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Abstract Models of HIV counseling and testing service for general population: a review Waranya Rattanavipapong* and Yot Teerawattananon*
*Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health
In spite of the policy of expanding HIV testing coverage to all adults up to 65 years of age being recommended by international organizations, social and ethical concerns related to HIV testing exist, including discrimination, stigma and human rights protection. The study reviewed service models of HIV testing in the general population to identify the appropriate and effective approaches towards achieving high uptake of testing among general population in Thailand. There are two voluntary counseling and testing (VCT) service models: facility- and community -based services. The acceptance rate ranged from 11% - 95% for facility-based VCT and from 51% - 83% for community-based VCT. Provider-initiated VCT was not only effective in offering VCT to general population, but also cost-effective for people aged 13-50 years. PIVCT should thus be performed in all healthcare facilities in Thailand, while further research on other approaches are recommended.
Key words: HIV, HIV/AIDs, HIV testing, counseling and testing, screening
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#1 HIV 249,340 253,124
#2 çhuman immunodeficiency virusé 71,326 298,459
#3 HIV [MeSH] 59,218 59,465
#4 AIDS 190,774 298,459
#5 çAcquired immune deficiency syndromeé 4,899 120,857
#6 çHIV/AIDSé 20,903 23,538
#7 testing 386,319 477,081
#8 screening 4,658,622 616,725
#9 çmass screeningé [MeSH] 50,099 23,140
#10 (((((#1) OR #2) OR #3) OR #4) OR #5) OR #6 339,781 413,088
#11 ((#7) OR #8) OR #9 4,911,072 1,037,028
#12 (#10) AND #11 90,438 39,851
#13 (#10) AND #11 Filters: Systematic Reviews; Meta-Analysis 1,513 324
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·∫∫°“√„Àâ∫√‘°“√μ√«®∑’˧≈‘π‘° (√âÕ¬≈– 25-30) ·≈–°“√ àßμàÕºŸâªÉ«¬‰ªμ√«®∑’ËÕ◊Ëπ (√âÕ¬≈–
28-39) ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫°“√„Àâ∫√‘°“√„π ∂“π°“√≥åªí®®ÿ∫—π∑’ˉ¡à¡’°“√μ√«®À“°“√
μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’
Chou ·≈–§≥–(16) ∑∫∑«π«√√≥°√√¡‡°’ˬ«°—∫°“√¬Õ¡√—∫°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’¢ÕߺŸâªÉ«¬ æ∫°“√
»÷°…“∑’Ë∑∫∑«π«√√≥°√√¡ 62 ‡√◊ËÕߢÕߪ√–‡∑» À√—∞Õ‡¡√‘°“ Õ—μ√“°“√¬Õ¡√—∫¢Õß ºŸâªÉ«¬∑’Ë¡“√—∫∫√‘°“√°“√«“ß·ºπ§√Õ∫§√—«Õ¬Ÿà∑’Ë√âÕ¬≈– 14-67
°“√ºπ«°‡¢â“°—∫∫√‘°“√ Kaai ·≈–§≥–(17) ∑∫∑«π«√√≥°√√¡‡°’ˬ«°—∫∫√‘°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’„π°≈ÿࡪ√–™“°√∑’Ë™Õ∫
μ√«® ÿ¢¿“æ ‡æ»μ√ߢⓡ„πª√–‡∑»·§π“¥“·≈– À√“™Õ“≥“®—°√ 27 ‡√◊ËÕß ¡’‡æ’¬ß Prost ·≈–§≥–
∑’Ë»÷°…“„π°≈ÿࡪ√–™“°√∑—Ë«‰ª§◊Õ ºŸâªÉ«¬„À¡à¢Õß√–∫∫À≈—°ª√–°—π ÿ¢¿“æ„π‡¡◊Õß
≈Õπ¥Õπ ª√–‡∑»Õ—ß°ƒ…∑’Ë¡’Õ“¬ÿ 18-55 ªï ·≈–¡“‡¢â“√—∫∫√‘°“√μ√«® ÿ¢¿“æ æ∫ºŸâªÉ«¬
38 √“¬ ®“° 85 √“¬ À√◊Õ√âÕ¬≈– 44.7 ¬Õ¡√—∫°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’ («‘∏’ rapid test)
°“√μ√«®„π·ºπ Pattanaphesaj ∑∫∑«π«√√≥°√√¡‡°’ˬ«°—∫ª√– ‘∑∏‘¿“æ·≈–§«“¡§ÿâ¡§à“¢Õß«‘∏’ªÑÕß°—π°“√μ‘¥
ºŸâªÉ«¬πÕ° ·≈–§≥–(18) ‡™◊ÈÕ‡Õ™‰Õ«’„πª√–‡∑»‰∑¬ ∫√‘°“√ PIVCT ¡’ª√– ‘∑∏‘¿“æ„π°“√‡æ‘Ë¡Õ—μ√“°“√‡¢â“√—∫
∫√‘°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’ ·≈–¡’§«“¡§ÿâ¡§à“„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬
Teerawattananon °“√ª√–‡¡‘πª√– ‘∑∏‘¿“æ¢Õß∫√‘°“√ PIVCT ·°àºŸâªÉ«¬∑ÿ°√“¬∑’Ë¡’Õ“¬ÿ 13-64 ªï
·≈–§≥–(19) ∑’Ë¡“√—∫∫√‘°“√∑’Ë‚√ß欓∫“≈™ÿ¡™π 8 ·Ààß „π 4 ¿“§¢Õߪ√–‡∑»‰∑¬ ‡ª√’¬∫‡∑’¬∫°—∫
‚√ß欓∫“≈∑’ˉ¡à¡’π‚¬∫“¬π’È PIVCT ¡’ª√– ‘∑∏‘¿“æ∑—Èß„π·ßà‡æ‘Ë¡Õ—μ√“μ√«®æ∫ºâŸâμ‘¥
‡™◊ÈÕ‡Õ™‰Õ«’·≈–Õ—μ√“°“√¬Õ¡√—∫°“√μ√«® Õ—μ√“°“√¬Õ¡√—∫°“√μ√«®‡æ‘Ë¡®“°√âÕ¬≈– 0.4
‡ªìπ√âÕ¬≈– 8.9 „πæ◊Èπ∑’Ë∑’Ë¡’§«“¡™ÿ°¢Õß°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’μË” ·≈–®“°√âÕ¬≈– 0.3
‡ªìπ√âÕ¬≈– 3.5 „πæ◊Èπ∑’Ë∑’Ë¡’§«“¡™ÿ°¢Õß°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’ Ÿß À≈—ß„Àâ∫√‘°“√ PIVCT π“π 16 —ª¥“Àå „π¢≥–∑’Ë°≈ÿà¡∑’ˉ¡à‰¥â√—∫∫√‘°“√ PIVCT ‰¡àæ∫°“√‡ª≈’ˬπ·ª≈ß∑’Ë¡’
π—¬ ”§—≠
°“√μ√«®„π·ºπ° Chou ·≈–§≥–(16) ∑∫∑«π«√√≥°√√¡‡°’ˬ«°—∫°“√¬Õ¡√—∫°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’¢ÕߺŸâªÉ«¬ æ∫
ºŸâªÉ«¬„π °“√»÷°…“∑’Ë∑∫∑«π«√√≥°√√¡®”π«π 62 ‡√◊ËÕߢÕߪ√–‡∑» À√—∞Õ‡¡√‘°“ Õ—μ√“°“√
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°√–∑∫Õ◊Ëπ‰¥â·°à °“√∑’˺Ÿâμ‘¥‡™◊ÈÕ‡Õ™‰Õ«’/‚√§‡Õ¥ å∂Ÿ°μ’μ√“·≈–
°“√‡≈◊Õ°ªØ‘∫—μ‘®“° —ߧ¡ ‡™àπ °“√∂Ÿ°ªØ‘‡ ∏®“°°“√®â“ßß“π
·≈–°“√®”°—¥ ‘∑∏‘„π°“√‰¥â√—∫º≈ª√–‚¬™πå„π°“√ª√–°—π™’«‘μ
‡ªìπμâπ(16,17,20,21)
§«“¡°≈—«º≈°“√μ√«® ‚¥¬‡©æ“–°√≥’º≈
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«‘μ°°—ß«≈‡√◊ËÕß°“√∂Ÿ°°’¥°—πÀ√◊Õ·∫àß·¬°(16,17)
Bateganya ·≈–§≥–(20) æ∫«à“°“√„Àâ∫√‘°“√μ√«®À“
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√—∫∫√‘°“√·ºπ°ºŸâªÉ«¬πÕ°¢Õß‚√ß欓∫“≈ ®–‰¥â√—∫∫—μ√‡™‘≠
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¢≥–√Õ√—∫∫√‘°“√ ºŸâªÉ«¬®–‰¥â√—∫ ◊ËÕ«‘¥’‚Õ‡°’ˬ«°—∫¢âÕ¡Ÿ≈æ◊Èπ
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«‘π‘®©—¬¿“¬„π 2 —ª¥“Àå(19)
°“√ª√–‡¡‘𧫓¡§ÿ⡧à“∑“߇»√…∞»“ μ√å¥â«¬·∫∫®”≈Õß Markov æ∫«à“π‚¬∫“¬ PIVCT ‡æ‘Ë¡Õ“¬ÿ¢—¬ª√–¡“≥ 5 «—π À√◊Õ 4 «—π ÿ¢¿“«–¢ÕߺŸâªÉ«¬ 1 √“¬ Õ—μ√“ à«πμâπ∑ÿπμàÕ ª√– ‘∑∏‘¿“æ à«π‡æ‘Ë¡ (incremental cost-effectiveness μ“√“ß∑’Ë 3 √“¬≈–‡Õ’¬¥¢Õß∫∑§«“¡∑’Ë»÷°…“∫√‘°“√„À⧔ª√÷°…“·≈–μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’„π™ÿ¡™π
√Ÿª·∫∫ °“√»÷°…“ √“¬≈–‡Õ’¬¥·≈–º≈≈—æ∏å
°“√μ√«®∑’Ë∫â“π Bateganya ·≈–§≥–(20) ∑∫∑«π«√√≥°√√¡‡°’ˬ«°—∫°“√„Àâ∫√‘°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’·°àª√–™“°√
∑—Ë«‰ª∑’Ë∫â“π °“√»÷°…“¢Õß Fylkesnes ·≈–§≥–‡ª√’¬∫‡∑’¬∫°“√„Àâ∫√‘°“√μ√«®∑’Ë
∫â“π·≈–§≈‘π‘°·°àºŸâ„À≠àÕ“¬ÿ 15 ªï¢÷Èπ‰ª®”π«π 2,445 √“¬ √âÕ¬≈– 84 ‡≈◊Õ°√—∫
∫√‘°“√∑’Ë∫â“π Õ—μ√“°“√¬Õ¡√—∫∫√‘°“√„À⧔ª√÷°…“·≈–°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ
‡∑à“°—∫√âÕ¬≈– 57 „π°≈ÿà¡∑’ˇ≈◊Õ°√—∫∫√‘°“√∑’Ë∫â“π ·≈–√âÕ¬≈– 12 „π°≈ÿà¡∑’ˇ≈◊Õ°
√—∫∫√‘°“√∑’˧≈‘π‘° ”À√—∫Õ—μ√“°“√¬Õ¡√—∫∫√‘°“√„À⧔ª√÷°…“À≈—ß°“√μ√«®·≈–
√—∫º≈«‘π‘®©—¬‡∑à“°—∫√âÕ¬≈– 56 „π°≈ÿà¡∑’ˇ≈◊Õ°√—∫∫√‘°“√∑’Ë∫â“π ·≈–√âÕ¬≈– 12 „π
°≈ÿà¡∑’ˇ≈◊Õ°√—∫∫√‘°“√∑’˧≈‘π‘°
Sabapathy ·≈–§≥–(21) ∑∫∑«π«√√≥°√√¡‡°’ˬ«°—∫°“√„Àâ∫√‘°“√μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’·°àª√–™“°√
∑—Ë«‰ª∑’Ë∫â“π„π°≈ÿࡪ√–‡∑»·∂∫·Õø√‘°“®”π«π 21 ‡√◊ËÕß √“¬ß“πÕ—μ√“°“√
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¡’‡æ’¬ß Corbett ·≈–§≥–∑’Ë»÷°…“„π°≈ÿࡪ√–™“°√∑—Ë«‰ª ·≈–√“¬ß“πÕ—μ√“°“√‡¢â“
√—∫∫√‘°“√μ√«®‡∑à“°—∫√âÕ¬≈– 51 ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°≈ÿà¡∑’Ë∂Ÿ° àßμàÕ„À≪√—∫∫√‘°“√
μ√«®πÕ° ∂“π∑’Ë∑”ß“π ´÷Ëß¡’Õ—μ√“°“√‡¢â“√—∫∫√‘°“√‡æ’¬ß√âÕ¬≈– 4
∫“∑μàÕ 1 ªï ÿ¢¿“«– ®“°°“√«‘‡§√“–Àå°≈ÿ࡬àÕ¬ æ∫«à“∫√‘°“√
PIVCT ®–§ÿâ¡§à“„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬∑’˧«“¡‡μÁ¡„®®à“¬
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Õ—μ√“°“√¬Õ¡√—∫°“√μ√«® (√âÕ¬≈–)
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Facility-based VCT Community-based VCT
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μ√«®À“°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’„πª√–™“°√∑’Ë¡’Õ“¬ÿ 15-65 ªï
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‘∑∏‘ª√–‚¬™πå¥â“π°“√§—¥°√Õß∑“ß ÿ¢¿“æ√–¥—∫ª√–™“°√„π ª√–‡∑»‰∑¬é ¿“¬„μâ°“√ π—∫ πÿπß∫ª√–¡“≥®“° ”π—°ß“π À≈—°ª√–°—π ÿ¢¿“æ·Ààß™“μ‘ ‚¥¬§≥–ºŸâ«‘®—¬®“°‚§√ß°“√
ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ (HITAP) ´÷Ë߇ªìπ Õߧå°√∑’ˉ¥â√—∫°“√ π—∫ πÿπ®“° ”π—°ß“π°Õß∑ÿπ π—∫ πÿπ
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ª√–‡¡‘π‡∑§‚π‚≈¬’¥â“π ÿ¢¿“æ (RTA5580010) ·≈–
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‡Õ° “√Õâ“ßÕ‘ß
1. √“¬ß“πº≈°“√»÷°…“ ¿“√–‚√§·≈–°“√∫“¥‡®Á∫¢Õߪ√–™“°√‰∑¬ æ.».
2547. ππ∑∫ÿ√’: ”π—°ß“πæ—≤π“π‚¬∫“¬ ÿ¢¿“æ√–À«à“ߪ√–‡∑»
°√–∑√«ß “∏“√≥ ÿ¢; 2552.
2. √“¬ß“πº≈°“√»÷°…“ ¿“√–‚√§·≈–°“√∫“¥‡®Á∫¢Õߪ√–™“°√‰∑¬ æ.».
2552. ππ∑∫ÿ√’: ”π—°ß“πæ—≤π“π‚¬∫“¬ ÿ¢¿“æ√–À«à“ߪ√–‡∑»
°√–∑√«ß “∏“√≥ ÿ¢; 2555.
3. —≠™—¬ ™“ ¡∫—μ‘, ∏‘¥“æ√ ®‘√«—≤π–‰æ»“≈. ‚§√ß°“√°“√‡¢â“∂÷ß
∫√‘°“√¬“μâ“π‰«√— ‡Õ¥ å√–¥—∫™“μ‘ ”À√—∫ºŸâμ‘¥‡™◊ÈÕ·≈–ºŸâªÉ«¬‡Õ¥ å National Access to Antiretroviral Program for PHA (NAPHA).
°“√∫√‘À“√§≈—߬“μâ“π‰«√— ‡Õ¥ å: °√¡§«∫§ÿ¡‚√§ °√–∑√«ß “∏“√≥ ÿ¢.
4. ÿ§π∏“ §ß»’≈, ÿ¢ÿ¡ ‡®’¬¡μπ, °π°»—°¥‘Ï «ß»å‡ªìß, ‡æ™√—μπ廑√‘ ÿ«√√≥,
«√√≥’ ™—¬»‘√‘‡æÁ≠¿“§, Õÿ…“ ‚∂À‘π—ß,·≈–§πÕ◊ËπÊ. √“¬ß“π©∫—∫ ¡∫Ÿ√≥å
‡Õ¥ å¿“¬„μâ√–∫∫ª√–°—π ÿ¢¿“æ „πª√–‡∑»‰∑¬. ππ∑∫ÿ√’:
”π—°ß“π«‘®—¬‡æ◊ËÕ°“√æ—≤π“À≈—°ª√–°—π ÿ¢¿“æ‰∑¬; 2553.
5. Martin EG, Schackman BR. Updating the HIV-testing guidelines- a modest change with major consequences. N Engl J Med 2013;368(10):884-6.
6. «‘‡§√“–Àå ∂“π°“√≥å‚√§‡Õ¥ å„πª√–‡∑»‰∑¬ [‡«Á∫‰´μå]. ”π—°‚√§
‡Õ¥ å «—≥‚√§·≈–‚√§μ‘¥μàÕ∑“ß‡æ» —¡æ—π∏å °√¡§«∫§ÿ¡‚√§.; 2554 [‡¢â“∂÷߇¡◊ËÕ 20 °ÿ¡¿“æ—π∏å 2556]. ‡¢â“∂÷߉¥â®“°: http://www.aidsthai.org/
th/contents/view/5.
7. «‘‡§√“–Àå ∂“π°“√≥å‚√§‡Õ¥ å„πª√–‡∑»‰∑¬ (ª√–®”ªï 2552) [‡«Á∫‰´μå]. ”π—°‚√§‡Õ¥ å «—≥‚√§·≈–‚√§μ‘¥μàÕ∑“ß‡æ» —¡æ—π∏å
°√¡§«∫§ÿ¡‚√§; 2552 [‡¢â“∂÷߇¡◊ËÕ 20 °ÿ¡¿“æ—π∏å 2556]. ‡¢â“∂÷߉¥â
®“°: http://www.aidsthai.org/th/contents/view/5.
8. ∂“π°“√≥å°“√μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’ª√–‡∑»‰∑¬ æ.». 2554: ”π—°
√–∫“¥«‘∑¬“ °√¡§«∫§ÿ¡‚√§ °√–∑√«ß “∏“√≥ ÿ¢; 2555. ‡¢â“∂÷ß
‰¥â®“°: http://www.boe.moph.go.th.
9. ª√–æ—π∏å ¿“πÿ¿“§. AIDS 2012; 2554 [‡¢â“∂÷߇¡◊ËÕ 19 °ÿ¡¿“æ—π∏å 2556]: ‡¢â“∂÷߉¥â®“°: http://th.trcarc.org/index.php?option=com_
content&view=category&layout=blog&id=37&Itemid=27.
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11. ∞“π¢âÕ¡Ÿ≈ ç°“√ª√–‡¡‘π‡∑§‚π‚≈¬’¥â“π ÿ¢¿“æ„πª√–‡∑»‰∑¬é [‡«Á∫‰´μå]. ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ
‡¢â“∂÷߉¥â®“°: http://db.hitap.net/articles.
12. Rothman RE, Ketlogetswe KS, Dolan T, Wyer PC, Kelen GD.
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13. Haukoos JS, White DA, Lyons MS, Hopkins E, Calderon Y, Kalish B, et al. Operational methods of HIV testing in emergency departments: a systematic review. Ann Emerg Med 2011;58(1 Suppl 1):S96-103.
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27. ÿ√®‘μ ÿπ∑√∏√√¡, ‡™‘¥™—¬ πæ¡≥’®”√— ‡≈‘», ‡¥àπÀ≈â“ ª“≈‡¥™æß»å.
‚§√ß°“√ª√—∫ª√ÿß·π«∑“߇«™ªØ‘∫—μ‘Õ‘ßÀ≈—°∞“π‡™‘ßª√–®—°…å
·π«∑“ß°“√μ√«®·≈–°“√ √â“߇ √‘¡ ÿ¢¿“æ„πª√–‡∑»‰∑¬ 2552.
°√ÿ߇∑æœ: ”π—°ß“π°Õß∑ÿπ π—∫ πÿπ°“√ √â“ß √‘¡ ÿ¢¿“æ; 2552.
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MMWR Recomm Rep 2006;55(RR-14):1-17.
