| HIV/AIDS prevention and control are global challenges in public health filed. It requiresgreat teamwork and coordination from numbers of institutions and departments, as well asinternational communications, supportive policies, public participation and commitments ofresources etc. Supervision and evaluation is the major assessment for HIV/AIDS preventionand control. Although the specific works have been evaluated, in the way, financial input,resource allocation and commitments, and work efficiency were not considered. In this case,current evaluation is not a full-scale assessment. Synthetic evaluation methods may becomecompensate for the shortage of current assessment. And to apply the Synthetic evaluationmethods can optimize resource allocation and improve the quality of prevention and controlactivities.The study was based on HIV/AIDS spatiotemporal data from2006to2012funded byChina Global Fund AIDS Program. And the data has generally followed unified qualitycontrol standards, the synthetic evaluation results can be used in a full-scale, scientific,objective practical assessment. In addition, the similarity of major risk factors, or financialinputs and costs, or management, etc. in synthetic evaluation may lead its results to be appliedand extended in this field.The concept of system dynamics and modeling methods are helpful in exploring thelogical and quantitative relations between evaluation index, and constructing logical andquantitative models to optimize the strategy of HIV/AIDS prevention and control, which willbenefit the national condition in China. And it also provides strategic decision support for thecontinuity and sustainable development in long-term plan of HIV/AIDS prevention andcontrol, and promotes HIV/AIDS prevention and control works. Meanwhile, it expands dataanalysis methods in HIV/AIDS prevention and control and accumulates experiences forfurther study in this area. Methods of the study include qualitative analysis and quantitative analysis. Descriptivestatistics, literature review, Delphi method and analytic hierarchy process (AHP) were appliedfor the establishment of index system and weights. Synthetic evaluation model were using Z-Score method, Topsis (Technique for Order of Preference by Similarity to Ideal Solution),osculating value method、 rank sum ratio (RSR) and Efficacy Coefficient Method, etc.System dynamics (SD) model of Chongqing HIV/AIDS prevention and control wereestablished and stimulated by K-means, SD modeling methods, systematic thinking, expertconsultation, regression, statistical prediction, quantitative economic model, etc. Policyinterventions experiment and evaluation were conducted with systematic analysis、literatureinduction、expert consultation and SD model.The sources of information in this study include conventional statistical information,special survey and monograph literature and documents, e.g. China Global Fund AIDSProgram Data,2006-2009Chongqing Centre CDC and39local counties CDC data (basicdata, surveillance data and routine data),2006-2012annual questionnaire investigationChongqing MSM population HIV/AIDS infection,2006-2012annual questionnaireinvestigation in HIV/AIDS knowledge awareness, HIV/AIDS patient satisfaction survey, andreport of HIV/AIDS control and prevention data quality by National Centre for AIDS/STDprevention and control, China CDC. HIV/AIDS spatiotemporal data base was formed withthose sources.Major Results：1. After two-round specialists consulting, vitality of94%and85.7%respectively in1stand2ndround have shown the study has attracted attention from the experts who were advised.And they had upper ranks in professional field, more work experiences and higher educationbackground. Therefore, the consultation is reliable. Build up HIV/AIDS prevention andcontrol index system which has three levels, including input and output two indicators on the1st level, and evaluation in six aspects is on2ndlevel, e.g. organization support, preventionactivities, treatment activities prevention and control quality and satisfaction, and the3rdlevelincludes31indicators. After literature review, two-round consulting and panel discussion, thethree-level index system was detailed in definition and description.2. In the3rdround specialist consulting, the recovery rate and validity of inquiry formwere both100%. At1stlevel, authority coefficients in the input section were about83.33% above0.8and the rest were in between0.72and0.8, about91.7%in the output section wereabove0.8and the rest were in between0.73and0.8. It indicates that the selected consultantsin HIV/AIDS prevention field have a higher authority. The weights of1stlevel two indicatorsare0.4458and0.5542. The six indicators in2nd level were weighted0.0890,0.2096,0.1375,0.2844,0.1335and0.1460, respectively. The index system satisfied the requirements ofpassing Cronbach’s alpha reliability testing and factor analysis validity testing. It implies thedesign of index system has good internal consistency. And it performed well in indicatorsrepeated measurement.3. Collected data of the3rdlevel indicators from39counties in Chongqing between2005and2013, the results have shown the difference among seven synthetic evaluation methods.39counties were sorted according to evaluation method. The entire sorted W coefficients overseven years were in the range of0.5to0.7after Kendall’s test, it indicated that theconsistency is general among seven methods. For example, in2012, the consistency Wcoefficient are W=0.925(P=0.001) between Z-Score and osculating value methods, W=0.904(P=0.002) between Z-Score and Topsis, and W=0.993(P=0.000) between osculating valuemethod and Topsis, and W=0.921(P=0.000) among Z-Score, Osculating value and Topsismethods. And consistency values in all other pairwise comparison were about0.7. Eventually,thirty-nine counties were comprehensively re-ranked yearly by Z-Score, Osculating value andTopsis methods from2006to2012. On the top of rank list were better economic areas,conversely, those appeared at the lower place of the list for a few consecutive years weredeveloping areas and also were remote.4. Systematic thinking and analysis was applied in Chongqing HIV/AIDS prevention andcontrol synthetic evaluation system. In a macroscopic view, it has depicted the systemcausality. The system dynamics model was determined after a number of simulation runs andparameter modification, including a total of40variables and equations, and it has passedvalidity testing. Intervention experiments have conducted into each classified area, it took thesteps of raising HIV/AIDS prevention and control fund based on local economic level, by18%-20%in class I,30%in class II and10%in class III annually, increasing budget forpublicity and promoting condom usage in high-risk population, that has shown statisticalsignificance in growing public HIV/AIDS knowledge awareness, and reducing syphilisinfection and HIV/AIDS infection in both high-risk population and very certain of population. Policy recommendation：Chongqing HIV/AIDS prevention and control work should be based on government’sadvocacy and support, and be cooperated fully with some certain well trained HIV/AIDSprevention non-government organizations or groups. Government cast in the lead role of thehierarchy network which consists of Chongqing Municipal Health Bureau and ChongqingCDC, local county CDC and grass-roots health institutions. In aspect of policy interventions,Government’s leadership and responsibilities should be strengthened in two ways. The one ispersisting in continuing HIV/AIDS prevention and control policies, which are expanding thefinancial input into grass-roots health institutions and public health field, and increasing thebudget on publicity and high-risk population interventions; the other is keeping assessing thequality of HIV/AIDS prevention and control works dynamically and, adjusting andoptimizing the prevention and intervention measures timely. |
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