 6 dimensions of the review analysis, scope and purpose of the standard score is 92 points, related to the interests of people of 94 points, writing the rigor of 91 points, 90.7 points clear of the show, authority and scientific good. Conclusion: the study of the construction of grassroots AIDS prevention service specification is referring to the related literature content, is constructed according to certain scientific steps. This research is to fully absorb the AIDS prevention and control of the demands of clients, but also from the grassroots AIDS prevention service experience in typical areas, on the basis of the basic level AIDS prevention and control services. At the same time referring to some of our existing service files and programs, the construction of China's grassroots AIDS prevention service specification. By the relevant experts, the "standard" has better It is scientific, authoritative and applicable.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.91

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