上海市HIV感染者和艾滋病患者医疗服务可及性研究

目的]了解上海市艾滋病病毒感染者和艾滋病患者（people livingwith HIV／AIDS，PHA）获得医疗服务的可及性及其影响因素，为进一步的干预研究提供针对性的建议。方法]采用个人深入访谈和小组访谈的方式，调查50名PHA以及46名包括政策决策者、服务提供者等在内的相关人员，定性调查资料采用N。Vivo8．0进行编码和分析。结果]上海市PHA医疗服务可及性不足，主要表现在距离可及性远，各区距上海市公共卫生临床中心平均距离达69．0kin，平均车程62min；目前仅一家定点服务机构，服务能力有限、免费抗病毒药物少、流动人口抗病毒治疗服务可及性差；PHA支付艾滋病相关诊疗服务能力不够。结论]上海市PHA获得医疗服务的可及性很不乐观，而且获得医疗服务的负担重，亟需扩大和合理利用医疗资源，提高艾滋病相关医疗服务的可及性，增强临床关怀。

Health Services Accessibility of People Living with HIV/AIDS （PHA） in Shanghai

Objective ] To learn the health services accessibility of people living with HIV/AIDS （PHA） and its influencing factors in Shanghai, and to provide suggestions for further interventions. Methods ] In-depth individual interviews and focus group discussions were conducted for data collection of 50 PHA and 46 relative personnel including policy makers, services providers, etc. N-Vivo 8.0 was used for coding and data analysis. Results ] The insufficiency of health services accessibility of PHA in Shanghai was mainly the long distance between each district and the Shanghai Public Health Clinical Center, as shown in the average distance of 69.0 km with the average travel time of 62 min. The prominent problems due to the only designated service agency were limited service capability, lack of high active antiretroviral treatment （HAART） drugs and poor accessibility to HAART drugs for the migrants. PHA showed economic unaffordability of AIDS related health services. Conclusion ] The health services accessibility of PHA in Shanghai is not so optimistic, and their burden of health care acquisition is heavy. It is urgent to improve PHA health services accessibility as well as clinical care in Shanghai.