云南省19个县针具交换服务模式及成本分析

目的分析针具交换的服务模式,测算针具交换的成本及效果,为推动未来资源的优化配置提供参考。方法对针具交换管理及工作人员、同伴教育员及部分注射吸毒人员进行定性访谈,了解针具交换的服务模式;利用调查问卷收集针具交换的成本和效果,利用艾滋病防治资源需求与效果分析（NEAR）系统测算针具交换避免注射吸毒人群感染HIV的例数,来估算成本效果比。结果针具交换活动主要以针具交换中心、同伴教育员、诊所和药店4种方式进行。2008-2011年,每分发1支针具的成本为5.59元,每干预1名注射吸毒人员的成本为803.79元,且单位成本随着分发的针具和干预的吸毒人员数量增加而呈逐渐下降。2008-2011年,19个县投入针具交换的费用为18 504 792元,避免了1 097名感染者,每避免1名感染者的成本为16 869元,通过开展针具交换避免的损失合计为308 458 848元,与开展针具交换的投入相比可得针具交换的成本效益比为16.7。结论针具交换具备成本效益价值,针具交换的各种服务模式各有优缺点,在实际工作中应相互结合。

An analysis of service model and cost of needle and syringe exchange in 19 counties of Yunnan

Objective To analyze the service model of needle and syringe exchange program（NSP）and estimate the related cost and benefit,and to provide evidence for future resource allocation.Methods Qualitative interviews were conducted among management staff,peer educators and injection drug users（IDUs） in relation with NSP and a questionnaire was used to collect the information about its cost,effectiveness and benefit.The system of resource need and effectiveness analysis for AIDS response（NEAR） model was used to calculate the cases averted by NSP.Results NSP was implemented mainly in NSP centers,clinics and pharmacies,as well as by peer educators.Between 2008 and 2011,the cost per syringe was 5.59 yuan,and the intervention cost per IDU was 803.79 yuan.The unit cost decreased gradually with the rising number of needle distributed and IDUs receiving intervention.From 2008 to 2011,expenditure for NSP was 18 504 792 yuan totally,and 1 097 new HIV infections were avoided,and the cost per avoided HIV infection among IDUs through NSP was 16 869 yuan.Totally 308 458 848 yuan of HIV/AIDS related expenditure were saved by NSP,and the cost benefit ratio was 16.7.Conclusion NSP is of good cost-benefit and different models have different advantages and disadvantages which should be used in combination.