【作者】 郭勇；

【导师】 杜玉开；

【作者基本信息】 华中科技大学 ， 儿少卫生与妇幼保健学， 2008， 硕士

【摘要】 研究目的利用在校医学生社会实践活动形式,结合当地医疗卫生保健机构中的HIV/AIDS VCT服务室,有针对性的开展VCT服务促进与技能支持活动,提高基层目标人群的自愿咨询检测意识,从而提高HIV咨询和检测率,实现早发现、早诊断、早治疗,遏制艾滋病流行蔓延。研究方法通过自愿报名,选择华中科技大学同济医学院30名预防医学专业学生,经统一培训后,利用暑假回家时间,由学校出具介绍信,结合当地艾滋病自愿咨询检测室或医疗卫生保健机构,对其家人、亲朋好友、同学、邻里乡亲,或社区居民有针对性的开展VCT服务的宣传教育活动,并对VCT服务机构和居民进行问卷调查、访谈。研究结果1.VCT服务机构情况:业务用房面积8～30 m2,平均18.4 m2;25%的VCT服务机构无专职人员;18.8%的机构采用快速检测试剂,81.2%使用酶标试剂;检测当天出结果的占12.5%,2天出结果的占12.5%,3～5天出结果的占43.8%,一周或以上的占31.2%;所有VCT服务机构均能为求询者提供部分转介服务。2.宣传前后居民艾滋病知识了解情况:宣传活动后居民对其正确的三大传播途径知晓率由74.3%提高到96.1%(χ2=64.438,P<0.001),艾滋病防治基本知识得分由7.81±2.44提高到9.51±1.17,差异具有统计学意义(t =24.918,P<0.001)。宣传活动前居民对艾滋病是否可治愈与非传播途径的知晓率较低,宣传教育活动后,居民的艾滋病知识回答正确率均有显著提高(P<0.001)。3.宣传后居民对VCT服务的地点及对象认知情况:宣传活动前居民对VCT的知晓率为36.7%。372名听说过VCT的居民中,对疾病预防控制中心与妇幼保健机构可提供VCT的知晓率分别为77.7%、22.0%,不清楚VCT服务提供地点者占12.4%。宣传活动后,1013名居民对疾病预防控制中心与妇幼保健机构开展VCT的知晓率分别为84.8%、35.1%。居民认为VCT服务对象构成情况,多性伴者82.4%,同性恋74.6%,献血者65.8%,孕妇50.5%。4.宣传前后居民对艾滋病病毒感染者的态度比较:通过宣传教育居民对艾滋病病毒感染者恐惧率由58.9%下降到39.0%(χ2=327.935,P<0.001);愿意与感染者交往比例由48.0%上升到68.6%(χ2=425.294,P<0.001);认为感染者值得同情比例由83.7%上升到93.2%(χ2=230.170,P<0.001)。5.影响居民接受VCT服务意愿的因素:经多分类Logistic回归分析,年龄、艾滋病防治知识得分、VCT服务必要性认识、艾滋病病毒感染者恐惧感对居民接受VCT服务有影响。6.综合指数法评价结果:利用综合指数法对活动效果进行综合评价,宣传前综合指数I为5.875,宣传后综合指数I为31.998。研究结论本研究利用医学生社会实践通过大量通俗易懂的报告会,播放宣传片,面对面的讲解、咨询,活动前、后居民的艾滋病防治知识及对VCT服务的认识得到显著提高;消除了居民对艾滋病感染者的恐惧与歧视及对HIV检测认识的误区,提高了居民接受VCT服务的意愿。建立的利用医学生社会实践开展VCT服务促进模式,可以给各医科院校社会实践活动提供借鉴,为艾滋病防治及VCT服务普及提供一个可供参考的模板,并为基层VCT服务医师培训工作提供机会。更多还原

【Abstract】 ObjectiveUsing medical students’social practice and integrating the HIV / AIDS VCT services room in local medical care and health institutions, target to promote VCT services and launch skill support activities to enhance the primary target population of voluntary counseling and testing awareness, so as to enhance HIV counseling and testing rate, and early discovery, early diagnosis, early treatment and curb the spread of the AIDS epidemic.MethodsThrough voluntary application, 30 students who majored in Preventive Medicine of the Huazhong University of Science and Technology Tongji Medical College were selected. After unified training, in the summer vacation, they went home with recommendation letters issued by school. In light of their local AIDS voluntary counseling and testing room, or medical care and health institutions, they targeted to their families, friends and relatives, schoolmates, neighbors, or community residents to launch publicity and education of VCT services, and they had VCT service agencies and residents conducted a questionnaire survey and interview.Results1.Information of VCT service agencies: The area of VCT service room is 8～30 m2, an average of 18.4 m2. 25.0% of VCT service agencies were without full-time staffs. 18.8% of the agencies adopted rapid detection reagent, and 81.2% used the enzyme reagent. 12.5% of the agencies could take out the results of the testing in one day; 12.5% of the agencies could take out the results of the testing in two days; 43.8% of the agencies could take out the results of the testing in 3～5 days; 31.2% of the agencies could take out the results of the testing in one week and more. All of the VCT service agencies could provide part of referral services for suffers.2.Information of residents understood AIDS knowledge before and after the publicity: After the publicity, the awareness rate that residents could correct understand the three major routes of transmission raised from 74.3% to 96.1%(χ2=64.438,P<0.001). After the publicity, the basic knowledge scores of AIDS prevention and control raised from 7.81±2.44 to 9.51±1.17, and had a statistically significant difference (t = 24.918, P<0.001). Before the publicity, residents had a low awareness with non-transmission and whether AIDS could be cured. After publicity and education, the residents answered the questions of AIDS knowledge. The correct rate had significantly increased (P<0.001).3.The awareness of the locations and objects of VCT services: Before the publicity, only 36.7% of residents heard VCT. Among 372 residents had heard of VCT, 77.7% knew that CDC could provide VCT services and 22.0% knew maternal and child health institutions could provide VCT services. The proportion of unknown was 12.4%. Among 1013 residents were surveyed, 84.8% knew that CDC could provide VCT services and 35.1% knew maternal and child health institutions could provide VCT services after the publicity. Residents thought that the composition of VCT service objects was multi-sexual partners 82.4%, homosexuality 74.6%, blood donors 65.8%, pregnant women 50.5%.4.The comparison of residents’attitude about HIV-infected persons before and after the publicity: The rate of fearing HIV-infected persons was dropped to 39.0% from 58.9%(χ2=327.935,P<0.001). The proportion of being willing to make friends with HIV-infected persons was raised from 48.0% to 68.6%(χ2=425.294,P<0.001). The proportion of considering that infected people should be deserved sympathy was raised from 83.7% to 93.2%(χ2=230.170,P<0.001).5 . The factors of affecting residents to accept VCT services: Through multi-classification logistic regression analysis, there were four factors of affecting residents to accept VCT services including age, the scores of AIDS knowledge, the awareness of VCT services and fear of AIDS infected persons.6.The results of comprehensive index: After the activities were evaluated via comprehensive index, the comprehensive index was only 5.875 before the publicity. But the comprehensive index was 31.998 after the publicity and education. ConclusionThis study used medical students to carry out large of reports, playing videos and face-to-face counseling for the residents of their hometown. The residents’knowledge of AIDS prevention and understanding of VCT services have been dramatically enhanced. The fear and discrimination with HIV-infected persons have been eliminated. However, the activities improved residents to accept VCT services. This study established a model of using medical students’social practice to launch VCT service promotion. It could give all medical schools a reference for propaganda of AIDS prevention and VCT services. It also could provide training opportunities for rural doctors of VCT.更多还原