Study Ofeffect Evaluation Of AIDS Intervention And Intervention Mode Based On Information-motivation-behavioural Skills Model Among MSM In Hubei

Background:Since 1981,the first AIDS Case reported by the United States,AIDS spread rapidly throughout the world.So far,AIDS became one of the major public health problems which cannot be ignored due to its popularity in many countries.Men who has sex with men(MSM)has been regarded as the high risk population and focus groups in the field of AIDS prevention because the population was hidden and has prevalence rate of rapid growth.At present,the primary AIDS prevention measures were high risk behaviors intervention aimed to MSM.This study aimed to evaluate the intervention effect among MSM from the perspective of MSM individuals(objective),intervention implementing agencies(subjective)and intervention mode.Then,we established AIDS intervention effect model based on this evaluation results.Objective:The aims of this study were:(1)Evaluation of intervention effect among MSM individuals.To assess effect on MSM through a series of indicators including AIDS knowledge,attitudes,behaviors and the acceptance of AIDS service.(2)Evaluation of intervention implementing agencies.To assess effect of intervention implementing agencies including government organizations and non-government organization(NGO)by SSM(3)Study of intervention mode.To clearly visual present the current intervention framework and mechanism in Hubei province through word frequencies analysis,mind manager based on qualitative interview of experts and leaders of primary NGOs and literature review.(4)Study of intervention model.Based on information-motivation-behavioral skills(IMB),we establish an intervention effect model which would support suggestions in formulation of intervention measures and plans,personnel training and effect evaluation of intervention measures implementation effect.Measures1.In the part of MSM individual effect evaluation,according to the different degree levels of MSM activities and familiarity of MSM,we recruitment MSM from different venues based on different study sites and we didn't control the sample size.Then the MSM met the entry criterion accepted rapid oral HIV test and questionnaire.We calculated the indicators of knowledge,behaviors and service acceptance and made evaluation about the outputs of the intervention on MSM.2.In the part of intervention implementing agencies,we first systematically reviewed the work records and materials of study sites in 2014.Then,based on SSM,we graded the ten sample agencies with an assessment form including 2 first class indicators,7 second class indicators and 16 third class indicators.Finally,we evaluated the work of agencies according to the scores rank.3.In the part of intervention mode,the experts and leaders in the field of AIDS intervention were interviewed by the project members.This interview focused on current intervention situation for MSM,existing problems and the future thoughts.The data analysis software Nvivo8.0 and Mind manager performed second class coding,semi quantitative analysis and visual analysis.Then we systematically combing the mechanism of current MSM intervention and the existing problems.4.In the part of intervention model establishment,the identified MSM accepted self-designed scale investigation including AIDS prevention information,motivation,behavioral skills and behaviors.Amos software performed structural equation model analysis and further analyzed model simulations and the relations among groups in IMB model.Results1.948 MSM form 10 sites of Hubei province enrolled in this study.Among them,740 participants accepted rapid oral HIV test and the HIV preliminary screening infection rate was 11.76%.The mean age of participants was 34.24±12.12 years and the participants were comprised mainly of young people(73.95%),unmarried people(60.13%)and mainly crowded in Wuhan city(60.86%).42.19%get college degree or above education.The participants were from gay-bar(36.71%),gay-bathroom(18.04%),park(11.29%),KTV(4.32%),CDC(14.77%)and other venues(14.87),respectively.After eliminating other interference factors,the MSM recruited from park got 3.539 times infection risk compared with MSM from gay-bar(95%CI:1.662-7.536;P<0.01).We have not discovered that HIV infection rate would be different due to different education,marital status,economic status,recruitment sites and self-identity.The AIDS knowledge investigation among MSM showed education,marital status,economic status,recruitment venues were protective factors(OR=0.685?OR=0.650?OR=0.884?OR=0.874).Age and HIV infection status were risk factors(OR=1.072?OR=1.269).The homosexual behavior investigation results showed that more than 60%of the respondents had anal sex with men in the last six months.There were a statistical difference between samples with Wuhan residence permits and samples without Wuhan residence permits(P<0.01;OR=1.04).Similarly,results a statistical difference was found in HIV infection and age in MSM(P<0.01;OR=2.18;P<0.01;OR=1.04).Heterosexual sex behaviors showed 21.63%in the past six months had heterosexual sex behaviors and only 37.45%among them used condoms.It's easier for MSM with old age to have high risk heterosexual sex behaviors-1.19 times the number compared with MSM with young age.Condoms Oil-based lubricants distribution were the most accepted AIDS service(72.05%,63.5%)and AIDS knowledge propaganda lectures was the least accepted AIDS service.2.Evaluation of effect on MSM intervention organizations.From the perspective of samples presented totality,the more developed the areas' economy,the better the effect of intervention organizations.The economic level and MSM active level was positively correlated with outputs of MSM intervention measures.On the one hand,government can provide an effective safeguard to organizations' assets which would give material guarantee in developed areas.On the other hand,the more active the MSM,the more number MSM of exposure;thus the more people covered,the higher the detection ratio.Then,a series of monitoring index of intervention effect can be effectively implemented.The areas with undeveloped economic level with small population base,by contrast,faced with various problems due to the lack of funds and population base.3.Qualitative interviews of staff in intervention institutions and visualization analysis found that the major institutions participating in intervention and prevention were NGOs(66.7%)and CDC(22.2%);Under the node of "problems" and "challenges",the top three most frequent diagnoses were prevention(38.9%),supervisor(14.8%)and infection(11.1%).The visual mind map of interview presented the current intervention mode in Hubei province for MSM was CDC in central city purchased social service organization and carried out outreach intervention relying on social organization;the intervention work in suburb focused on daily medication management of positive among MSM.The main challenges the current mode faced was:dialectical view for the intervention work of NGOs;criteria of intervention effect assessment of NGOs;HIV positive identity perception;high-risk behavior of the individual.4.IMB structural equation model found that variable information was interpreted by two indicators including prevention information and communication information and the normalization factor load were 0.2256 and 0.3786 respectively.Motivation variables were composed of HIV/AIDS prevention attitude,attitude toward the use of condoms,HIV/AIDS experience attitude and the attitude about whether infected with HIV.The standard factor loads of 7 measurement indicators of motivation variable were 0.7513,0.5085,0.4851,0.6917,0.6286 and 0.6042,respectively.Behavior skills consisted of usage of condoms,persuasion of using of condoms with partners,accessibility of condoms,condom use skills,refusing high-risk sexual behavior and self HIV testing(0.7513,0.5085,0.4851,0.6917,0.6286,and 0.6042).Prevention skill have one indicator-condoms usage(0.88).In the model,information had a direct impact on motivation,behavior skills and prevention behavior(0.17,0.37,and 0.46).Protection motivation has a direct effect on behavior skills and prevention behavior(0.38,0.17).Behavior skills have a direct effect on preventive behavior(0.75).Conclusions1.The intervention mode of government-leading and social organization widely participating for MSM has formed,in Hubei province and many results have been achieved among MSM presented by AIDS knowledge,homosexual behaviors,heterosexual sex behaviors and acceptation of AIDS service.However,there is significant difference in intervention outputs among groups with different characteristics.Thus,we suggested the targeted intervention measures should be adopted according to the characteristics of different MSM groups.2.In general,the outputs of intervention work carried by the cup institution mainly got better reflected.The effect of CUP institutions' interventions was correlated with the local GDP level and the density of MSM population activities.It is recommended that different CUP institutions should carry out intervention programs according to local conditions.The evaluation plan of CUP institutions should also be planed based on different levels to develop different evaluation index system.3.Hubei province has now formed a top-down intervention model with government-led,non-governmental organization collaboration and active participation of the whole society.The main features of the model are:CDC through the form of public tender or commissioned,the planned intervention workload and intervention funds entrusted to non-governmental organizations,the organization in the MSM activities.In this intervention mode,NGO undertakes the CDC to communicate with the MSM crowd to facilitate the conduct of various behavioral interventions,especially in the distribution of condom and voluntary counseling and testing have a greater advantage.However,CDC organizations are required to conduct regular supervision and standardized training in the rational use of funds for NGO organizations,the professionalism of interventions,etc.4.Structural model analysis showed that the main factors influencing the prevention behavior of MSM people are information,motivation and behavior skills,and the final model is better.The structural equation model combines mathematical knowledge with professional,which is a good choice for dealing with behavioral problem data.SEM has many unique advantages compared with traditional statistical methods.This study supported the theoretical hypothesis of the IMB model,relying solely on knowledge education cannot effectively promote the transformation of high-risk behavior,need from information,motivation,behavior skills in three aspects of comprehensive intervention.