Study On The Influential Factors And Status Of Free HIV Voluntary Counseling And Testing In Changsha City

Objectives:To understand the situation of free HIV Voluntary Counseling and Testing (VCT) service in Changsha City, three aspects of health service are studied, including the utilization of VCT, VCT providers and cost-effectiveness of VCT. And to identify the influential factors of VCT service in Changsha City.Methods:With convenience sampling,200HIV infection high-risk populations, which made up of50injection drug users,50patients with sexually transmitted diseases,50female sex workers and50men who have sex with men were investigated using self-designed questionnaires and standardized scales. Professional staffs in Changsha City who provide free VCT were recruited as samples of health serviceprovider. Using self-desiged questionnaire, Minnesota Satisfaction Questionnaire-Short Form Scale (S-MSQ), and Scale for AIDS Discrimination to investigate the basic demographic characteristics, job satisfaction and the discriminatory attitudes towards AIDS among the service providers. Meanwhile, using the report data of10clinics which provide free VCT in Changsha to analyze cost-effectiveness of VCT during the period of2008to2013.Results:1) In all samples of high risk population, the rate of VCT awareness was36.5%(73/200),38.5%(77/200) participants had unitized the VCT services. Moreover, the rate of VCT service utilization and awareness among men who have sex with men group both ranked at the highest levels, the rate were68.0%(34/50) and60.0%(30/50) respectively; and female sex workers was the lowest group, the rate were10.0%(5/50) and8.0%(4/50) respectively.70%particpants at high level of HIV/AIDS related knowledge, and there were129(64.5%) particpants reported that they would not be infected was the main reason of rejecting the VCT service. By comparing the two groups which had used the VCT service or not, it had been found that statistically significant differences in the aspect of emotional problems. Specifically, there were78(39%) persons with the depressive symptoms and97(48.5%) samples with symptoms of anxiey, respectively. Compared with the sample without used the VCT service, there were higher proportion of who have used the VCT service with higher HIV/AIDS-related knowledge (χ2=14.723, P <0.01), positive symptoms of depression (χ=10.628, P<0.01) and positive anxiety symptoms (χ2=15.764, P<0.01). The logistic regression analysis showed that stable marital status(OR=2.320,95%CI:1.061～5.067), homosexual orientation (OR=0.379,95%CI:0.164～0.871) and high level of HIV/AIDS-related knowledge(OR=2.342,95%CI:1.072～5.116) were significantly associated with the utilization of VCT.2)In Changsha city, there were22professional staff who provide VCT services. It was showed that the overall job satisfaction scores were76.1that in the "general satisfaction" level and overall attitude of AIDS discrimination scores were39.6that in the "medium level of discrimination". There was statistically significant differences (χ2=7.183, P<0.05) had been occurred among the VCT professional services staff and other department staff attitude of discrimination in AIDS.3) In ten districts of Changsha City, the average density of VCT clinic was1.51per million populations. During the period from2008to2013, the costs had been raised from￥697,000to￥953,700. The cost per VCT visiting ranged from￥125.5to￥197.8during2008to2010, and then dropped to￥143.4in2013. The cost of per complete VCT procedure ranged from￥126.2to￥198.3during2008to2010, and then dropped to￥145.1in2013. The cost of per HIV positive case detected from2008to2013ranged from￥43,562.5to￥8,082.2.Conclusion:1) The rate of awareness and utilization among the surveyed sample of four HIV infection high-risk populations were relatively low. Multivariate logistic regression analysis showed that stable marital status, homosexual orientation and high level of HIV/AIDS-related knowledge degree were the main factors that significantly associated with the utilization of VCT among high risk groups.2) The score of job satisfaction of professionals of VCT was in the level of "general satisfaction", and the discriminatory attitude of AIDS was in the middle level. Compared with other professionals who working in CDC settings, the VCT professionals had a lower level of the attitude of AIDS discrimination.3) During the period from2008to2013, the cost of per VCT visit and the cost per complete VCT procedure were first increased and then decreased gradually tended to be steady trend. And the cost per HIV positive case detected was decline.