| ObjectiveThe objectives of the study are to survey the condition of health resources at township and village levels in high AIDS prevalence areas of Henan province and assess the health service capacity on AIDS prevention and treatment,to investigate the health status of HIV-infected people,the demand and utilization of health services,evaluate the function and role of the health institution in AIDS prevention and treatment in rural areas, investigate the situation of AIDS prevention and treatment activities and HIV infection rates,morbidity,mortality and evaluate the effects of AIDS prevention and treatment.This study also surveys HIV-infected people’s satisfaction level and responsive judgment on health institution and,assesses the effectiveness of health services in order to explore the mode of medical treatment and analyze the problem of this mode,and then make policy recommendations for the next stage of AIDS in rural areas.MethodIn this study,literature search,spot investigation,descriptive analyses are used to analyze the situation of health care institutions and medical treatment of AIDS in the rural areas.In this investigation,the researcher selected two representative areas of high prevalence of AIDS,Shangcai and Sui County.Cluster sampling and the stratified random sampling are used in this spot investigation.The objects includes 47 township hospitals,84 village clinics,131 medical staffs from township and village,720 HIV-infected people,726 healthy people.SPSS15.0 was applied to analyze the data;x2 test,non-parametric hypothesis testing,and fuzzy comprehensive evaluation method are used for statistical analysis. Results1.AIDS Prevention and treatment mode in rural areas:"the three-level network" mode has been formed,and the appointed health institutions of AIDS have covered the 13 provincial cities with more serious epidemic.Currently,the province had 577 appointed health institutions at the township level,253 at village level.This investigation includes 23 designated rural hospitals and 51 designated village clinics.2.Health status of HIV-infection people and effect factors:The vast majority of HIV-infected people are in onset period,88.2%of patients have symptoms.The rate of opportunistic infections is 57.1%and,the main factors affecting the health HIV-infected people are the upper respiratory tract infection and diarrhea.3.The needs for Health services and the utility of them on behalf of HIV-infection people are much greater than those of the general population.Their two-week morbidity rate is 45.2%;the general population’s rate is 13.5%.Their rate of going to hospital every two weeks and the average number of visits are 46.7%and 5.0±3.9 times respectively;for the general population,the figures are 12.1%and 3.2±2.9.In the selection of medical institution,HIV-infection patients are more likely to go to the basic health service institutions,91.3%of them choose township hospitals and village clinics.The results show that the patients’ choices of health institutions in the two counties are different.In Shangcai County,91.7%of the patients choose village health clinic while in Sui County two-third of them choose township hospital an one-third of them the village clinic.4.Distribution of qualified AIDS health Service institutions:The results show that nine county-level medical institutions could carry out HIV counseling and testing and preliminary screening in the two counties;each of them has a health institution which could carry out CD4 cell detection.The number of designated township hospitals for the control of HIV/AIDS has accounted for 48.9%of all the hospitals and all of them are located in 23 township hospitals in two counties.The 51 designated village clinics has accounted for 4.5%of all the clinics which are distributed in 10 AIDS-concentrated townships.5.Health resources allocation:①Number of sickbeds and medical equipment:In the two counties’ hospitals,the number of sickbeds for every 1000 people of Rural Population is 0.4 in Shangcai,0.8 in Sui County.In the appointed institutions of AIDS,average number of beds,Equipment worth(ten thousand Yuan) and medical equipment which is worth more than one thousand Yuan,were 25,21.4 and 13 respectively.In non-appointed health institutions,they were 28.5,30.2 and 11.4.②The number of personnel:the medical personnel of the appointed health institution of AIDS account for 54.4%of all the medical personnel of all the township medical institutions;the medical professionals,account for 54.2%;in non-appointed health institution of AIDS,medical personnel account for 45.6%, the health professionals accounted for 45.8%.Number of medical personnel and the medical professionals for every 1000 people of Rural Population in Shangcai was 1.1 and 0.7;in Sui County was 1.0 and 0.7.③Educational level and qualifications:The numbers of medical personnel who have college education and the above only account for 12.5%and, 30.7%medical personnel are only with technical secondary education.In appointed township hospitals,the number of medical personnel who have secondary education and the above account for 67.4%.The figure is 71.6%in non-appointed health institution of AIDS.In sample village clinics,medical personnel with secondary education and the above account for 91.3%.The qualified physicians and rural physicians account for 41.8%,54.5% respectively.(4) Fund for AIDS prevention:the total amounts of fund of Shangcai County were 10 times larger than that of Sui County and the fund allocation is also different.In Shangcai most of the fund goes to the village clinics(60.6%) while in Sui County goes to rural hospitals(30.2%).6.Knowledge and Skills:80.3%of the medical professionals have a good knowledge of AIDS and the average score is 85.55 points,(85.55±8.31).What they know very well are the knowledge about the spread of AIDS and the knowledge on prevention.What they know less is the professional knowledge,such as the diagnosis and treatment of AIDS and occupational protection.Medical professionals in different institutions have different AIDS awareness rates:the rate of township hospitals is higher than that of rural clinics;the rate of appointed health institution of AIDS is higher than that of non-appointed health institution of AIDS;Shangcai County has a higher rate than Sui County.7.Evaluation on activities of prevention and treatment:the HIV-infected people who have taken antiretroviral treatment account for 82.3%;accepted anti-opportunistic infection rate is 100%.The percentage of HIV-positive pregnant women who has taken an integrated intervention is 97.2%.All HIV-positive pregnant women who are in delivery have taken the anti-viral drugs.81.9%of them have received follow-up interview service.63.8% HIV-infected people can timely get condoms,99.3%of their newly-born infants have received the follow-up services and the artificial feeding rate among the infant is 94.4%.8.Evaluation on effect of AIDS prevention and treatment,data show that the number of HIV-infected people in the two counties has dropped from 162 and 3569 in 2004 down to 102 and 210 in 2007.In 2003,2004 and 2007 the total HIV infection rate of the entire population of the two counties was 0.13%,0.31%and 0.37%.By 2007,the two counties had totally 352 HIV-positive pregnant women who gave birth to 283 infants of whom only three infants are with HIV when 18-month-old,the ratio of mother-to-child transmission was 0.85%;AIDS mortality has dropped from 5.2%in 2004 down to 3.0%in 2007.9.Evaluation on responsiveness and satisfaction of medical institutions:scores given by the HIV-infected people to the responsiveness of the two kinds of medical services system,township hospitals and village clinics,are 62.96 and 64.6 which are between "very good" and "good".The scores by the general people are 53.54 and 56.28 which are between "good" and "common"。60.1 of HIV-infected people expressed their satisfaction with township hospitals and 70.2%expressed their satisfaction with village clinics.ConclusionsMode of AIDS medical treatment has been formed in rural areas with County-level AIDS hospitals and Centers for disease control and prevention as the leading part,township hospital as the hinge and village clinics as the basis.The two levels rural medical institutions,township and village,have made up the main body of AIDS medical treatment and the medical staff in rural areas are undertaking the main task of medical treatment. HIV-infected people have a greater medical need than the general people and different endemic areas have used medical services differently.The distribution of the appointed medical institution of AIDS was reasonable,and the institutions also have the capacity of basic medical services.The effectiveness of AIDS prevention and treatment in rural areas are significant and the HIV-infected people have expressed greater satisfaction with the responsiveness than the general population,but the service still has some room for improvement. Recommendations:the build-up of AIDS prevention and treatment institutions in rural areas can improve the capacity of medical treatment.Through the training of medical professionals we can enhance their skills of treatment.By strengthening medical education and behavioral interventions among the HIV-infected people we can enhance condom use among them and reduce the risk of sexually transmitted AIDS.By establishing a scientific evaluation system for AIDS prevention and treatment and giving an objective assessment on the capacity and effectiveness of implementation,we can discover and solve problems, and improve the utilization of anti-AIDS resources and efficiency of prevention and treatment. |
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