The Feasibility Study Of Provider Initiated Testing And Counseling (PITC) In General Hospital

Objective: HIV counseling and testing is the important for prevention and control .Now VCT (Voluntary Counseling and Testing) is the main measure for HIV counseling and testing .While there are mang deficiencies in VCT through implement process, like few people who voluntary accept test, and health resource wasteing. WHO suggests that VCT and PITC be an important measure to improve the identification rate of HIV infection and to provide service of HIV prevention, treatment for HIV, care and support for the infected. PITC makes it easy for more HIV-infected people to be diagnosed and treated in their early stage of infection. And it also improve the number of people for testing and counseling scope. PITC services currently carried out in China in the early stage. The study for the feasibility and mode of PITC is the focus work.PITC service carried out in different levels general hospitals in shijiazhuang city, Hebei province to explores the feasibility, necessity,influent factors , and ofoperation mode of PITC.Method:From all the general hospitals of different levels in Shijiazhuang, Hebei, randomly sample 9 hospitals (3 hospitals at the provincial level, 3 at the prefecture level, and 3 at the county level) with the method of stratified sampling. The departments involved in this project are gynaecology and obstetrics department, urology department, dermatology and STD department, anorectal departmentand respiratory department of each hospital. People involved in this project include hospital leadership, department managers, the medical staff, pregnant women, STD patients, tuberculosis patients, pneumonia patients and suspected patients identified by doctors. The three basic methods for this study were used, such as questionnaire investigation, group discussion and leaders interview. The questionnaires for patients and medical staff were designed by study group. The data of investigation analyzed by SPSS 13.0,and used the multivariate logistic analyses to find the factors of acceptance to PITC service.nine group discussions were organized for medical staffto concluded their attitude to PITC services and favorable, difficult factors. Nine leaders (including the leadership of the hospital project and director) were interviewed, and they showed their opinion and gave some advice to PITC service.Results:In this study, 2550 patients and 540 medical staff have been investigated and 9 hospital leaders interviewed.1.The proportion of patients who consider it is not necessary for HIV test reaches as high as 83.6%. There is little possibility that those people who are at risk for HIV infection could actively ask for HIV test. Therefore, it is very necessary to carry out PITC service. When answering the question "What kind of help do you want from doctors?", 81.0% of them have chosen counseling about AIDS problems and 50.2% HIV test. This result indicates that PITC service is in line with patients' needs and there is certain feasibility of carrying out this service. In this investigation, 72.7% of the patients have chosen "fear of arousing suspicion" when they answer the question "the reason for refusing AIDS test". This means social discrimination will influence the acceptance of patients for PITC service2.95% of the medical staff believe that it is necessary to carry out PITC service. And according to the result of group discussion, the majority of the medical staff thought that it was necessary for PITC77.2% of the medical staff think it is feasible to provide the patients with initiative HIV testing and counseling; and 62.3% of the staff are willing to provide this service to the patients.3.All the interviewees think that PITC is necessary and the majorities agree on PITC service in their own medical institutions, and supporting the relevant departmens. The difficulties include the shortage of testing expense, lack of technical guidelines for clinical operations, funds and policy, etc.Conclusion:1.PITC is an important supplement to VCT. It can improve the accessibility of HIV testing and counseling service , the coverage rate on high risk group. The limited health resources will be utilized fully. And it provides the patients who need HIV prevention, treatment, care and support with more comprehensive diagnosis. PITC services in comprehensive hospitals are essential.2.Leaders of the medical institutions and the majority of the medical staff are willing to provide PITC service, which is accepted by most of the patients. The medical institutions possess resources for PITC. Therefore, the PITC service is feasible with the medical staff training strengthened and service quality improved.3.Currently, there are many adverse factors to the development of PITC, which include lack of specialized knowledge for HIV prevention, treatment and counseling, the heavy workload of the staff, lack of confidential places, policy basis and operating specifications, testing fees, neglect of testing's importance andsocial discrimination, etc.4.Service mode of PITC:The establishment of relevant departments in general hospitals is determined by different epidemic degree. According to the survey result, there are department of gynecology and obstetrics, anorectic department, respiratory department and dermatology and STD department. PITC service requires separate places and professional staff. Also, free HIV test should be provided to the patients as much as possible. It is easy for the patients accept PITC with excellent advocacyaction.