「愛滋個案管理和加強型伴侶服務試辦計畫」成效評估

Abstract

背景： 國內愛滋病毒感染人數逐年增加，公共衛生人員個案管理及伴侶服務的負擔日益沉重，然而我國伴侶服務完成率亦亟待提升，有鑑於此，疾病管制署於2013年至2014年委託臺灣愛滋病護理學會於新北市試辦「愛滋個案管理和加強型伴侶服務試辦計畫」，以建構有效之公衛端愛滋病個案管理模式，提升個案管理品質並減輕公衛人員負擔。目前國內多數研究僅針對愛滋病指定醫院辦理之愛滋病個案管理師計畫進行評估，而試辦計畫對於提高就醫率及伴侶服務完成率之成效，亟待進一步探討。 目的： 探討「愛滋個案管理和加強型伴侶服務試辦計畫」的介入，對於HIV感染者之完成伴侶服務及就醫情形之影響 方法： 本研究採取僅有後測之對照組設計(The comparison group posttest-only)設計方式，以「慢性傳染病追蹤管理－愛滋及漢生病子系統」資料庫為研究工具，並以2011年至2014年間全國確診人類免疫缺乏病毒感染個案為研究對象，依個案之確診年份及管理縣市，區分為介入組、新北市對照組及其他縣市對照組，採邏輯斯迴歸及考克斯比例風險模式分析方式，藉以檢視試辦計畫提升個案診斷後完成伴侶服務及就醫之成效。 結果： 研究結果發現，介入組之診斷後4個月內伴侶服務完成率為18.4%，顯著高於新北市對照組的9.5% (p<.0001)及其他縣市對照組的10.3% (p<.0001)，在使用多變項分析調整其他影響因素的作用後，介入組相較於新北市對照組，有較高的機會於診斷後完成伴侶服務(OR=2.3, p<.0001; HR=1.625, p<.0001)。 結論： 試辦計畫之介入，使診斷後完成伴侶服務之比例有顯著且正向之提升，顯示委託民間專業護理團體介入之愛滋個案管理模式，能整合醫院、公衛、社會等資源，使介入措施及服務能有效率的輸送，進而顯著提升伴侶服務之完成情形。

Background： The number of domestic HIV infection increases every year, therefore, the burden of case management and partner services of public health workers increases accordingly. Since the completion rate of partner service needs to be enhanced, Taiwan Centers for Diseases Control commissioned Taiwan AIDS Nurses Association a pilot program “HIV Case Management and Strengthened Partner Service Program” to implemente in New Taipei City during 2013 and 2014. The goal of this pilot program is to construct effective HIV case management model in public health and to enhance the quality of case management. At present, most domestic research only focus on HIV Case Management Program in the designated HIV hospitals, the medical rates and completion rates of partner services of the polit program needs to be further evaluated. Objectives： Evaluate the intervention of “HIV Case Management and Strengthened Partner Service Program” on the completion rates of the partner services and rates of seeking medical care in HIV-infected persons. Methods： This evaluation research applies a comparison group posttest-only design. This research uses database of “Chronic infectious diseases case management system' as a research tool. Only HIV-infected persons diagnosed during the period from 2011 to 2014 were included in this research. According to year of diagnosis and county of management, we selected two control group: New Taipei Comparision Group and Other Cities and Counties Comparsion Group to compare with Intervention Group. Logistic regression and Cox proportional hazards model analytical methods were conducted to assess the program impact. Results： Completion rate of partner service within 4 months is 18.4% in Intervention Group,which is higher than New Taipei Comparision Group (9.5%, p<.0001) and Other City and County Comparsion Group (10.3%, p<.0001). Mutivariate analysis through Logistic regression and Cox proportional hazards model indicated that Intervention Group has higher chance to complete partner service than New Taipei City Comparison Group (OR=2.294, p<.0001; HR=1.625, p<.0001). Conclusion： The Intervetion Group has shown significant positive effects on completion rate of partner services after HIV diagnosis. The CBO (Community-Based Organisations) partner service model provided by HIV professional organization could integrate intervention with hospital, local health department and social resources to futher enhance the completion rate of partner services of HIV infected person.