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Abstract：
BACKGROUND: Primary care may be an avenue to increase coverage of HIV testing but it is unclear what challenges primary healthcare professionals in low- and middle-income countries face. We describe the HIV testing practices in community health centres (CHCs) and explore the staff\'s attitude towards further development of HIV testing services at the primary care level in China.
METHODS: We conducted a national, cross-sectional survey using a stratified random sample of CHCs in 20 cities in 2015. Questionnaires were completed by primary care doctors and nurses in CHCs, and included questions regarding their demographics, clinical experience and their views on the facilitators and barriers to offering HIV testing in their CHC. Multivariate logistic regression was conducted to examine the association between staff who would offer HIV testing and their sociodemographic characteristics.
RESULTS: A total of 3580 staff from 158 CHCs participated. Despite the majority (81%) agreeing that HIV testing was an important part of healthcare, only 25% would provide HIV testing when requested by a patient. The majority (71%) were concerned about reimbursement, and half (47%) cited lack of training as a major barrier. Almost half (44%) believed that treating people belonging to high-risk populations would scare other patients away, and 6% openly expressed their dislike of people belonging to high-risk populations. Staff who would offer HIV testing were younger (adjusted odds ratio (aOR) 0.97 per year increase in age, 95% confidence interval (CI):0.97-0.98); trained as a doctor compared to a nurse (aOR 1.79, 95%CI:1.46-2.15); held a bachelor degree or above (aOR 1.34, 95%CI:1.11-1.62); and had previous HIV training (aOR 1.55, 95%CI:1.27-1.89).
CONCLUSIONS: Improving HIV training of CHC staff, including addressing stigmatizing attitudes, and improving financial reimbursement may help increase HIV testing coverage in China.
METHODS: We conducted a national, cross-sectional survey using a stratified random sample of CHCs in 20 cities in 2015. Questionnaires were completed by primary care doctors and nurses in CHCs, and included questions regarding their demographics, clinical experience and their views on the facilitators and barriers to offering HIV testing in their CHC. Multivariate logistic regression was conducted to examine the association between staff who would offer HIV testing and their sociodemographic characteristics.
RESULTS: A total of 3580 staff from 158 CHCs participated. Despite the majority (81%) agreeing that HIV testing was an important part of healthcare, only 25% would provide HIV testing when requested by a patient. The majority (71%) were concerned about reimbursement, and half (47%) cited lack of training as a major barrier. Almost half (44%) believed that treating people belonging to high-risk populations would scare other patients away, and 6% openly expressed their dislike of people belonging to high-risk populations. Staff who would offer HIV testing were younger (adjusted odds ratio (aOR) 0.97 per year increase in age, 95% confidence interval (CI):0.97-0.98); trained as a doctor compared to a nurse (aOR 1.79, 95%CI:1.46-2.15); held a bachelor degree or above (aOR 1.34, 95%CI:1.11-1.62); and had previous HIV training (aOR 1.55, 95%CI:1.27-1.89).
CONCLUSIONS: Improving HIV training of CHC staff, including addressing stigmatizing attitudes, and improving financial reimbursement may help increase HIV testing coverage in China.
摘要：
背景：初级保健可能是增加艾滋病毒检测覆盖率的一种途径，但目前尚不清楚低收入和中等收入国家的初级保健专业人员面临哪些挑战。我们描述了社区卫生中心（CHC）的HIV检测实践，并探讨了工作人员对进一步发展中国初级保健水平的HIV检测服务的态度。
方法：我们进行了一次全国，2015年对20个城市的CHC进行分层随机抽样的横断面调查。问卷调查由CHC的初级保健医生和护士完成，包括关于他们的人口统计的问题，临床经验以及他们对在CHC中提供HIV检测的促进者和障碍的看法。进行了多变量逻辑回归，以检查提供HIV检测的工作人员与其社会人口统计学特征之间的关联。
结果：共有来自158个CHC的3580名员工参加。尽管大多数人（81％）同意艾滋病毒检测是医疗保健的重要组成部分，只有25%的人会在患者要求时提供艾滋病毒检测。大多数人(71%)担心报销，一半（47％）认为缺乏培训是主要障碍。几乎一半(44%)的人认为治疗属于高危人群的人会吓跑其他患者，6％的人公开表示不喜欢属于高风险人群的人。提供艾滋病毒检测的工作人员更年轻(调整后优势比(aOR)每年增加0.97，95％置信区间（CI）：0.97-0.98）；与护士相比，接受过医生培训（aOR1.79，95CI：1.46-2.15）；拥有本科或以上学历（aOR1.34，95CI：1.11-1.62）；并且以前接受过HIV培训（aOR1.55，95CI：1.27-1.89）。
结论：改善CHC工作人员的艾滋病毒培训，包括解决污名化的态度，改善财务报销可能有助于增加中国的艾滋病毒检测覆盖率。
方法：我们进行了一次全国，2015年对20个城市的CHC进行分层随机抽样的横断面调查。问卷调查由CHC的初级保健医生和护士完成，包括关于他们的人口统计的问题，临床经验以及他们对在CHC中提供HIV检测的促进者和障碍的看法。进行了多变量逻辑回归，以检查提供HIV检测的工作人员与其社会人口统计学特征之间的关联。
结果：共有来自158个CHC的3580名员工参加。尽管大多数人（81％）同意艾滋病毒检测是医疗保健的重要组成部分，只有25%的人会在患者要求时提供艾滋病毒检测。大多数人(71%)担心报销，一半（47％）认为缺乏培训是主要障碍。几乎一半(44%)的人认为治疗属于高危人群的人会吓跑其他患者，6％的人公开表示不喜欢属于高风险人群的人。提供艾滋病毒检测的工作人员更年轻(调整后优势比(aOR)每年增加0.97，95％置信区间（CI）：0.97-0.98）；与护士相比，接受过医生培训（aOR1.79，95CI：1.46-2.15）；拥有本科或以上学历（aOR1.34，95CI：1.11-1.62）；并且以前接受过HIV培训（aOR1.55，95CI：1.27-1.89）。
结论：改善CHC工作人员的艾滋病毒培训，包括解决污名化的态度，改善财务报销可能有助于增加中国的艾滋病毒检测覆盖率。
