本文選題：自愿咨詢檢測(cè) + 高危人群��； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的：從衛(wèi)生服務(wù)利用方、衛(wèi)生服務(wù)提供方以及衛(wèi)生服務(wù)的成本效果三個(gè)角度,全面評(píng)估長沙市免費(fèi)艾滋病自愿咨詢檢測(cè)服務(wù)(Voluntary Counseling and Testing, VCT)的工作現(xiàn)狀及其主要影響因素,為更有效地利用艾滋病自愿咨詢檢測(cè)服務(wù)、降低艾滋病病毒(Human Immunodeficiency Virus, HIV)感染率、有效防治艾滋病提供參考資料。 方法：以長沙市作為研究現(xiàn)場(chǎng),①通過方便抽樣選取200名HIR感染高危人群作為自愿咨詢檢測(cè)服務(wù)利用方樣本,分別為美沙酮門診靜脈吸毒者、門診性傳播疾病患者、娛樂服務(wù)場(chǎng)所女性性服務(wù)工作者和高校男男性行為者各50名,采用自編“一般情況調(diào)查問卷”、“艾滋病相關(guān)知識(shí)問卷”、“艾滋病自愿咨詢檢測(cè)利用情況調(diào)查問卷”以及標(biāo)準(zhǔn)化“情緒問題量表”調(diào)查了解四類HIV感染高危人群利用自愿咨詢檢測(cè)服務(wù)情況及其相關(guān)影響因素；②將長沙市提供免費(fèi)艾滋病自愿咨詢檢測(cè)服務(wù)的專業(yè)工作人員作為衛(wèi)生服務(wù)提供方樣本,采用自編一般情況調(diào)查問卷了解其基本人口學(xué)特征,采用標(biāo)準(zhǔn)化明尼蘇達(dá)工作滿意度問卷(短式量表)和醫(yī)務(wù)人員艾滋病歧視量表對(duì)VCT專業(yè)工作人員的工作滿意和艾滋病歧視態(tài)度進(jìn)行調(diào)查,并與CDC其他專業(yè)工作人員進(jìn)行比較；③利用長沙市疾病預(yù)防控制機(jī)構(gòu)工作報(bào)表中的數(shù)據(jù)資料,對(duì)全市所有開展免費(fèi)艾滋病咨詢檢測(cè)服務(wù)的10所門診,在2008～2013年期間所提供的檢測(cè)服務(wù)進(jìn)行成本效果分析。 結(jié)果：①四類HIV感染高危人群樣本中,VCT服務(wù)的總利用率為38.5%(77/200),VCT服務(wù)的總知曉率為36.5%(73/200)。樣本中高校男男性行為樣本VCT服務(wù)利用率和知曉率最高,分別為68.0%(34/50)和60.0%(30/50),最低的為娛樂服務(wù)場(chǎng)所女性性服務(wù)工作者樣本分別為10.0%(5/50)和8.0%(4/50)。70.0%的樣本(140/200)艾滋病相關(guān)知識(shí)知曉率高(≥12分)。在調(diào)查未利用VCT服務(wù)的原因中,129人(64.5%)報(bào)告為“認(rèn)為自己不會(huì)感染”。調(diào)查樣本中,抑郁癥狀陽性率(PHQ-9≥10分)為39%(78/200),焦慮癥狀陽性率(GAD-7≥10分)為48.5%(97/200)。與未利用過VCT服務(wù)的樣本組比較,曾利用過VCT服務(wù)組的艾滋病相關(guān)知識(shí)得分高(χ2=14.723,P0.01)、有陽性抑郁癥狀(χ2=10.628,P0.01)和有陽性焦慮癥狀者(χ2=15.764,P0.01)的比例更高。多因素logistic分析顯示,四類HIV感染高危人群樣本利用VCT服務(wù)的影響因素為：有穩(wěn)定婚姻狀況(OR=2.320,95%CI:1.061～5.067)、性取向?yàn)橥?OR=0.379,95%CI:0.164～0.871)和艾滋病相關(guān)知識(shí)知曉率高(OR=2.342,95%CI:1.072～5.116)的樣本更可能利用VCT服務(wù)。②長沙市區(qū)范圍內(nèi),共有22名提供VCT服務(wù)的專業(yè)工作人員,專業(yè)工作人員的明尼蘇達(dá)工作滿意度總分為76.1分,處于“一般滿意”水平,與其他專業(yè)工作人員的滿意度得分無差異(χ2=3.513,P0.05)；“醫(yī)務(wù)人員艾滋病歧視量表”的總分為39.6分,處于“中等歧視”水平,VCT服務(wù)專業(yè)工作人員對(duì)待AIDS歧視低于其他業(yè)務(wù)科室工作人員,差異有統(tǒng)計(jì)學(xué)意義(χ2=7.183,P0.05)。③10個(gè)免費(fèi)VCT門診每百萬人口的平均配置密度為1.51個(gè),2008年至2013年成本投入從69.70萬元上升到95.37萬元。VCT服務(wù)例均檢測(cè)成本由2008年125.5元上升到2010年197.8元,再下降到2013年的143.4元；完整VCT服務(wù)成本由2008年126.2元上升到2010年198.3元,再下降到2013年的145.1元：陽性檢測(cè)成本由2008年43562.5元下降到2013年8082.2元。 結(jié)論：①被調(diào)查的四類HIV感染高危人群樣本VCT服務(wù)知曉率和利用率低,分別為36.5%和38.5%；其中高校男男性行為者樣本的知曉率和利用率均為最高,娛樂場(chǎng)所女性性工作者樣本均列最低。有穩(wěn)定的婚姻狀況、性取向?yàn)橥院桶滩∠嚓P(guān)知識(shí)知曉率高更可能利用VCT服務(wù)。②提供VCT服務(wù)專業(yè)工作人員工作滿意度總體處于“一般滿意”水平,對(duì)AIDS歧視態(tài)度處于中等水平,VCT服務(wù)專業(yè)工作人員對(duì)待AIDS歧視低于其他業(yè)務(wù)科室工作人員。③10個(gè)免費(fèi)VCT門診2008年至2013年的例均檢測(cè)成本、完整VCT服務(wù)例均成本呈現(xiàn)先上升后下降逐漸趨于平穩(wěn)的趨勢(shì),發(fā)現(xiàn)并確認(rèn)陽性檢測(cè)成本基本呈現(xiàn)下降趨勢(shì)。
[Abstract]:Objective: To evaluate the status of the free AIDS voluntary counseling and testing service (Voluntary Counseling and Testing, VCT) and its main influencing factors from the three angles of health service utilization, health service providers and the cost effect of health services, in order to make more effective use of AIDS voluntary counseling and testing services and reduce the effective use of AIDS. Human Immunodeficiency Virus (HIV) infection rate, effective prevention and treatment of AIDS to provide reference materials.
Methods: taking Changsha as the research site, 200 high risk population of HIR infection were selected as voluntary counseling and testing services by convenient sampling, which were divided into 50 cases of methadone outpatient drug addicts, outpatient sexually transmitted diseases, female sex service workers in entertainment services and male male actors in Colleges and universities. "General situation questionnaire", "AIDS related knowledge questionnaire", "AIDS voluntary counseling and testing utilization questionnaire" and standardized "emotional problem scale" survey to understand the use of voluntary counseling and testing services of four types of high-risk groups of HIV infection and related factors; (2) to provide free AIDS in Changsha City The professional staff of voluntary counseling and testing service, as a sample of health service providers, use the self-made general situation questionnaire to understand their basic demographic characteristics, and adopt the standardized Minnesota job satisfaction questionnaire (short scale scale) and the AIDS discrimination scale of medical staff to the work satisfaction of VCT professional staff and AIDS disproportionate. Investigate the attitude and compare with other professional staff of CDC. (3) using data from the report of the Changsha disease prevention and control agency, 10 outpatients of all free AIDS counseling and testing services in the city were used to analyze the cost effectiveness of the inspection services provided during the 2008~2013 year period.
Results: (1) the total utilization rate of VCT service was 38.5% (77/200), and the total awareness rate of VCT service was 36.5% (73/200) in the samples of four types of high risk people with high risk of HIV infection. The highest utilization rate and awareness rate of VCT service in the samples of male male behavior in Colleges and universities were 68% (34/50) and 60% (30/50) respectively, and the lowest was the female sex service workers in the entertainment service place. The awareness rate of AIDS related knowledge of 10% (5/50) and 8% (4/50).70.0% (140/200) was higher (> 12). Among the reasons for unused VCT service, 129 people (64.5%) reported that they were "not infected". The positive rate of depressive symptoms (PHQ-9 > 10) was 39% (78/200), and the positive rate of anxiety (GAD-7 > 10) was found in the survey samples. ) for 48.5% (97/200). Compared with the sample group that had not used VCT services, Zeng had a higher score on AIDS related knowledge in the VCT service group (x 2=14.723, P0.01), with positive depressive symptoms (chi 2=10.628, P0.01) and those with positive anxiety symptoms (chi 2=15.764, P0.01) higher than that of the cases. Multifactor logistic analysis showed that the four class HIV infection high risk population samples The factors affecting the use of VCT services are: stable marital status (OR=2.320,95%CI:1.061 to 5.067), sex orientation (OR=0.379,95%CI:0.164 ~ 0.871) and AIDS related knowledge (OR=2.342,95%CI:1.072 ~ 5.116) are more likely to use VCT services. (2) there are 22 professional VCT services in Changsha urban area The total score of job satisfaction of staff and professional staff in Minnesota was 76.1 points, at the level of "general satisfaction", and there was no difference from other professional staff (x 2=3.513, P0.05); the total score of "AIDS discrimination scale for medical staff" was 39.6 points, at the level of "medium discrimination", and VCT service professional workers. The discrimination against AIDS was lower than those of other business department staff, the difference was statistically significant (x 2=7.183, P0.05). (3) the average distribution density of 10 free VCT outpatients per million population was 1.51, and the cost input from 2008 to 2013 increased from 697 thousand yuan to 953 thousand and 700 yuan.VCT service and the cost increased from 125.5 yuan in 2008 to 197.8 in 2010. Yuan, then down to 143.4 yuan in 2013, the total cost of VCT services rose from 126.2 yuan in 2008 to 198.3 yuan in 2010 and then down to 145.1 yuan in 2013: the cost of positive detection decreased from 43562.5 yuan in 2008 to 8082.2 yuan in 2013.
Conclusion: (1) the awareness rate and utilization rate of VCT services in the four types of high-risk group of HIV infection were low, 36.5% and 38.5%, respectively. The rate of awareness and utilization of male male sex workers in Colleges and universities were the highest, and the sample of female sex workers in the entertainment places were the lowest. The knowledge awareness rate is more likely to use VCT services. (2) the job satisfaction of the VCT service professional staff is generally at the "general satisfaction" level, the AIDS discriminatory attitude is at the middle level, and the VCT service professionals treat AIDS discrimination lower than the other business department staff. (3) 10 free VCT outpatients from 2008 to 2013 In terms of testing cost, the cost of VCT service shows a trend of rising first and then decreasing steadily. It is found and confirmed that the cost of positive detection basically shows a downward trend.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.91

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