Y HOC VIET NAM THANG - SO 2/2014 VAI TRO CUA Y TE TIT N H A N TRONG HOAT DONG PHONG CHONG HIV/AIDS TAI TINH BUOC HO TRO* CUA DIT AN QUY T O A N CAU Nguyen Hoang Long*, Tran Khanh Toan** T O M TAT Nghien cffu cat npang nham 6anh gia vai tro cua y te tif nhan cong tac phong chong HIV/AIDS du'Oc thu'c tiien tai 252 cd s6 y te tif nhan huyen thuoc tinh tren_toan quoc di/a tren cac chi so va thang ve sif sin co va sin sang die dich vy Y te (SARA) cua WHO. Ket qua cho thay cac dich vu phong chong HIV du'Oc cung cap la chuyen benh nhan co nguy ca cao (47,3%), tu van HIV t i / nguyen (34,5%), dieu tri STI (18,6%) va dieu tn nhiem trung cO hpi (14,4%); tu" van dieu tri ARV (10,3%) va xet nghiem test nhanh HIV tif nguyen (8,3%). Tu" van va xet nghiem phong chong lay truyen tif me sang du'Oc cung cap d 89,1% va 28,3% cac phong kham San/nha hp sinh. Vai tro cua y te tu" phong chong HIV/AIDS han che. Can tang cu'dng dao tao, giam sat ho trd chuyen mon ky thuat cho y te tu' nhan tham gia phong chong HIV/AIDS. TiJ'khoa: Y te tu' nhan, phong chong HIV/AIDS, tif van va xet nghiem tif nguyen, lay truyen tCf me sang con. SUMMARY PARTICIPATION OF PRIVATE HEALTH SECTOR I N H I V / A I D S CONTROL I N PROVINCES SUPPORTED BY GLOBAL FUND This cross-sectional study which aims to assess the role of pnvate health care facilities in the prevention of HIV/AIDS was conducted at 252 private health facilities in districts in provinces using the WHO tool about the availability and availability of health services (SARA). The results showed that the HIV prevention services that were provided were referral of high nsk patients (47.3%), voluntary HIV counseling (34.5%), STI treatment (18,6%) and treatment of opportunistic infections (14.4%); ARV treatment counseling (10.3%) and rapid HIV voluntary testing (8.3%). Counseling and testing for prevention of mother to child transmission were provided in 89.1% and 28.3% of obestrict clinics/maternity wards. The role of private health care in HIV/AIDS is still limited. It is necessary to strengthen trainning, technical and professional support to pnvate health sector in participating in HIV/AIDS control. Keywords: Private health sector, HIV/AIDS control, voluntary counseling and testing, mother to child HIV transimission. * Cgcphdng chdng HIV/AIDS, Bd Yte; Tru'dng Dai hoc YHa Ngi ** Bg mdn Y htpc gia dinh, Dai hgc Y Ha Ngi Phan bign khoa hgc: PGS.TS Nguyin Thj Kim Chuc 68 L DAT VAN DE Viet Nam da dat du'dc nhieu tiTu phong chong HIV/AIDS, ca ve trien khai cac hoat dpng tu" van, xet nghiem HIV tu" nguyen, phong chong lay truyen tif me sang con; giam thieu tac hai, dieu tri ARV cung nhu* giam ty le mac va tii vong HIV/AIDS [1,3]. Hien co hdn 55.000 cd sd y du'dc tif nhan tren toan quoc dang cung Cfng 43,5% dich vu ngoai tru va 2,1% dich vu npi tru, gop phan lam giam tai cho cac c6 sd y te cong. Y te tu' cung du'dc ky vpng gop phan tang cu'dng hieu qua trien khai cac chu'dng trinh y te, co cong tac phong chong HIV/AIDS. Tuy nhien, hien chu^ CO cac nghien cu'u danh gia day du ve vai tro cija y te tu' nhan cac chu'dng trinh y te quoc gia nhu'cong tac phong chong HIV/AIDS [1,2]. Nghien cu'u du'dc thyc hien khuon kho Dl/ an Ho trd he thong y te Quy Toan cau tai trd nam (2012-2016) nhkm ho trd tang cu'dng nang lu'c he thong y te, gop phan cai thien va tri cac qua cua cac chu'dng trinh y te quoc gia khac, ca ITnh vi/c y te cong va tu'. Muc tieu: Mo ta hoat dpng cua y te tu" nhan phong chong HIV/AIDS tai tinh thu'c hi?n dy an ho trd he thong y te Quy toan cau tai trd. II. DOI TU'pWG VA PHU'aNG PHAP NGHIEN CUU 2.1. Dja ban va doi tu'dng nghien cthi: Nghien cifu thu'c hien tai tinh Quang Ninh, Khanh Hoa, Binli Phu'dc va Soc Trang tLf thang 69/2013, moi tinh chpn mpt huyen nong thon va mpt thi xa, plip tru'c thupc tinh. Toan bp 252 cd sd y te (CSYT) tu" bao gom ca cac phong kham da khoa va chuyen khoa Npi, Nhi, San va nha hp sinh tren dja ban du'dc chpn tham gia nghien cifu. 2.2. Phu'dng phap nghien cu'u: Thiet ke nghien cii'u mo ta cat ngang, thu'c hien qua phong van bang bp cau hoi cau true ve cac loai hinh cd sd, nhan lyc, to chu'c, trang thiet bj, thdng tin, cac loai dich vu t\f van, dy phong va dieu tri san co tai cac cd sd y te tu". Danh gia s;/ san CO cua cac djch vu y te theo hu'dng dan cua WHO (SARA) [7]. So lieu du'dc xy ly bSng phan Y HQC VlgT NAM THANG - SO 2/2014 mem SPSS 11.5 vdi cac test thong ke mo ta d mii'c y nghTa thong ke a= 0,05. vya kiem luon nhiem vy kham chu'a benh, Tuoi trung binh doi tu'dng tra Idi phdng van la 48, thdi gian trung binh lam viec cho cac cd sd y te cong la 22 nam va cac cd sd y te tu" la 12 nam. III. K I T QUA NGHIEN cCrU 3.1. Thong tin ve doi tu'dng nghien cii'u 3.2. Hoat dong cung cap dich vu phong Trong so 252 cd sd y te tU tham gia nghien chong HIV/AIDS cinj, CO 168 phong kham npi (66,7%); 46 phong Bieu cho thay cac dich vu du'dc cung kham San/nha hp sinh (18,2%); 23 phong kham cap chu yeu la chuyen g(f\ benh nhan c6 nguy c6 da khoa (9,1%) va 15 phong kham Nhi (6,0%). cao (47,3%), tu' van HIV tu- nguyen (34,5%), Tat ca cac cd sd deu co bac sT lam viec tai cac cd dieu tri benh lay truyen qua du'dng sinh due sd y te nha nu'dc dang ky kham chya benh ngoai (18,6%) va nhiem trung cd hoi (14,4%). Cd gid hoac can bp y te ve hu'u phy trach vdi nhan 10,3% cd sd tL/ van dieu trj ARV va chi 8,3% so lyc tu" mpt den tren mu'di ngu'di. Doi tu'dng tra Idi cd sd cd xet nghiem test nhanh HIV. chu yeu la bac sT chiem 91,6%, vCra lam quan ly Bieu 1. Ty le cac CSYT cd cung cap cac djch vu phong chdng HIV Test nhanh HIV ty nguyen Tir van dieu tri ARV Cap phit bao cao su Dieu trj nhiem triing co hpi Digu tri STI Tu van HIV tir nguyen Chuyen giri bpnh nhan 10 20 30 40 50 Tinh chung cd 34,5% CSYT t& co cung cip dich vu t& vin HIV va 8,3% th&c hien xet nghiim nha HN; ty le d cac PKDK cao hdn so vdi cac phdng kham Ngi va Nhi vdi p . Bieu do 1 cho thay cac dich vu du'dc cung cap chu yeu la chuyen g(f benh nhan c6 nguy c6 cao (47 ,3%), tu' van HIV tu- nguyen ( 34, 5%), dieu tri benh lay truyen qua du'dng. van tir nguyen va 22,7% vdi tu" van lay truyen tir me sang con. Oac biet, ty le du'dc ho trd, giam sat ve chuyen mon ky thuat dat cao nhat trong tu' van lay truyen HIV tir. die dich vy Y te (SARA) cua WHO. Ket qua cho thay cac dich vu phong chong HIV du'Oc cung cap la chuyen benh nhan co nguy ca cao (47 ,3%), tu van HIV ti/ nguyen ( 34, 5%), dieu