Implementation Status And Related Factors Of Provider-initiated HIV Testing And Counseling In Two Counties Of Liangshan Yi Autonomous Prefecture

ObjectivesThis study aims to identify for the progress of PITC in Liangshan, explore the challenges and response of PITC from perspective of administrators and analysis doctors’willing of PITC and service quality relevant factors as well as acceptability and related factors of PITC among outpatients, which will guide the further research and PITC expansion.MethodsReview for PITC routine documents/records and fields observation were used to identify the progress of PITC in Liangshan.Qualitative research:In-depth interviews were used among10health system administrators and20doctors as well as21outpatients. For health system administrators, interview focused on attitudes, difficulties and sustainability of PITC while willingness of supply PITC were highlighted among doctors. Furthermore, the acceptability and attitudes to HIV was concerned among outpatients. Nvivo8.0was used for coding, sorting and concept generation.Quantitative research:A cross-sectional design,2county level hospitals and2township hospitals were selected from counties with relative high (Butuo county) and medium (Meigu county) HIV epidemic in Liangshan. All outpatients aged from18to64were recruited with face to face interview by trained local staff. Based on the description of PITC accepting rate, logistic regression was used for uni-variate analysis and multi-variate analysis. Epidata3.0and SAS9.1were used for data management and analyze respectively.ResultsThis research altogether collected2702documents and reooras of previous PITC work in Liangshan. There were10health system administrators,20doctors and21outpatients were investigated in qualitative interview. A total of413outpatients were involved in the quantitative survey.1. The progress of PITC in Liangshan Prefecture:PITC related publicity materials were showed in the local medical institution, including AIDS-related knowledge and PITC standard process. PITC were provider to all the patients unless the patients refuse it clearly. Rapid-test was used in HIV primary testing. The coverage of HIV testing was enhanced with more and more HIV+cases founded. However, the PITC records were not complete with36.5%loss of address information and72.0%missing of confirmatory testing results.2The current situation and challenges about PITC in perspective of administrators: All the interview objects firmly believed that PITC policy had great significance for HIV/AIDS prevention and control through its advantages in integration of health resources. Most of the administrators called for appropriate supervision and technical support. There was disagreement on the problem whether PITC should be charged. The challenges were as follows:both the limited quantity and quality among medical staff, reagent purchasing lag, repeated inspection, complicated procedures of PITC among related institutions and lack of HIV risk cognition among patients. Most of the leaders believe that the main factor which impact sustainability of PITC is fund support. Furthermore, the enthusiasm of PITC among doctors was affected by economic incentives, policy requirements and evaluation mechanism.3The doctors’willingness and related factors about PITC:All the doctors realized the necessity of PITC. The possible factors that influence the doctors’initiative were: workload, effective communication to the patients, PITC related risk subsidy, PITC relevant policy and operational guidelines, etc.4The prevalence of PITC acceptance and related factors:accept rate was47.7%(95%CI=42.9%-52.3%) among413respondents. The protect factors include Male (OR=7.283,95%CI=3.939-13.645), covered by HIV/AIDS related publicize (OR=1.855,95%CI=1.013-3.395), worry about infection of HIV/AIDS (OR=2.699,95%CI=1.616-4.506), while the risk factors include previously received HIV testing (OR=0.226,95%CI=0.124-0.409), afraid of blood test (OR=0.050,95%CI=0.024-0.106), know more about AIDS knowledge (OR=0.446,95%CI 0.258-0.773).Conclusions1In the areas with high HIV epidemic, local public health leaders and medical supported to carry out PITC, while nearly half outpatients were willing to accept PITC. Accordingly, PITC was feasible, acceptable and valid in such area.2The barriers need to be solved in PITC administrative level include publish relevant policy or the guideline, supply reagent on time, standardize PITC related records, simplify testing process, shorten feedback time of test results, reduce duplication detection.3There were some factors that obstacle doctors to offer PITC, such as lack of HIV/AIDS prevention and control knowledge, limited skills of the counseling, language barrier, unfamiliar with reagents update, lack of corresponding policy/incentive mechanism. Accordingly, the training on skill and technical specifications among doctors should be strengthened.4The patients were lack of perception for HIV/AIDS, the cognition of blood testing was wrong and women tended to refuse the testing.