The Research Of The Importance And The Relevant Influence Factors About Outreach-Workers In The Needle-exchange

ObjectiveInvestigate importance and relevant influence factors of outreach workers in needle exchange. Summarize their experience in this work. This study can provide some evidence to make full use of outreach workers’advantages, let needle exchange can continue to carry out. The ultimate goal is reduce HIV infection rate of drug users and their sex partners.MethodsRespondent Outreach workers length of time of this study is from June to August in2012. Use Representative sampling to chose all of the outreach workers (ORWs) in the HAARP project sites.211people include100in-service ORWs and111ORWs has leaving needle exchange work. Project manager Use Chester sampling to chose33project managers. They are the HAARP project manager and ORWs managers. Interview object use convenience sampling to chose3project managers,1police,1drug users family member,2ORWs and2drug users. Investigate methods cross sectional studies, Cluster sampling methods, Investigate style is questionnaire. Use Qualitative and Quantitative research, The data input in Epidata and the quality was checked by double entering. The effective data was analyzed with SPSS, it include descriptive analysis, Multiple comparison analysis of variance, rank-sum test, logistic analysis.Investigate methods cross sectional studies, Cluster sampling methods, Investigate style is questionnaire. Use Qualitative and Quantitative research, The data input in Epidata and the quality was checked by double entering. The effective data was analyzed with SPSS, it include descriptive analysis, Multiple comparison analysis of variance, rank-sum test, logistic analysis.Result:Basic information:A total number of211NSP outreach workers (ORWs) have been enrolled into the study, of which100are still in-service, and111are resigned. Of those in-service ORWs,73(73%) are males and79(79.0%) are drug users;52(52.0%) have education for middle school.28(28%) have salary payment among350-450. Of those ORWs who have resigned,87(78.4%) are males;56(50.5%) are unmarried; there are statistically significant difference in terms of marital status when compared those resigned and in-service ORWs (χ2=16.746, P=0.000). The majority of resigned ORWs are unmarried, and the majority of in-service ORWs are married;107resigned ORWs have ever taken drugs (96.4%), there are statistical significant difference in term of proportion of drug using experience when compared those resigned ORWs with in-service ORWs (χ2=15.243, P=0.000), the proportion of drug users in resigned ORWs group is higher than that of in-service group. For ORWs,63(58.9%) ORWs who are also drug users are currently on MMT treatment.31(30.0%) are still taking drugs. In term of drug abstinence status, there are statistically significant difference when compared those resigned and in-service ORWs (χ2=12.898, P=0.002); the proportion of drug abstinence among in-service ORWs is higher than that of in resigned ORWs group.The role of outreach workers in the NSE, the number of people covered by outreach workers is large, From August2008to July2012, the211ORWs have distributed3508715clean needles and syringes to a number of25129drug users, with418026person times. Trust of clients in ORWs:clients of14%ORWs tell about their drug using place, which accounted for41%clients; clients of21%ORWs tell about HIV infection status, which accounted for49%. High acceptability rate of ORWs, clients of73(73%) ORWs are happy to receive ORWs services. Accessibility is good,82(82.0%) can find clients easily,22ORWs7times per week. NSE outreach workers have pushed forward other services delivery of HIV/AIDS prevention and control work:91(91%) ORWs provide HIV/AIDS knowledge to their clients in addition to NSP distribution,73(73.0%) refer their clients to MMT treatment,69(69%) provide peer education,86(86%) provide IEC martial to their clients. Advantage of NSE outreach workers:outreach workers can easily get contact with targeted population, they can get trust, ORWs work is cost effective, they have low payment, but they are high efficient and hard working.31(93.9%) project management staffs have admitted the good performance of ORWs.19(57.6%) project management staffs thought the ORWs who are on MMT treatment have the best outreach work performances.The related influencing factors of the effect in needle exchange among ORWs: the influence of the project management, the selective recruitment of ORWs, Project management staffs from16counties (84.2%) recruited former drug users who are either abstinent or patient of MMT treatment as outreach workers, They always contact clients and be manage easily. Apply incentive mechanism into ORWs management to stimulate ORWs initiatives and effects, which include①apply bonus incentives in addition to basic salary payment.②salary payment links with job responsibilities.③material awards to those ones with outstanding work performance. After analyzing, the quantity is higher in the counties which have three kinds of incentive measures. The influence of management style, Ways of ORWs management include①direct ORWs management by project staffs;②set up drop in centre (DIC) and employ DIC official to manage ORWs, project staffs are responsible for DIC management;③select a key outreach worker in charge. All kinds of management works the same way. The influence of capacity building, Ways of outreach capacity building includes①training;②study tour;③others method, the NSE distributed and the ability was increased. Multi sector departments coordinate to cooperate outreach service delivery.19project counties all have cooperation with Public Security Bureau.14project counties have coordination and cooperation with community management sectors,13counties have cooperative relationship with government related departments. Through these, provide a good work environment.The influence of working styles:Ways of NSP distribution and Ways of contact with targeted population,70(70%) ORWs distributed NSP in both ways. According to analysis on the difference of needles distribution by different ways of contact, rank test results shows that there is no statistical significant difference, which means the distributions of NSPs by volume in different ways are the same.20(20%) ORWs wait clients home,40(40%) ORWs distributed NSPs to clients’home and wait clients home. In terms of average NSP distribution per person in different ways, there is no statistical significant difference. The related influencing factors of the service availability of ORWs services to clients, and acceptance of clients, and the trust of clients in ORWs. After the logistic regression analysis, With the analysis on risk factors for difficulty of finding clients, for those drug users, distribution by dropping in clients’ house are positively correlated relationship, distribution by appointed time and place is negative correlation. With the analysis on risk factors for Acceptability of ORWs services to clients, clients of ORWs who are not drug users are much more likely to receive ORWs service. With the analysis on risk factors for shall clients tell about their drug using place, for those drug users, distribution NSP by actively getting contact with clients are positively correlated relationship.Risk factors that hinder ORWs service delivery:the influence of own factor,26(78.8%) project management staffs choose that ORWs have low level of education,22(66.7%) project management staffs think ORWs have low working discipline and are not easy to management.21(63.6%) project management staffs think ORWs relapse easily;32(97.0%) project management staffs think that the ORWs drug user status are the most bad management. The influence of work factors,54(55.1%) ORWs choose the factors of low salary pay which is not sufficient for living,21(21.4%) ORWs worry the frequent contact with drug users would lead them to relapse.22(66.7%) project management staffs found ORWs take their position to sell drugs,31(93.9%) project management staffs think ORWs have high mobility, the turnover of the ORWs is52.60%,23.4%ORWs were locked up by police,23.4%of ORWs were laid offConclusion:①The outreach workers play an important and irreplaceable role in needle exchange;②Outreach from drug users are easy to get the trust of the target population, their accessibility is higher, at the same time, the implementation of the needle exchange also led to other prevention and control of HIV/AIDS services.③Outreach personnel management through selective recruiting outreach, establish reward mechanism, appropriate management methods, improve the ability construction enhance the capacity and etc. Improving the hairpin quantity of outreach workers, accessibility, acceptability, and working efficiency, etc.④Currently, outreach workers themselves and there are still some deficiencies and obstacles in the work, the turnover rate is high, thus affect the needle exchange efficient and smooth implementation.