Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Expanding VCT among MSM in China:Opportunities for Innovation?,在中国,MSM,中推广自愿咨询检测,(VCT),：是创新机遇吗？,James W.Dilley,MD,James W.Dilley,医学博士、,Professor of Clinical Psychiatry,临床精神医学教授、,Vice-Chair,UCSF Dept.of Psychiatry,UCSF,（旧金山加州大学）精神医学学院副院长,Chief of Psychiatry,SF General Hospital and Executive Director,UCSF AIDS Health Project,兼,UCSF,艾滋病卫生项目精神医学专家，旧金山总医院院长兼主任,Acknowledgements,致谢,WilliMcFarland,MD,PhD,WilliMcFarland,医学,博,博士,MaryKamb,MD,CDC,MaryKamb,医学,博,博士,，,，疾,病,病控,制,制中,心,心,BillandMelindaGatesFoundation,BillandMelindaGates,基金,会,会,Goalsfortoday:,今天,的,的目,标,标：,BrieflyreviewourHIVC&TprograminSF-arethereanyapplicablelessons?,简要,回,回顾,旧,旧金,山,山的,HIV,咨询,与,与检,测,测项,目,目,是否,可,可以,从,从中,吸,吸取,适,适用,的,的经,验,验教,训,训？,Brieflyreviewsomeoutcomedataoncounselingassociatedw/testing,简要,回,回顾,一,一些,有,有关,检,检测,的,的咨,询,询效,果,果数,据,据,Proposesometopicsforfurtherdiscussion,为进,一,一步,讨,讨论,提,提议,若,若干,主,主题,Background,背景,beganATSin1985incommunityhealthclinics;servedover250KpeopleforHIVsince,1985,年，,率,率先,开,开始,在,在社,区,区卫,生,生诊,所,所使,用,用,ATS,（收,集,集追,踪,踪系,统,统）,；,；自,成,成立,以,以来,，,，为,超,超过,25,万人,次,次提,供,供了,艾,艾滋,病,病服,务,务,Began w/group“pre-testcounseling”(video w/Q&A)andindividual post-testresultsfocusedonRR counseling,最早提供,群,群体“检,测,测前咨询,”,”（视频,问,问答）和,着,着重于,RR,咨询的个,体,体检测后,结,结果服务,Since:multiplechangesincluding indivpre/post counseling;addition of otherservicesincluding mobile testing;confidentialtesting;partnernotification/”Letting ThemKnow,”,”;on-site STD screening/txservices;formallinkagetocareservice;HepatitisA/Bvaccines;RNAtesting,起始：包,括,括个人检,测,测前后咨,询,询在内的,许,许多变化,；,；包括流,动,动检测在,内,内新增的,其,其他服务,；,；保密检,测,测；性伴,侣,侣通知,/,“让伴侣,知,知晓,”,；性病现,场,场检查服,务,务；护理,服,服务官方,联,联接；甲,肝,肝,/,乙肝疫苗,；,；,RNA,（核糖核,酸,酸）检测,Telephone appointments and Marketing,电话约诊,和,和营销,Early HIV Testing AdinGayPress,1986,GayPress,（同性恋,杂,杂志）上,的,的早期,HIV,检测广告,，,，,1986,年,AIDScases:30,000,艾滋病病,例,例：约,30,000,Living withHIV:18,000,HIV,携带者：,约,约,18,000,Newinfections:8-900 per year,新感染者,：,：每年约,8-900,HAART:75%,MSM:90%,Tenderloin,田德隆区,Castro,卡斯特罗,Location,Location,Location!,位置，位,置,置，位置,！,！,Mobile,Community BasedHIVTesting,基于社区,的,的,HIV,流动检测,Individual tents;IndividualCounseling.,单独帐篷,；,；单独咨,询,询,Exampleof“added value”Service:Linkage to Care,“增值”,服,服务示,例,例：与护,理,理联接,In 1999,began specialized short-term case management for all individuals who test HIV-positivethroughourHIVCounseling and Testing Program(HCAT).,1999,年开始通,过,过,HIV,咨询与检,测,测项目,(HCAT),致力于对,所,所有,HIV,检测呈阳,性,性的患者,进,进行短期,病,病例管理,。,。,Clients are offered upto4 counselingsessions asthey navigate the process of livingwith anewHIVdiagnosis.Eachsessionfocusesonclient needsandtargetsappropriatefollowup referrals.,向患者提,供,供,4,次咨询会,谈,谈服务，,此,此项服务,帮,帮助指导,新,新,HIV,携带者如,何,何就诊。,每,每次会谈,均,均以患者,需,需求为重,点,点，旨在,为,为患者提,供,供适当的,复,复诊转介,服,服务。,Acceptance of Services,服务接,受,受,Main reasonsfor declining,B.,拒绝接,受,受服务,的,的主要,原,原因,84%ofthoseofferedLinkage accepted theservice.,A.,向其提,供,供了联,接,接方式,的,的,84%,的患者,接,接受了,服,服务。,Alreadyreceivingservices:39%,已接受,服,服务：,39%,Wantedtosee ownMDfirst28%,希望首,先,先见到,自,自己就,诊,诊的医,师,师,28%,Feelingtoooverwhelmed:18%,Declined to give reason 9%,拒绝透露原因,9%,ReferraltoPrimary MedicalCare,初级医,疗,疗护理,转,转介,Almostall(96%)clientsweregivenanimmediatereferraltoHIV-specific primarymedicalcare services.,几乎所,有,有,(96%),的患者,在,在第一,时,时间被,推,推荐接,受,受专门,针,针对,HIV,的初级,医,医疗护,理,理服务,。,。,Most(71%)of these clientsre,por,tedsuccessfully followingthrough on thereferral*.,其中大,多,多数,(71%),患者表,示,示转介,成,成功,*,。,Themostcommonmedicalreferralswereto:,最常见,的,的医疗,转,转介如,下,下：,Private physiciansorplans,私人医,生,生或计,划,划,PublicHealth clinics,公共卫,生,生诊所,Alternativehealthcareproviders,其他可,选,选健康,护,护理提,供,供方,*A,“,“successful”referralhas beenmadewhen theclienthas contactwiththereferredorganization or agency.,*,患者若,与,与转介,组,组织或,机,机构取,得,得联系,，,，转介,即,即“成,功,功”。,ReferraltoSupport Services,支持服,务,务转介,Most(72%)of ourclients weregivenaSupport Referral,59%oftheseweresuccessful.,大多数,(72%),患者获,得,得了支,持,持转介,服,服务，,其,其中,59%,转介成,功,功。,Typical SupportServiceReferrals:,典型支,持,持服务,转,转介：,ethnic/culturalidentitybasedsupportgroupsfor positives;,基于族,群,群,/,文化认,同,同的阳,性,性患者,支,支持群,体,体,individual psychotherapyorsubstance abuse services.,私人精,神,神治疗,或,或药物,滥,滥用服,务,务,*A,“,“successful”referralhas beenmadewhen theclienthas contactwiththereferredorganization or agency.,*,患者若与转介,组,组织或机构取,得,得联系，转介,即,即“成功”。,Is Counseling AssociatedwithTesting Important?,将咨询与检测,相,相关联，这很,重,重要吗？,Knowledge ofHIV infection isPrevention:Amongthosew/HIV,对感染,HIV,的知识即预防,：,：,HIV,携带者,-68%,-53%,Total Reduction in Unprotected Intercourse,未采取保护措施的性行为减少总量,Reduction in Unprotected Intercourse with Known HIV-Partner,已知性伴侣为,HIV,携带者而未采取保护措施的性行为减少量,Percent Reduction,减少比率,MarksG.,JAIDS,.2005;39(4):446-453i,Does Counseling Assocdw/Testing Change High Risk Behavior?,与检测相关的,咨,咨询是否会改,变,变高危性行为,？,？,2 review articlesof 1980s,early 1990s assessing effectiveness ofHIV counseling,20,世纪,80,年代和,20,世纪,90,年代初的两篇,评,评论文章评估,了,了,HIV,咨询的效果,Higgins,1991,JAMA (24studies),Higgins,1991,JAMA,（,24,项研究）,Weinhardt,1991,AJPH(27 studies through1995)