Research And Development On HIV/AIDS Voluntary Counseling And Testing (VCT) Model For Rural Community At Hebei Province In China Comprehensive AIDS Responds (CAREs)

Objective: At the end of 2004, there are 39.4 million people living with HIV/AIDS (PLHA), which increased 2.8 million from 2002. The new infected cases are up to 4.9million. Since the first HIV case found in 1985, there are 840,000 PLHA in China, and there are 80,000 infected cases have become patients and 160,000 died of HIV. Based on the present situation, the number of PLHA was increased by 40% in China every year. It should be the critical term for China to prevent HIV/AIDS. It is very important to find out effective strategy in order to develop HIV/AIDS prevention and control. HIV/AIDS Voluntary Counseling and Testing (VCT) project has been effectively used for HIV/AIDS prevention and control in many countries. From early 2004, the VCT project was set up at 51 counties at province level in CAREs. The objective of the study is to develop the theory and practice on HIV/AIDS VCT model for rural community in CAREs. It could be identified to an important strategy for HIV/AIDS prevention and control. On the other hand, the problem in VCT service, and the beneficial and harmful factors can be found through survey and research. In the present study, there are two rural communities (YongQing county and GuAn county in LangFang city, Hebei province) had been chosen in CAREs. In 1995, about 1,560 former blood donors had accepted HIV testing. And the actual number of former blood donors is more than 2,600. By September 2003, there were 148 PLHA and 40 have been dead among them. There are over 15,000 former blood donors in GuAn county. By August 2003, there were 30 PLHA. Method: Hebei Health Bureau organized the training course for the leaders, counselors and laboratory staff in these counties; the total number of participants is 29. In order to develop the skill of counseling in VCT center, every counselor must familiar with counseling practice before training course closing. The role-playing was used from beginning to the end of course, and this participatory teaching method was satisfied to all the participants. The basic method for needs assessment and quality assessment were used, such as questionnaire investigation, group discussion and interview. The questionnaires for former blood donors and medical staff were designed by study group. The data of investigation analyzed by SPSS 11.0,and used the multivariate logistic analyses to find the factors of acceptance to HIV VCT service. The investigator organized six group discussions for blood donors, and concluded their attitude and impression to VCTservices. Nine leaders (including the leaders of CDC, the local Health Office, hospital of county, family plan office and health care center for woman and child) were interviewed, and they showed their opinion and gave some advice to VCT service. Results: The awareness rate of some knowledge for VCT increased after training from the outcome of questionnaire. Among 7 times role-playing, only one group failed, the others can play the role successfully following VCT counseling protocol cards. All of the counselors can undertake their future counseling work in VCT center through this training course. The two VCT centers in above two counties CDC started in April 2004. There are laboratory for HIV testing, counseling room and waiting room in VCT center. In every room, some equipment was placed according to the strategies. The workers include one leader to organize the whole VCT center, at least two counselors (2 counselors in YongQing county, 3 counselors in GuAn county) and laboratory staffs (3 in YongQing county, 2 in GuAn county) To finish the STD treatment, prevention of mother-to-child transmission, opportunistic infection treatment, community care and social support, connected with the other medical section and government station, a referral network was developed. 730 blood donors had face-to-face interview, the outcome of awareness rate of HIV/AIDS, attitude to HIV/AIDS and risk behaviors are rather lower compared with another questions. The other awareness rate can be shown in the below:transmission route is 26.8% to 85.2%; HIV/AIDS prevention is 23.3% to 67.3%. The stigma environment is common in those counties through the investigation: 65% people said that they would not live or work with HIV infected persons. From the data of questionnaire, 90.1% people are eager to know the knowledge of HIV/AIDS related and 90.0% people may accept HIV testing in the future. By logistic analysis, the level of education background and the awareness rate of HIV transmission route were the main factors for acceptance of HIV/AIDS VCT services. From VCT center setting up, to November 2004, there are over 400 people accepting counseling, and among them there are 10% people coming back for second counseling. The reason for receiving counseling is that they are former blood donors. Through HIV testing some new cases were found in two counties, and in YongQing county the mother-to-child transmission route was found. Conclusion: Teaching method and quality assessments in training course are very important for VCT service center. Role-playing helped counselors familiar with the skill of counseling, learn to use language for counseling, and could confirm the idea of clients of VCT center. So the participatory method can be identified effective for training. It is practical and acceptable to develop VCT service center in county CDC, and build lab for HIV testing, counseling room and waiting room.