Investigation And Research On HIV Testing In Medical Institutions At The County And Township Levels In Dehong Prefecture From 2013 To 2018

Objective(s):This study first adopted quantitative research methods to analyze the HIV testing data of medical institutions at the county and township levels in Dehong Prefecture from 2013 to 2018,analyzes the status of HIV-positive detection in medical institutions at county and township levels,the characteristics of newly reported HIV-diagnosed persons in medical institutions at county and township levels,and the related factors that affect HIV-positive detection in medical institutions.It provides a theoretical basis for improving the management level of hospitals,improving the efficiency of HIV testing in medical institutions,and exploring medical institutions to formulate precise HIV testing measures.Methods:In this study,medical institutions at the county and township levels in A and B counties of Dehong Dai and Jingpo Autonomous Prefecture in Yunnan Province were selected as the research site,using a combination of qualitative and quantitative methods.Quantitative surveys were conducted by specially trained personnel,using uniformly designed forms to retrospectively collect data and information on HIV antibody testing in county and township medical institutions from 2013 to 2018,the specific content includes:the general demographic characteristics of the HIV testers,HIV testing information and testing results;and then through the Dehong Prefecture AIDS Comprehensive Prevention System to download the local HIV-positive data information reported before 2018,combine two parts of data to build a database.Use χ2 testing to compare the difference in the proportion of newly reported HIV-diagnosed people with different characteristics in medical institutions;compare the difference in the ratio of newly reported HIV-diagnosed people from different levels of medical institutions.The logistic regression model is used to analyze the factors affecting the detection of newly reported HIV-diagnosed people in medical institutions.The qualitative research uses self-made interview outlines to conduct interviews with medical staff in medical institutions and CDC staff to learn about HIV testing links,referral services,and the situation of HIV testing services provided by their medical institutions.Summarize and refine the interview records to summarized the main points.Results:1.From 2013 to 2018,the number of HIV tests in County A county hospitals increased year by year,and the positive rates of each year were 0.88%,0.70%,0.79%,0.98%,0.86%,0.71%,the trend of positive rates was not statistically significant.(χ2 Trend=0.307,P=0.580).The newly reported HIV-diagnosed persons were mainly 40-49 years old,male,and elementary school education.Heterosexual behavior infection accounted for 77.34%.The detection departments were widely distributed,among them,the proportion of newly reported HIV-diagnosed people found in the infection department and surgical system was high,they were 37.77%and 17.63%respectively.From 2013 to 2018,the HIV positive rate of county hospitals in County A has appeared in the top three departments,including infectious department,outpatient and emergency,surgical system,dermatology and other departments.2.From 2013 to 2018,the number of HIV tests in County B county hospitals increased from 8 665 to 17 839,and the positive rates of each year were 0.88%,0.62%,0.71%,0.36%,0.46%,0.44%,The positive rate of detection shows a downward trend.(χ2 Trend=24.834,P<0.001).The newly reported HIV-diagnosed persons were mainly 40-49 years old,male,and elementary school education.Heterosexual behavior infection accounted for 75.16%.;Multiple departments detected HIV-positive infections,and newly reported HIV-diagnosed people found in outpatient and emergency department and internal system department accounted for 28.03%and 18.47%of the positive samples.From 2013 to 2018,the HIV positive rate of county hospitals in County B has appeared in the top three departments including outpatient and emergency department,infection department,surgical system,internal system and dermatology department.3.From 2013 to 2018,the number of HIV detection in county health centers in County A rose from 1 861 to 15 453,and the positive rate of detection showed a downward trend(χ2Trend=47.770,P<0.001).The newly reported HIV-diagnosed persons were mainly 40-59 years old,male,and elementary school education.Heterosexual behavior infection accounted for 71.43%.4.From 2013 to 2018,the number of HIV detection in county health centers in B county rose from 2 004 to 12 812,and the positive rate of detection showed a downward trend(χ2Trend=38.941,P<0.001).The newly reported HIV-diagnosed persons were mainly 30-39 years old,male,and elementary school education.Heterosexual behavior infection accounted for 84.00%.5.There were statistical differences in the proportion of newly reported HIV-diagnosed people tested by in different years,genders,and departments in county hospitals.There were statistical differences in the proportion of newly reported HIV-diagnosed people tested in different years,gender,age,marital status in township hospitals.6.The differences in the marital status of newly reported HIV-diagnosed persons in county and township medical institutions were statistically significant(P=0.003).7.Age,testing year,gender,and department may be the factors influencing newly reported HIV-diagnosed persons in county hospitals;The year of detection,gender,marital status,and ethnicity may be factors influencing newly reported HIV-diagnose-d persons in township health centers.8.HIV testing is highly accessible in county and township medical institutions,and most patients could receive HIV testing services in Dehong Prefecture.There were dedicated personnel responsible for the management of HIV testing in this hospital.Few people actively inform doctor about their HIV infection status.There were very few cases of HIV screening without confirmation.9.The personnel responsible for HIV testing know PITC well,and most clinicians who were not in charge of HIV testing management say they have only heard of PITC.Conclusion(s):1.The number of HIV tests in sample medical institutions increased from 2013 to 2018.Except for county hospitals in County A,the positive rates of other sample medical institutions have a downward trend.More HIV-infected people can be found by carrying out HIV testing in medical institutions.2.The newly reported HIV-diagnosed persons were mostly low-educational and the main route of infection is sexual transmission,and medical staff in relevant departments of medical institutions have increased propaganda of health knowledge to this part of the population.Understanding the status of HIV testing in medical institutions and the HIV infection status of patients can carry out precise HIV testing in medical institutions and reduce occupational exposure.3.The HIV positive rate of county-level medical institutions was higher than that of township health centers.Increase HIV testing in county-level medical institutions,and rely on township health centers to carry out AIDS publicity and education.4.Provide high-quality HIV testing services to reduce the number of patients who refuse HIV testing,the loss of patients who are initially screened positive,and patients who have repeated testing.Suggestion:1.Increase the importance that medical institutions attach to routine HIV testing.Increase support and guarantees for medical staff responsible for HIV testing and training for clinical medical staff to reduce the probability of occupational exposure of clinical medical staff.2.Combine the HIV testing services of medical institutions with other health care services.When medical institutions provide free health care services to local residents,they can also provide HIV testing services for residents.3.Optimize HIV testing measures in county-level medical institutions.Establish a smart HIV monitoring and testing platform in medical institutions.Medical institutions rely on smart monitoring and testing platforms to carry out precise HIV testing and increase testing efforts in departments with a high HIV positive rate.Strengthen the integration of medical and prevention,and provide patients with"one-stop" testing and treatment services.In areas with high HIV prevalence,medical institutions can provide patients with HIV screening,diagnose,consultation,treatment and care services.4.Strengthen health education in township medical institutions.Carry out targeted publicity of HIV-related knowledge,take HIV testing as a routine test in medical institutions,and adopt targeted publicity in different industries,different age groups and different places.Improve residents’ awareness of actively taking HIV testing.