Evaluation Of Health Care Service Of Aids In The Village Clinics Of Henan Province

Up to now, Henan province has reported more than 48,000 HIV-positive infectors, and 34,000 of them are still alive. More HIV/AIDS survivors live in rural areas, of which 85% are in the southeast of Henan. And most of these areas are the State Poverty Counties or the Provincial Poverty Counties. Medical resources of these areas are relatively less, and base healthcare facilities are worse, medical service is relatively of low level. Due to the economic status and disease feature, HIV-positive infectors need to acquire handy, convenient and standard health care service in township hospitals especially in village clinics. We carried out questionnaires and interviews on AIDS knowledge among medical staffs in clinics of Henan rural areas in 2009.Objectives:To master the healthcare facilities distribution in HIV sentinel village clinics and whether they can satisfy HIV-positive infectors' treatment needs. To investigate the doctors' knowledge, attitude and needs toward AIDS, and asses the village clinic present situation on AIDS preventing and treating. To provide the basis for determining the AIDS medical aid work of the whole province for the Henan Health Administrative.Methods:Literature research, field surveys, interviews and other methods were adopted in this thesis. Questionnaire survey was conducted among doctors in 206 village clinics who attended the training in year 2007-2009. General survey was conducted in 206 HIV sentinel villages which undertake the task of treating HIV-positive infectors. Doctors in the clinics of AIDS sentinel villages were interviewed.Results:1. A total of 206 AIDS village clinics were surveyed, involving 8 provincially administered municipalities,14 counties (including cities and districts) and 73 townships.206 questionnaires were distributed and 206 questionnaires were taken back. All of them are valid. The response rate is 100%.2.206 medical staffs in village clinics were surveyed.162 staffs are male(78.64%), 44 staffs are female(21.36%); 84 persons are less than 30 years old (40.77%), 86 persons were between the age of 30 and 49 (41.75%),36 staffs are above 50 years old(17.48%), the youngest one was 24 years old, the oldest one was 68 years old, average 38.52 years old; 151 staffs (73.30%) were graduated from secondary technical school and below,53 staffs (25.73%) were graduated from junior college,2 staffs (0.97%) were graduated from college.174 staffs (84.46%,) were of primary title,31 staffs (15.05%) were of middle title,1 staff (0.49%) was of senior title.116 staffs (56.31%) were from township hospitals, 72 staffs (34.95%) were from local village clinic,18 staffs were from county hospitals and level above ones.14 staffs(6.80%) engaged in AIDS prevention work for less than 1 year,86 staffs(41.75%) engaged in AIDS prevention work for more than 1 year but less than 3 years,106 staffs(51.46%) engaged in AIDS prevention work for more than 3 years, average period is 2.8 years.3. General facilities for village clinic:the basic working conditions of 206 village health clinic designated AIDS village in Henan Province were as follows:office space should have diagnostic room, treatment room, observation room, a pharmacy, duty office and so on. Office furniture:medicine cabinets, diagnostic bed, telephone, bed; medical equipment; oxygen equipment, the sputum catcher, high pressure sterilization pot and so on.4. The awareness rate of basic AIDS knowledge is above 90%. Basic AIDS knowledge include seven aspects, such as three routes of AIDS transmission, the difference between HIV and AIDS, whether mosquito bites can transmit HIV, whether HIV can survive in vitro, the asymptomatic period of AIDS, whether HIV can be eliminated from infectors. The awareness rate of 21 questions about AIDS opportunistic infections and anti-HIV treatment is below 90%. The awareness rate of 6 questions about AIDS treatment policy is below 90%, the awareness of the policy of free treatment to rural patients is lowest at 32.5%.If we set 60 as the passing line, the average score is 72.8; staffs' score above 80 occupied 42.6%, and 7.7% of the staffs was unqualified. The average score of AIDS basic knowledge was 80.6, the average score of AIDS professional knowledge was 74.8, the average score of AIDS basic knowledge was 56.6. The results indicated that the difference between the scores of staffs of different gender, different age, and different title was of no significance (P>0.05); the score of staffs of different level of education was of significance (P<0.05).5.502 village clinic staffs were interviewed. The problem was focused on HIV/ AIDS awareness of AIDS patients of poor compliance due to the low awareness of HIV/AIDS; medical conditions were limited; village clinic staffs'salaries could not be ensured, they were seriously social discriminated. We should strengthen the support of AIDS knowledge propagation, give more medical technical support on AIDS and take more care about village clinic staffs.Conclusions:1. The quantity of respondents and the village clinics in this survey met the requirement of designed project.2. Training effects on AIDS prevention and treatment to AIDS sentinel-village clinic staffs were remarkable. Most of the medical staffs were young man between the age of 30 and 49 with primary title that graduated from secondary technical school.3. The main approach to acquire basic theories and clinical technics of AIDS for medical staffs in village clinic was to attend HIV/AIDS preventing and treating training class that were held by the Henan Health Administrative and its subordinates. They could correctly answer the questions about the infection route, preventive measures and general symptoms of AIDS. Unfortunately, they know less about professional knowledge about AIDS, how to deal with opportunistic infections, how to carry out standard virus treatment and how to deal with the adverse effects of anti-virus drugs. The awareness of AIDS treatment policy was relatively low. The main factors that affected anti-AIDS clinical work were the lack professional knowledge, poor compliance and awareness of AIDS among HIV-positive infectors, limited medical care facilities, and uninsured salary for medical personnel, and severe social discrimination.Suggestions:1. Continue to carry out practical, results-oriented training. All levels Health Administrative Departments should plan the training according to trainees' level, regular forms, highlighting the basic theory of AIDS and clinical skills training, to consolidate existing knowledge, delivering the latest progress in medical treatment, continue to improve the village medical treatment level.2. Strengthen health education and antiretroviral therapy education of AIDS to enhance the awareness of AIDS prevention and antiretroviral therapy's importance and necessity in patients, to improve the compliance of antiretroviral therapy and anti-opportunistic infections treatment.3. with cognitive ability and level of understanding the importance of antiretroviral therapy, the need for initiatives to improve compliance with anti-virus and anti-opportunistic infections treatment.4. Strengthen propaganda, reduce social discrimination.