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目的建立完善适合广州市海珠区实际的艾滋病病例综合管理模式并进行效果评价。方法循证决策方法,在广州市海珠区建立一个由区疾控中心、医疗机构、社区卫生服务机构和社会组织共同参与的“四位一体”艾滋病病例综合管理模式。采用数据分析、定性调查等进行效果评估。结果有效扩大了HIV抗体检测覆盖面,促进了艾滋病病例的及时发现;病例管理工作指标提升,首次个案随访率从2012年的96.33%上升到2014年的100.00%,随访检测率从2012年71.72%上升到2015年的89.75%(P<0.000 1),抗病毒治疗覆盖率从2012年56.94%上升到2015年的85.13%(P<0.000 1);2015年生存质量总分高于2012年,2015年心理和环境2个维度得分均高于2012年(P<0.05),2015年的社会支持总分及主观支持、支持利用度的得分均高于2012年;与获知感染前比较,79.41%的吸毒者不再共用针具吸毒;92.4%的病例接受过社区机构的服务,2012年仅12.6%;95.7%的病例对社区机构提供的随访服务表示满意。结论 “四位一体”艾滋病病例综合管理模式对提高工作效率和管理指标、促进病例及时发现,减少危险行为、提高生存质量、增加社会支持程度等发挥了巨大作用,应进一步完善和推广。
Objective To establish and improve the actual integrated HIV / AIDS management model in Haizhu District of Guangzhou City and evaluate its effect. Methods Evidence-based decision-making method in Haizhu District, Guangzhou to establish a district CDC, medical institutions, community health service agencies and social organizations to participate in “four in one ” AIDS case management model. Using data analysis, qualitative surveys, etc. to assess the effect. The results effectively expanded the detection coverage of HIV antibody and promoted the timely detection of AIDS cases. The index of case management work improved and the first case-follow-up rate increased from 96.33% in 2012 to 100.00% in 2014, and the follow-up detection rate increased from 71.72% in 2012 The coverage rate of ART increased from 56.94% in 2012 to 85.13% in 2015 (P <0.000 1), reaching 89.75% (P <0.000 1) in 2015; the total quality of life in 2015 was higher than that in 2012 and 2015 Psychology and environment were higher than those of 2012 (P <0.05). The total score of social support and subjective support and utilization of support in 2015 was higher than that of 2012. Compared with pre-infection, 79.41% of drug abuse No need to share needles and drugs. 92.4% of the patients received community service and only 12.6% in 2012; 95.7% of the patients were satisfied with the follow-up services provided by community agencies. Conclusion The integrated management model of the “four in one” AIDS cases has played a great role in improving work efficiency and management indicators, promoting timely detection of cases, reducing risk behaviors, improving quality of life, and increasing social support, which should be further improved and promoted.