An Analysis Of Different AIDS Diagnosis And Treatment Service Models In Two Counties Of Guizhou Province

BackgroundThe number of people living with HIVpresents an increasing trend these years.Antiretroviral Therapy (ART) can effectively reduce the death related to HIV/AIDS. But the loss of the HIV/AIDS during the diagnosis to treatment will decrease the effect. To explore the suitable model from HIV diagnosis to treatment and decrease the death due to HIV infection, our country started a pilot trial in 2012 called the "one stop service" model from HIV/AIDS diagnosis to Antiretroviral Therapy (ART). That is to refer the newly diagnosed HIV/AIDS directly to the ART agency and simplify the streamline from screeningto ART, with a hope to reduce the mortality. This research selected Dushan County, which performed the pilot "one stop service" inGuizhou Province, and its neighbor Pingtang County, which had been conducting the standardservice model as the studying sites.Objective To compare the differet service models in two couties of Guizhou Province. And compare the effect of two different models, and analyze the reasons. At the same time, to understand the knowledge and attitude of the HIV/AIDS about the service received. And provide evidence for improving the quality and effect for AIDS prevention and treatment.Methods A cross-sectional research was conducted. A qualitative and quantitative combined method was used. The research include three sections:before and after self-contrast and comparative study of parallel analysis、the questionnaire investigation of HIV/AIDS and qualitative interview of medical and health personnel.1. Before and after self-contrast and comparative study of parallel analysisThe newly diagnosed HIV/AIDS adult residents reported by the two local counties were the subjects. The year when "one stop service" was performed and the year before were the observational years. The subjects were divided into four groups according to the reporting county and the diagnosed time. The subjects reported by Dushan during Nov.1,2013 to Oct.31,2014 was the group of Dushan Before, while subjects reported by Pingtang during the same period was divided into the group of Pingtang Before. The subjects reported by Dushan during Nov.1,2014 to Oct.31, 2015 (when the "one stop service was performed") was the group of Dushan After, while,similarly, in Pingtang the group of Pingtang After.Information from the database system of the two counties was supplied by the county CDC.The interval time from confirmation to ART, the proportion of CD4testing, the proportion of ART of all cases, the proportion of ART of those meet the ART standard, the proportion of ART within 30days after conforming of all cases, the proportion of ART within 30days after conforming of those meet the ART standard were used as the indexes for the effect comparison of the two counties. SPSS 19.0 was used to analyze the data. The comparison of the data is ttest, Chi-square test and nonparametric test.2 Questionnaire investigations of HIV/AIDSA questionnaire was offered to the newly diagnosed HIV/AIDS, reported by the two counties during the "one stop service" year, and who met the inclusion criteria.The contents included the basic characteristics, the recognition of the service offered, and the reception to the service. Excel 2010 was used to input the data and SPSS 19.0 was used to analyze the data. The comparison of the data is t test, Chi-square test and nonparametric test.3. Qualitative interview of medical and health personnelAccessing to relevant documents and interviewing the physicians of the two counties conducting the service models. The interviewing included the status of the service model, and the contents of two models. Record the conversation with permission and transfer the records into words. Categorize, checked and concluded the main viewpoints of the physicians.Results1. After the conduction of "one stop service" in Dushan County, the confirming to ART interval time reduced from 55.00days to 4.00days. The proportion of CD4 testing of increased from 65.52% to 100.00%. and the proportion of ART increased from 31.03% to 87.88%. While, in Pingtang County, the interval time from confirmation to ART changed from 68.00 days to 43.50 days, the proportion of CD4 testing changed from 90.91% to 88.24% and the proportion of ART varied from 45.45% to 58.82%.2. The awareness of the HIV/AIDS about the services received including confirming, CD4 testing and the benefit of ART needs to be improved. There is no clear concept of the process of service and time in the HIV/AIDS due to only one service model they received. The HIV/AIDS surveyed in the two county were satisfied with the services offered. The patients’main concern was the side effects of drugs. HIV/AIDS received the ART mainly because of the construction of the physicals. The majority of the HIV/AIDS were in good state according to self-report. Those who felt not so good isdue to the side effectsmainly.Most HIV/AIDS were aware of the need of long-time medication.3.Two county service models exist difference in many aspects including funding, attention to of the program, the instrument, incentives and other aspectsIn the funding aspect, Pingtang County government appropriated 100,000RMB annually for HIV while the Dushan County the government didn’t. The nation allocated 150,000RMB to Dushan for the conduction of "one stop service". In the attention aspect, Dushan issued the "one stop service" document and cleared the responsibilities of each unit. In the instrument aspect, Dushan County have the CD4 testing instrument. Thus, confirmation and CD4 testing can perform synchronously and Dushan expanded the standard of ART to that those who have the willingness to ART can start it. At the incentive aspect, Dushan Countyestablished the incentive mechanism.The physicians’diagnosis, transference, start of ART, success of ART can be awarded certain allowance. The enthusiasm of medical and health personnel was improved.Conclusion1."One stop service" is obviously better than the standard model in shorting the interval time from diagnosis to treatment, and increasing the rate of ART, and eventually, enhance the effect of prevention and treatment;2.The conduction of "one stop service" needs the government and health administrative department to pay attention to, and supply supporting in funding and incentive mechanism, etc.3. The awareness of HIV/AIDS about confirming, CD4 testing and benefits of ART should be improvedandthe health personnel took an important role in the ART and adherence of HIV/AIDS. Strengthening the training of medical personnel is helpful to improve the effectiveness of HIV/AIDS prevention and control.