An Investigation Of Task Shifting Of HIV/AIDs Follow Up With PEST Analysis In Jiangxi Province

Objective:Through the prevalence survey and PEST analysis to understand the status of the task shifting of HIV/AIDS follow up in Jiangxi province,analyze its working environment,and provide reference for revising and improving the follow up task shifting guidance program.Methods:To investigate all the county (district) task shifting work present situation,sample survey of professionals engaged in AIDS prevention and treatment in county (district) centers for disease control,and the AIDS follow up personnel in primary medical health institutions from November 2016 to November 2017 in Jiangxi province,including basic demographic data of HIV/AIDS patients,their attitude to AIDS follow up task shifting and the behind reasons,etc.All staff and HIV/AIDS patients are conducted semi-structured interviews,using PEST analysis method from four dimensions including the political,economic,social and technical environment to analyze AIDS follow up task shifting working environment in Jiangxi province.After checking the collected questionnaires,Excel 2013 and Epi Data 3.1 were used to establish and input the database,which was imported into SPSS 22.0 for statistical analysis.Results:1.By November 2017,26 out of 100 counties (districts) in Jiangxi province have adopted the work model of task shifting.Among them,15 counties (districts) adopted the shifting mode for new reported cases,5 counties (districts) adopted the shifting mode for all cases,and the remaining 6 counties(districts)adopted different methods.A total of 1,841 HIV/AIDS patients were shifted,with an average of 71 per county (district).2.At the present stage,it is mainly shifting the task about contacting HIV/AIDS patients?informing and HIV testing spouses/fixed partners,completing the filling and reporting of individual follow up forms,and delegating publicity and education?dangerous behavior intervention?condom distribution?psychological care and support to primary medical and health institutions for HIV/AIDS patients.The rate of each assessment index (follow up rate,CD4+T cell detection rate,virus load detection rate,spouse/fixed partner HIV antibody detection rate,medical treatment physical examination rate,antiviral treatment rate) was basically improved.3.A total of 102 professional staff of the county (district) center for disease control and 92 grassroots follow up staff were investigated.There were statistically significant differences between the two groups in age,education,major,whether full-time engaged in HIV/AIDS prevention and treatment,years of working experience,and attitudes towards task shifting(P<0.05).60.78% of the professionals and 77.17% of the grassroots follow up personnel held a positive attitude towards the follow up task shifting.Among the respondents who did not support follow up shifting,95% of professionals and 90.47% of grassroots follow up personnel said that unclear allocation of funds was one of the reasons for their lack of support.4.A total of 147 HIV/AIDS patients were investigated.46.26% of HIV/AIDS patients were willing to shifting,among which those patients who were followed up in the CDC had the lowest acceptance rate(36.19%).Among HIV/AIDS patients who did not want to be shifted,67.09% were concerned about identity exposure.5.PEST analysis results showed:(1)Political environment: including promoting grassroots medical health institutions to participate in AIDS prevention and treatment,protecting the rights and interests of HIV/AIDS patients and standardizing follow up work,but lack of work assessment system.(2)The central transfer payment and special funds of provincial finance provided an economic environment for AIDS follow up shifting.(3)Social environment: the characteristics of AIDS epidemic in China are changing,which is conducive to the new follow up work.However,the AIDS discrimination environment still exists in Jiangxi province,which is not conducive to the development of follow up.(4)Technical environment: the professional level of AIDS follow up personnel in grassroots medical and health institutions is limited,and there is no special staff responsible for follow up,which has no substantial help to HIV/AIDS patients.Conclusion:At present,only a few counties (districts) in Jiangxi province have carried out the task shifting for AIDS follow up,and the contents are limited to the routine follow up work.Most professionals in the centers for disease control and prevention and follow up staff in primary medical health institutions showed a supportive attitude towards the shifting mode of AIDS follow up,but most HIV/AIDS patients do not accept the shifting.Jiangxi province basically has the political and economic environment for AIDS follow up shifting model,but most areas do not have the social environment and technical conditions,follow up work should be carried out according to local conditions.The implementation of administrative support and financial funds should be ensured in the areas where AIDS follow up is carried out.On the basis of ensuring grassroots manpower,work content should be reasonably arranged,the professional ability of staff in primary medical health institutions should be improved,the willingness of HIV/AIDS patients should be paid attention to,and patient privacy should be effectively guaranteed.This study can provide reference for Jiangxi province to improve follow up subsidence work,and for other regions to improve the quality of AIDS follow up work.