Y HOC VIET NAM THANG 6 • SO 1/2015
MO HiNH BAC THANG HIV/STI: KET QUA CAN THIEP NANG CAO SITC K H 6 E T I N H DUC CHO NAM BAN D A M DONG GIOI 6' H A NO!
T O M TAT
Sif tham gia, gan ket vdi can thiep di/ phong cham soc HIV 6 nam quan he tinh due dong gidi trong do CO nam ban dam dong gidi (NBDDG) con han che.
Nghien cffu hoi effu ho so khach hang la NBDDG tham gia can thiep nang cao sffc khoe tinh due nam 2014- 2015 nhSm mo ta mo hinh bac thang HIV va benh lay tmySn du'dng tinh due (STI). Co 349 ngu'di tham gia, ty" l§ nhiem HIV la 7%, nhiem mpt trong ba benh giang mai, lau va chlamydia la 29%. Ty le quay trd lai I3y k6t qua va tu' van sau xet nghiem la 50%. Co tdi 32% ngu'di tham gia mSc mot trong bon benh HIV/STI. Ty I? ngu'di du'Ong tinli vdi mpt trong bon benh, biet ket qua va du'dc tu' van sau xet nghiem la 23%. Ty l§ nhffng ngu'di du'dc dieu trj STI va/ho3c chuyen gid HIV la 20%. Can thiep gop phan lam giam ty I? mat dau qua cac nac thang trong mo hinh bac thang HIV/STI. Can tSng cu'dng cac bien phap ttiu th^p thdng tin lien lac vci lien lac, nang cao si/ gan ket vdi kh^ch hSng. CSn cd them nghien ciru ve hanh vi tim kiem sffc khde vb md hinh dd phong, cham sdc cho nhuYig NBDDG,
TWkhda: Mo hinh bac thang HIV/STI, sffc khde tinh di^c, nam b^n dam dong gidi
S U M M A R Y
H I V / s n CASCADE: RESULTS FROM THE SEXUAL HEALTH P R O M O T I O N I N T E R V E N T I O N FOR MEN SELL SEX
TO OTHER MEN I N H A N O I Participation and engagement in HIV prevention and care interventions among men who have sex with other men including men sell sex to other men is limited, A retrospective chart review was performed of 349 male sex workers (MSW) at the sexual health promotion intervention in 2014-2015 to discribe HIV and sexually transmitted infection (STI) cascade.
Among 349 participants, proportion of being infected with HIV was 7%, with one of three STI namely syphilis, gonorrhea and chlamydia was 29%. Rate of
* Tmng lam Nghien cuU va Dao tao HIV/AIDS, Tm&ng 0^1 hgc YHa Ngi
**Bg mon Dich tehgc, Tru'dng D^i hgc Y Ha Ngi Chju trach niii?m chinh: Vu Offe Vi$t Email: vdviet@hmu,edu.vn Dt: 0966611576 Ng^y nh$n bdi: 20/3/2015
Ngay phan bien khoa hpc: 4/4/2015 Ngay duyet b4i: 20/4/2015
Vu Dire Viet*, Le iVIinh Giang**
returning for results and post-test counselling was 50%. Up to 32% of the participants was infected with one of the four HIV/STI. Rate of cases positive with the four HIV/STI, knowing the results and receiving post-test counselling was 23%. That of those being treated for s n and referred for HIV was 20%. The intervention helped to reduce rate of lost followup through steps in the HIV/STI cascade. Improvement in attiaining contact and contacting MSW is needed.
There should be further research on health seeking behavior, and prevention and care model for MSW.
Keywords: HIV/STI cascade, sexual health, male sex workers
I. DAT VAN OE
Hieu qua va sff thanh cong cua cae can thiep dff phdng, cham sdc HIV deu can ed sff tham gia va gan ket eiia nhffng doi tu'dng dffdc hu'dng ldi trffc tiep tff can thiep do. Tuy nhien, nghien CU\J da cho thay sff tham gia va gSn ket eua nhffng nam quan he tinh due dong gidi, trong dd eo nam ban dam dong gidi la kha thap. Ket qua giam sat ket hdp hanh vi va cac ehi so sinh hpc 2006 va 2009 eho thay ty le nam eo quan he tinh due dong gidi (NQHDG) da tffng xet nghiem va quay t r d lai nhan ket qua xet nghiem HIV la du'di 30% ( 1 , 2). Tuy nhien, hien tai chda cd nhieu can thiep ket hdp dff phong HIV vdi sang Ipc, dieu t n cae nhiem trung lay truyen qua dffdng tinh due (viet tat la STI) cho nhffng NQHDG, eijng nhu' chu'a cd nghien cffu danh gia sff tham gia gan ket eiia hp vdi can thiep.
Cae giao due vien sffe khde tff van eung cap thong tin ve nhffng chii de lien quan den sffc khde tinh dye nhu" tam quan trpng ciia sffc khde tinh due, sff da dang tinh due, HIV va benh lay truyen qua du'dng tinh due, k/ thi va iffig pho vdi ky thi. Sau khi co ket qua xet nghiem, nhffng ngffdi du'dng tinh vdi HIV se dffdc gidi thieu chuyen girt den cac cd sd chSm soc dieu trj ngoai tru. Nhffng tru'dng hdp du'dng tfnh vdi STI se du'dc dieu trj va/hoac chuyen girt den benh vien chuyen khoa da lieu. Tuy nhien vdi sff chuan bi chu dao va cung cap dich vu can thi?p tu'dng doi hoan thien nhu* vay, sff gan ket cua khach hang c6 dffdc cai thien hay khong con chu'a du'dc biet ro. Do dd nghien effu nay dffdc
Y HOC VlgT NAM THANG 6 • SO 1/2015
thu'c hien vdi mue dich tim hieu mo hinh bac thang HIV/STI d nam ban dam dong gidi tham gia can thiep nang cao sffc khde tinh due.
II. OOI TUglSJG VA PHU'aNG PHAP NGHIEN CUXJ Nghien eifXi hoi cffu ho sd toan bp khach hang da tham gia ccn thiep NCSKTD tff thang 6 nam 2013 den ngay 31 tiiang 3 nam 2015, Doi tu'dng nghien cffu la nam ban dam dong gidi (NBDDG) tren dja ban thanh pho Ha Npi, Nhffng ngu'di du'dc mdi tham gia can thiep dffdc chpn mau theo thdi gian va dia diem. Tru'dc tien nhdm nghien cffu xae dinh dja diem va thdi gian ma NBDDG thu'dng xuyen xuat hien, Cae dja diem du'dc khao sat bao gom nhffng ndi cong epng nhff vffdn hoa cong vien va quanh cae ho Idn; va eac ed sd eung cap djch vu nhu' eae quan xong hdi, mat xa tam quat cho nam gidi va do nhan vien la nam gidi thffc hien. Sau do, tat ea eac ddi tu'dng tai nhffng dia diem tren du'dc sang Ipe, neu dil tieu chuan se du'dc mdi tdi ddn vj tu' van sffe khoe nam gidi dat tai tru'dng Dal hpe Y Ha Npi de tham gia vao can thiep. Tieu chi Iffa chpn bao gom sinh ra ed gidi tinh sinh hpe la nam gidi, trong dp tuoi tff 16 den 29, hien dang eu' tru tai Ha Npi, cd quan he tinh due vdi it nhat mpt ngu'di nam gidi khac de doi lay tien hoac ldi fch vat chat khac trong vdng 90 ngay qua, va tff nguyen tham gia nghien euli, Tong so ed 349 doi tu'dng da tham gia vao can thiep.
So lieu du'dc thu thap va phan tfch bao gom nhffng thong tin ed ban ve tuoi, dja diem dot tffdng dffdc tuyen chpn, ket qua xet nghiem HIV va s n gom giang mai, lau, chlamydia va thffc
trang quay lai lay ket qua xet nghiem, dieu tri va chuyen girt. So lieu du'dc xff ly bang chu'dng trinh phan mem Excel 2013. Cac phan tich thong ke mo ta du'dc thffc hien. Nghien cffu can thiep da du'dc thong qua bdi Hpi dong dao dffe Tru'dng Dai hpc Y Ha Npi.
III. KET QUA
Co 349 NBDDG da tham gia can thiep du'dc tu' van tru'dc xet nghiem va xet nghiem HIV/STI.
Ngu'di tham gia cd dp tuoi trung binh la 22,6. Ty- le doi tu'dng du'dc tuyen chpn tff nhffng dja diem djch vu la 42%, va tff nhffng dja diem cong epng la 58%. Ty le ngu'di tham gia du'dng tfnh vdi HIV la 7%, trong dd b/ ie ngffdi du'dng tfnh dffpc chuyen giii la 5%, Ty le dffdng tfnh vdi mpt trong 3 STI gom giang mai, lau va chlamydia ia 29%, trong do ty le ngu'di da du'dc dieu trj nhffng benh tren la 19%. Trong so 113 ngu'di mac mpt trong bdn benh bao gom HIV, giang mai, lau va chlamydia, ty le so ngffdi mac 1 benh, 2 benh dong thdi, va 3 benh dong thdi lan lu'dt la 77%, 17% va 6%. Khong cd ngu'di nao dong thdi mac ca 4 benh,
Bieu do 1 trinh bay mo hinh bac thang HIV/sn d NBDDG da tham gia can thiep nang cao sffc khde tinh due. Trong so 349 ngffdi tham gia, ty le so ngu'di da quay trd lai lay ket qua xet nghiem la 50%. Cd tdi 32% ngu'di tham gia mac mpt trong 4 benh s n bao gom HIV, giang mai, lau va chlamydia. Ty le sd ngu'di dffdng tfnh vdi mpt trong bon benh biet ket qua va dffdc tff van sau xet nghiem la 23%. Ty te nhffng ngu'di du'dc dieu trj s n va/hoac chuyen girt HIV la 20%.
120%
100%
80%
60%
40%
20%
0%
Bieu do 1: Mo hinh bac thang HIV/STI c^ NBDDG Efamgia can thifp nang cao su'e khoe tinh dye (n=349)
Tu v5n, x6t
I
nghiem HIV/STI
Bietk^tqua.du'vc HIV/STIduo'ng tu'vlnsaux^t tinh(+)
nghiem
HIV/STI (+) biet STI(+) di^u ketqua.du'O'ctU' tri, HIV(+)chuyen
v l n s a u X N gm
Y HOC VIET NAM THANG 6 - SO 1/2015
IV. BAN LUAN
Ket qua cua nghien cu'u nay cho thay ty le NBDCG mac HIV va cac STI kha cao. So vcli ket qua nghien citu cung tren nhom NBDDG du'dc thirc hien nam 2010 (3), ty ie ngu'di n h i i m HIV trong nghien cCru nay cao hdn dang ke, 7 % so vdi 2%. Ty le nhiem giang mai, iau va chlamydia cung cao hdn. SU khac biet nay co the la do nghien cu'u tru'dc day thu'c hien phong van cat ngang va xet nghiem sang loc HIV/STI, trong khi do nghien cu'u can thiep nay da cung cap mot djch vu can thiep toan dien bao gom ca kham va t l / van ve su'e khoe tinli d_uc. NhuHg ngu'di cd van de ve su'e khoe, co bieu hien cua benh lay truyen diTdng tinh due cd nhieu kha nang tim den can thiep nhieu lidn nhutig ngu'di khong cd dau hieu cua benh (4). Tuy nhien, sir gia tang ty le mae HIV/STI nay phai chang la eo sir gia tang so ngu'di m k thiTe sir trong nhom nay.
Tham gia tu^ van, xet nghiem HIV giup eho nhung ngu'di eo nguy ed nhu' nam quan he tinh due dong gidi c6 ban dam hieu du'dc nguy ed lay nlilem cho ban than ho, gop phan giup ho thay doi hanh vi nguy cd eung nhu' tiep can djch vu y te. Tuy nhien, nghien dia cho thay phan Idn nhD'ng ngu'di nay khong du'dc xet nghiem, biet ket qua va du'cJc tu' van sau xet nghiem (5). Ket qua nghien eihi nay cho thay ty le nhiilng ngu'di tham gia can thiep niing eao su'e khoe tinh due quay t r d lai lay ket qua xet nghiem da dUde nang len d^ng ke. Cd du'dc ket qua nay la do can thiep da thiTe hien mpt so nhu'ng eal thien trong vile pho blen thong tin ve can thiep, thu thap thong tin khach hang, cung cap dich vu than thien CO chat lu'dng, va lien lac vdi khach hang sau can thiep.
Can thiep da ehu trong xay dimg ed sd vat chat, dao tao chuyen nion va ky nang eho dpi ngu nhan vien tu' van giao due sire khde va nhan vien y te. Thong tin ve can thiep eung du'dc pho bien rong rai. Viee nay da tao dieu kien cho nhihig NBDOG de dang tiep can va cam thay thoai mai khi tham gia kham, xet nghiem ve sire khde tinh due trong d d ed HIV va STI. Cu the can thiep da cung cap ro dja ehi, sd do du'dng d l , tuyen xe bu'/t, trang t r i eae phdng chifc nang, phat trien logo, t d rdi eung cap thdng tin, website sdng_hanh_phiie cung cap thdng tin ve hoat ddng ciia phdng kham. Trang Facebook sohg_hanh_phuc giup gia tang ket noi vdi epng dong nam eo quan he vdi nam gidi. Odi ngu nhan vien cd trinh do, cd kinh nghiem du'dc dao tao tap huan ve sire khde tinh due, tu' van xet nghiem HIV, ky nang phdng van tao ddng li/c.
Mo hinh bac thang HIV/STI cho^thay can thiep da gdp ph3n lam giam ty le bj^ mat dau qua cac giai dpan trong qua trinh du' phong cham soc ngu'di nhiem. Mot so nguyen nhan cd the dan den viec khach hJng khong quay t r d lai nhan ket qua va de nhan dUdc dich vu dieu trl STI va chuyen girt HIV. Mpt so ngu'di khdng cd hoac thay doi so dien thoai, cung cap sd dien^^thoai khdng chinh xac. Cd ngu'di da sau can thiep da chuyen dia diem lam an sinh song, hoac ban viec. Cd ngUdi lai sd biet tinh trang benh ciia minh. Nhu' vay, sir c i i thien trong phu'dng phap tiep can huy dpng ddi tu'dng tham gia can thiep, stf nang cao chat lu'dng dich vu da gdp phan nang eao gan ket eiia NBDOG vdi can thiep nang eao sire khde tinh due. Tuy nhien sir tham gia, gan ket con cd nhu'ng han che nhat dinh,^phan ldn la do tfnh di bien dpng cao eua quan the nay.
V . KET LUAN
Ty le nhiem HIV va eae benh lay truyen du'dng tinh due d NBDOG tham gia nghien CU\J la kha cao, trong khi dd ty le nhu'ng ngu'di gan ket vdi can thiep nang eao sire khde tinh due edn han ehe. Can thiep nay da gdp phan lam giam ty le mat dau doi tu'dng qua cac bac thang trong rhd hinh bac thang HIV/STI. Tuy vay, can thiep nay ran tiep tue tang cu'dng cac bien phap thu thap thdng tin lien lae, nang cao hdn ni?a sir gan ket vdi khach hang. Can ed them nghien ciru ve hanh vi tim kiem sire khde va md hinh eh§m sde cho nhu'ng NBDOG.
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