武汉市医务人员对主动开展艾滋病检测咨询工作的认知及态度北大核心CSCD

医疗机构是发现艾滋病病毒（HIV）感染者和艾滋病病人的重要窗口,是参与艾滋病防治的重要阵地[1]。医务人员主动开展艾滋病检测咨询服务（Provider initiated HIV testing and counseling,PITC）,是由医务工作人员主动提出对就诊者进行HIV检测咨询,帮助咨询者做出决定,并提供HIV感染状况的医疗服务信息＂[2]。武汉市于2015年在全市推行PITC工作。     

武汉市医务人员对主动开展艾滋病检测咨询工作的认知及态度

正医疗机构是发现艾滋病病毒(HIV)感染者和艾滋病病人的重要窗口,是参与艾滋病防治的重要阵地~([1])。医务人员主动开展艾滋病检测咨询服务(Provider initiated HIV testing and counseling,PITC),是由医务工作人员主动提出对就诊者进行HIV检测咨询,帮助咨询者做出决定,并提供HIV感染状况的医疗服务信息"~([2])。武汉市于2015年在全市推行PITC工作。本     

在性病专科门诊开展医务人员主动提供HIV咨询检测服务情况分析

2007年世界卫生组织基于高危人群自愿寻求艾滋病病毒(Human immunodeficiency virus,HIV)咨询检测意愿低的情况,提出了对HIV高危人群实施由医务人员主动提供HIV咨询检测(Provider-initia-ted HIV testing and counseling,PITC)的策略。从2008年12月起,南京市皮肤病性病专科医院以艾滋病自愿咨询检测服务为依托,在性病门诊开展了PITC工作,取得了较好的效果,现报告如下。     

综合性医院扩大HIV检测咨询服务模式运行与实施

艾滋病病毒（Human immunodeficiency virus,HIV）检测是发现HIV感染者的唯一手段,如何扩大HIV检测成为艾滋病防治面临的难题。医疗机构是发现感染者和病人的重要窗口,为扩大HIV咨询检测面,世界卫生组织（World Health Organization,WHO）和联合国艾滋病规划署在艾滋病自愿咨询检测（Voluntary counseling and testing,VCT）的基础上,提出了医务人员主动提供HIV咨询检测（Pro-vider-initiated HIV testing and counseling,PITC）策略。广州军区武汉总医院作为武汉市首批“综合性医院扩大HIV咨询检测综合服务模式试点项目”试点单位,2012年6月1日至12月30日,选取广州军区武汉总医院皮肤性病科、泌尿外科、呼吸内科等12个科室开展PITC项目试点,进行了有益尝试,取得良好效果。     

基层医疗机构开展医务人员主动提供艾滋病检测咨询服务工作模式探讨

目的在基层医疗机构开展医务人员主动提供艾滋病自愿检测咨询(PITC)工作,探索其工作模式。方法采用明确组织分工,建设工作网络,开展人员培训,规范实验室操作,严格工作流程,完善信息报送,管理检测试剂等措施,探讨开展PITC的模式。结果建立了以县防治艾滋病工作委员会办公室为领导,以县疾病预防控制中心及县妇幼保健院为技术指导,以基层医疗机构为实施单位的工作网络,共建立HIV检测点5个、快速检测点25个,对免疫缺陷者、孕产妇等六类人群共26 034人开展了PITC服务,27人确认为HIV阳性。结论总结出了在基层医疗机构开展PITC的具体工作流程,初步探索出在基层医疗机构开展PITC的工作模式。     

北京市2012年医疗机构主动提供艾滋病检测咨询情况

目的分析医疗机构主动提供艾滋病检测咨询(PITC)的情况,了解PITC实施的可行性和医疗机构重点科室的检测率及阳性率,为制定北京市艾滋病防治策略提供依据。方法在北京市所有二级及以上医院的重点科室均开展PITC,并且每季度收集按照科室来源填报的季度报表,运用SPSS 13.0进行描述性分析、卡方检验等。结果 PITC实施以后,医务人员主动提供艾滋病病毒(HIV)检测的科室的HIV检测率由高到低依次为:住院部47.04%、男科16.28%、产科11.36%、皮肤性病科8.89%、妇科7.39%、肛肠科7.15%、其他科室6.11%、泌尿科5.98%、透析科5.62%和感染科4.09%。HIV阳性检出率由高到低依次为:皮肤性病科5.11‰、男科4.14‰、其他科室1.85‰、感染科1.31‰、肛肠科1.09‰、泌尿科0.48‰、住院部0.45‰、透析科0.10‰、妇科0.07‰、产科0.07‰。三级医院除感染科外,其余各重点科室的HIV检测率均高于二级医院,差异有统计学意义(P0.01);三级医疗机构皮肤性病科、男科、产科、透析科、感染科和其他科室的HIV检测阳性率高于二级医院;泌尿科、肛肠科、住院部的检测阳性率低于二级医院,差异有统计学意义(P0.001)。结论医疗机构开展PITC,有助于HIV扩大检测工作的开展,是艾滋病防治的一项有效策略。     

男性性病诊疗服务体系的完善及规范化服务

目的通过完善男男性行为人群（MSM）的性病诊疗服务体系,促进男性性病诊疗服务的规范化。方法完善MSM的性病转介体系和性病服务内容,形成性病、艾滋病检测阳性者的服务机构、组织之间的顺畅转介关系,开展医务人员主动提供艾滋病病毒（HIV）检测咨询（PITC）促进。对服务日志进行统计并分析。结果自2011年4月至10月15日期间,MSM社区组织向性病门诊转介疑似性病患者156例;HIV感染者组织转介的性病患者诊治17例;性病门诊求诊者中453人接受了PITC服务,完成转介初筛HIV阳性25例。性病转介诊疗服务满意度和HIV阳性转介咨询服务满意度均很高。结论社区组织和医疗机构的合作是促进规范化性病服务的重要策略,医疗机构与成熟的社区组织开展进一步实质性合作可以促进服务质量提高。     

以社区为基础发现和管理HIV感染者/AIDS病人的模式

目的以社区为基础开展艾滋病自愿咨询检测（VCT）/医务人员主动提供HIV检测咨询服务（PITC）,建立有效发现和管理艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（PLWHA）的模式。方法采用定性调查方法,主要是个人访谈和专题小组讨论。结果对湖北省十堰市和襄樊市医疗卫生服务机构人员11人进行单独访谈,并以城市为单位组织了两次小组访谈,十堰组5人,襄樊组6人。以社区开展VCT/PITC服务既有优势又存在可克服的困难。结论以社区开展VCT/PITC服务是切实可行的,其有利于提高VCT/PITC服务的可及性及利用率,达到有效发现和管理感染者/病人的目的。     

医疗机构医务人员提供艾滋病检测咨询试点工作经验初探

目的通过医疗机构医务人员提供检测咨询（PITC）试点工作,了解PITC工作在中国的可行性,探讨PITC工作中存在的问题及解决办法,为制定PITC相关政策提供依据。方法选择广东省番禺市、山东省济南市、辽宁省沈阳市作为PITC试点城市,共选择3个城市中的5家医疗机构为试点,收集试点工作报表、季度工作总结、督导报告和访谈结果等资料进行分析。结果医务人员推荐艾滋病病毒（HIV）检测率,由高到低依次为：婚检门诊（99.5%）、妇科门诊（14.5%）、肺结核科门诊（12.9%）、产科门诊（11.4%）和皮肤性病门诊（5.2%）;就诊者接受HIV检测率由高到低依次为：婚检门诊（99.5%）、肺结核科门诊（85.9%）、性病门诊（65.3%）、产科门诊（44.0%）及妇科门诊（17.4%）;HIV阳性检出率在前三位的科室为：皮肤性病科（0.4%）、肺结核科（0.2%）和婚检室（0.1%）。一部分人不愿意接受HIV检测,主要是检测费用过高。结论开展PITC工作具有可行性,政策支持、医务人员的认识、宣传、检测费用等因素,对PITC工作的开展起重要作用。     

我国医疗机构医务人员提供艾滋病检测服务现况调研

目的 了解近年来我国医疗机构医务人员提供艾滋病检测咨询（PITC）服务现况,收集存在的问题和建议。方法 采用目的抽样的方法,对我国6个省/直辖市PITC开展情况进行调研。采用专题小组访谈或个人访谈的方式进行资料收集,调研对象为疾病预防控制机构（简称疾控机构）和医疗机构中负责/参与PITC工作的人员。采用主题分析法对访谈资料进行整理、编码、主题归类和分析。结果 共调研6个省/直辖市中疾控机构19家,医疗机构16家;召开疾控机构专题小组访谈19次,医疗机构专题小组访谈15次,个人访谈3次;疾控机构共访谈74名工作人员,医疗机构共访谈60名工作人员。调研地区均高度重视PITC工作,逐步出台并完善相关政策,不断推进PITC工作的开展。但由于国家层面缺乏PITC政策支持,各地PITC工作进展不一;且普遍存在PITC培训不足,医务人员开展PITC工作能力不足;宣传力度不够,就诊者检测意识薄弱等问题。结论 PITC在扩大检测方面占主体地位,应尽快出台政策文件,规范PITC工作的开展,充分发挥医疗机构扩大检测的作用。     

湖北省2008-2010年VCT情况分析

目的分析湖北省2008-2010年艾滋病自愿咨询检测(VCT)情况,为制定艾滋病防治对策提供依据。方法对2008-2010年全省VCT门诊求询者的基本信息、艾滋病病毒(HIV)抗体检测情况及各类VCT门诊工作状况进行统计分析。结果 2008-2010年,到全省各级VCT门诊接受咨询检测的人数共计163 634人,男女性别比为1.34∶1;求询者以20～39岁青壮年为主,占73.48%;求询者类型以有非婚异性性行为史为主,且其构成比逐年上升。96.76%的求询者接受了HIV抗体筛查检测,筛查阳性率以配偶/固定性伴HIV抗体阳性者和有男男性行为史者两类人群为高,分别为8.52%和5.97%,与其他类型人群之间存在显著性差异。2008～2010年,各级医疗机构设立的VCT门诊数占VCT门诊总数的比例分别为64.86%、64.71%和70.06%,其咨询检测人数占VCT总人数的比例分别为39.59%、41.98%和47.55%。结论应进一步加强对配偶/固定性伴阳性和有男男性行为史人群的早期发现和干预工作,减少二代传播;同时应加快推进医疗机构医务人员主动提供的艾滋病检测咨询服务,充分发挥医疗机构的优势和作用。     

HIV/AIDS Stigma: Reliability and Validity of a New Measurement Instrument in Chennai, India

HIV/AIDS stigma is a frequently cited barrier to HIV prevention, including voluntary counseling and testing. A reliable and valid measurement instrument is critical to empirically assess the extent and effects of HIV/AIDS stigma. The paper reports the development and psychometric testing of an HIV/AIDS stigma scale among 200 men in India. The resulting 24-item scale and the four subscales had good internal consistency (Cronbach's alpha overall was 0.81; subscales were 0.86, 0.73, 0.72 and 0.76, respectively). The scale and distinct subscales suggest a valid and reliable measure for HIV/AIDS stigma in a setting with highly prevalent HIV risk behaviors.     

Effect of an HIV counseling and testing program on AIDS-related knowledge and practices in tuberculosis clinics in Abidjan, C?te d'Ivoire.

SETTING: Two out-patient tuberculosis treatment centers, Abidjan, C?te d'Ivoire. OBJECTIVE: To assess the effect of a human immunodeficiency virus (HIV) counseling and testing program on acquired immune-deficiency syndrome (AIDS) related knowledge and behaviors among persons with newly diagnosed tuberculosis. DESIGN: Since 1994, patients with newly diagnosed tuberculosis have received individual or group HIV pretest counseling, informed consent, free HIV testing for those who consent, and post test counseling. From January 1995 through August 1996 in Abidjan's two largest tuberculosis clinics, knowledge and beliefs about HIV/AIDS were assessed before and immediately after the group pretest sessions, and again 4 months later. RESULTS: Prior to pretest counseling, 68.9% and 68.0% of the 559 enrolled subjects could correctly identify five modes of HIV transmission and five modes of HIV prevention. These proportions increased significantly immediately after pretest counseling (90.0%, 86.6%, respectively), and remained higher 4 months later (83.7%, 87.7%) (all P < 0.01). Among men, consistent condom use during the preceding 4 months with a partner who was not a commercial sex worker increased from 9.9% at enrollment to 23.6% at the 4-month visit (P = 0.001), but not for women (6.3% vs. 9.5%, P = 0.40). CONCLUSIONS: An HIV pretest counseling program conducted in an out-patient tuberculosis clinic was well accepted, and significantly increased the level of HIV/AIDS knowledge and, among men, self-reported condom use.     

Adapting an evidence-based intervention for HIV to avail access to testing and risk-reduction counseling for female victims of sexual violence in post-earthquake Haiti

Haiti has the highest prevalence of HIV/AIDS in the Caribbean. Before the 2010 earthquake, Haitian women bore a disproportionate burden of HIV/AIDS, had lower HIV knowledge, less capacity to negotiate for safer sex, and limited access to HIV testing and risk-reduction (RR) counseling. Since 2010, there has been an increase in sexual violence against women, characterized by deliberate vaginal injuries by non-intimate partners, increasing victims’ risk of sexually transmitted infections including HIV/AIDS. Needed is an adaptation of evidence-based interventions for HIV that include HIV testing and counseling for this stigmatized population. We reviewed several features of Centers for Disease Control and Prevention's 103 evidence-based interventions for HIV (e.g., measures used, participant risk characteristics, theoretical framework, outcome variables, and evidence tier) in an attempt to seek a feasibly adaptable evidence-based intervention for HIV that could be used for victims of sexual violence (VOSV). RESPECT, one of the reviewed evidence-based HIV interventions, comprises of one-on-one, client-focused HIV prevention/RR counseling, and RAPID HIV testing. Adapting RESPECT can enhance access to testing for Haitian VOSV and can influence their perceptions of HIV risk, and establishment of RR goals for future consensual intimate relations. Adapting and implementing RESPECT can increase uptake of evidence-based HIV interventions among Haitians and positively affect a region with high HIV prevalence and increased rates of sexual violence.     

HIV Voluntary Counseling and Testing Service Preferences in a Rural Malawi Population

Voluntary counseling and testing (VCT) services have become an integral component of HIV prevention efforts in sub-Saharan Africa. This study of a rural Malawi district population examined variation in past and desired use of VCT services among 868 women aged 15 to 34 and 648 men aged 20 to 44 aware of HIV/AIDS. Only 11% of men and 7% of women had been tested, but of those untested, 76% of men and 61% of women desired testing. Ninety percent of respondents willing to know their results preferred to hear them from a test site counselor and on the same day of the test. However, 27% of women wanting to be tested did not want to know their test results, a finding significantly associated with knowing someone affected by AIDS and perceiving oneself at HIV infection risk. Knowledge of the behaviors of HIV prevention, knowing someone with AIDS, knowing the locations of a test site, and perceived risk of HIV infection all had a consistently significant association with past and future VCT use for men and women.     

2007-2013年江油市HIV检测情况

目的了解江油市艾滋病病毒（HIV）检测现状,为制定艾滋病防治措施,评估检测策略提供科学依据。方法以＂中国疾病预防控制信息系统＂中,2007-2013年HIV检测数据和疫情报告数据为依据,采用SPSS 13.0统计软件进行分析。结果 2007-2013年江油市HIV检测量从2007年的26 642人次上升到2013年的157 417人次,平均增长率为29.70%,阳性检出数从2007年的9例上升到2013年的86例,平均增长率为29.76%,差异有统计学意义（χ2=15.99,P〈0.05）。综合医院的样本检测量和阳性检出数逐年增加,分别占总数的18.12%和52.23%。传播途径构成变化较大,异性性传播变化最为明显,同性性传播有所增加,吸毒途径传播呈下降趋势。结论继续做好自愿咨询检测（VCT）工作,大力提倡医务人员主动提供咨询检测（PITC）能及早发现HIV感染者和病人,从而降低HIV的传播流行。     

Use of and exposure to HIV prevention programs and services by persons at high risk for HIV

Although HIV information is widely available in this country, little is known about how commonly used HIV prevention activities reach persons at highest risk for HIV. In this paper, we describe the extent to which HIV prevention strategies reach a sample of high-risk persons and whether such exposure correlates with having been tested for HIV. Data are from the 2000 HIV Testing Survey, an anonymous interview study of men who have sex with men (MSM), injection drug users (IDU), and high-risk heterosexuals (HRH), recruited from appropriate venues in seven states and New York City. We report the proportion of persons exposed to three types of interventions: information (media messages, brochures), counseling or skills-building (group counseling, role play, calling an AIDS hotline), and prevention supplies (provision of condoms, bleach kits), stratified by HIV testing status (ever, never). Exposure to information interventions was high among 2491 respondents (85%-96%) and did not differ by testing status. Use of counseling or skills-building interventions varied by testing status for IDU (8% untested versus 41% tested, p < 0.01) and HRH (14% versus 20%, p = 0.03) but not MSM (15% versus 23%, p = 0.08). Among tested IDU, those receiving bleach kits were more likely to report consistent bleach use when injecting with nonsterile needles (25% versus 9%, p = 0.003). Exposure to HIV prevention information is high but exposure to counseling or skills-building interventions is less common and more prevalent among those previously tested. Prevention initiatives should focus on counseling and testing, skills-building, and prevention supplies.     

江西省艾滋病自愿咨询检测现状分析

目的更好地做好江西省艾滋病防治工作。方法采用描述性方法分析江西省艾滋病自愿咨询检测(VCT)现状。结果从事艾滋病咨询工作的专职人员较少。接受检测后咨询及转介服务人数占检测前咨询人数的比例分别为5.22%、1.39%。接受检测的人以20~29岁人数最多,其次30~39岁。萍乡、南昌市检测初筛阳性构成比较高,分别为39.13%、26.09%。结论建立健全VCT服务网络,提高咨询服务质量。广泛开展对目标人群的VCT服务宣传和外展活动,有效开展VCT服务,遏制艾滋病的传播。     

Effectiveness of HIV counseling services on knowledge, attitude, behavior and practice (KABP) among pregnant women attending PPTCT program

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score = 15.3) and post test (mean score = 35.6) (P < 0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individuals with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p < 0.0001). The condom use among the study participants significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p < 0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.     

南宁市邕宁区2008--2011年艾滋病自愿咨询检测结果分析

目的分析邕宁区艾滋病自愿咨询检测（VCT）工作开展情况,以了解艾滋病疫情的现状、分布特点和流行趋势,为艾滋病的防控工作提供依据。方法对2008-2011年到南宁市邕宁区疾病预防控制中心VCT门诊求询者的资料和HIV抗体检测结果进行分析。结果2008-2011年共检测求询者1165人,均为异性性传播;共检出艾滋病病毒（HIV）抗体阳性252人,总阳性率为21．63％;各年的阳性率分别为：13．36％、18．62％、31．07％、37．75％;≥50岁人群阳性率高于〈50岁的。求询者中以20～39岁人群为主,男女比例为1．5：1;求询原因以性行为为主（占53．73％）,其次是静脉吸毒（占44．38％）。结论异性性传播为邕宁区艾滋病的主要传播途径,要加强艾滋病防治知识和VCT工作的宣传,加强对重点人群的干预,防止艾滋病疫情的进一步蔓延。