VAI TRO CUA Y TE TIT N H A N TRONG HOAT DONG PHONG CHONG HIV/AIDS TAI 4 TINH BUOC HO TRO* CUA DIT AN QUY T O A N CAU T O M TAT Nghien cffu cat npang nham 6anh gia vai tro cua y te tif
Trang 1VAI TRO CUA Y TE TIT N H A N TRONG HOAT DONG PHONG CHONG
HIV/AIDS TAI 4 TINH BUOC HO TRO* CUA DIT AN QUY T O A N CAU
T O M TAT
Nghien cffu cat npang nham 6anh gia vai tro cua y
te tif nhan trong cong tac phong chong HIV/AIDS
du'Oc thu'c tiien tai 252 cd s6 y te tif nhan 6 8 huyen
thuoc 4 tinh tren_toan quoc di/a tren cac chi so va
thang do 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%), t u 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 con du'Oc
hp sinh Vai tro cua y te tu" trong phong chong
HIV/AIDS con han che Can tang cu'dng dao tao, giam
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
P A R T I C I P A T I O N OF PRIVATE HEALTH
SECTOR I N H I V / A I D S CONTROL I N 4
PROVINCES SUPPORTED BY GLOBAL FUND
This cross-sectional study which aims to assess
the role of pnvate health care facilities in the
health facilities in 8 districts in 4 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 counseling (10.3%) and rapid HIV voluntary
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
Nguyen Hoang Long*, Tran Khanh Toan**
L DAT VAN DE
Viet Nam da dat du'dc nhieu thanh tiTu trong 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 do 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, trong do 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 trong cac chu'dng trinh y te quoc gia nhu'cong tac phong chong HIV/AIDS [1,2] Nghien cu'u nay du'dc thyc hien trong khuon kho Dl/ an Ho trd he thong y te do Quy Toan cau tai trd trong 5 nam (2012-2016) nhkm ho trd tang cu'dng nang lu'c he thong y te, gop phan cai thien va duy tri cac thanh qua cua cac chu'dng trinh y te quoc gia khac, ca trong ITnh vi/c y te cong va tu'
Muc tieu: Mo ta hoat dpng cua y te tu" nhan
trong phong chong HIV/AIDS tai 4 tinh thu'c hi?n
dy an ho trd he thong y te do 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 4 tinh Quang Ninh,
Khanh Hoa, Binli Phu'dc va Soc Trang tLf thang 6-9/2013, moi tinh chpn mpt huyen nong thon va mpt thi xa, thanh 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
Trang 2mem SPSS 11.5 vdi cac test thong ke mo ta d
mii'c y nghTa thong ke a= 0,05
III K I T QUA NGHIEN cCrU
3.1 Thong tin ve doi tu'dng nghien cii'u
Trong so 252 cd sd y te tU tham gia nghien
cinj, CO 168 phong kham npi (66,7%); 46 phong
kham San/nha hp sinh (18,2%); 23 phong kham
Tat ca cac cd sd deu co bac sT lam viec tai cac cd
sd y te nha nu'dc dang ky kham chya benh ngoai
gid hoac can bp y te ve hu'u phy trach vdi nhan
lyc tu" mpt den tren mu'di ngu'di Doi tu'dng tra Idi
chu yeu la bac sT chiem 91,6%, vCra lam quan ly
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
3.2 Hoat dong cung cap dich vu phong chong HIV/AIDS
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 sinh due (18,6%) va nhiem trung cd hoi (14,4%) Cd 10,3% cd sd tL/ van dieu trj ARV va chi 8,3% so
cd sd cd xet nghiem test nhanh HIV
Bieu do 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
T u van HIV tir nguyen
Chuyen giri bpnh nhan
0 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 nhanh HN; ty le nay d cac PKDK cao hdn so vdi cac phdng kham Ngi va Nhi vdi p <0,05 (Bieu do 2)
Bieu do 2 Ty le cac CSYT cd cung cap djch vu tu' van va xet nghiem HIV
36.4 34 9 Tir v k v e HIV AIDS
I PK Nhi
PKSK PKN'pi
22,7% cac PKBK cung cap dich vu dieu tri nhiim trung cd hoi va sang Ipc Lao cho benh nhan HIV/AIDS, caohdnso vdicac phdng kham Noi, Nhi (p<0,05) Cung cap djch vu td van dieu tri ARV d cac lOfil CSYT la tddng du'dng nhau
Trang 3Bleu do 3 Ty le cac CSYT co dich vu cham soc, dieu tri cho BN HIV/AIDS
Dieu tri iiluem triing co hoi
I Sana lpc Lao cho BN
I Tu vin di^u tn AR\' -0
PKNoi PK Nhi
Co 89,1% phdng kham San/nha hg sinh va 31,8% PKBK cung cap dich vu td van phdng chong lay truyen td me qua con, Ty le cd sd co lam xet nghiem HIV cho phu niT mang thai lan Iddt la 28,3% va 9,1% Cd 73,9% phdng kham san va 54,5% PKBK gidi thieu phu nO den CSYT khac lam xet nghiem (Bleu do 4)
Bleu do 4 Ty le cung cap dich vu phong lay truyen HIV tir me sang con
:l00 " " \ " " y ^ " S9,l
Tu vin lav tniyin HIV me - con
73.9 :
• Xel nghi?m HIV cho PNMT :m HIV cho PNMT M H H
J J PKBK PK San/Nha hp sinh
Bang 1 cho thay khoang 50% so cd sd dddc tap huan ve phdng chong HIV/AIDS; hdn 60% cd sd co tii lieu hddng dan dd phdng lay truyen me con va dddi 30% cd tai lieu hddng dan td van td nguyen
Ty le dddc cung cap bleu mau bao cao, dddc phan hoi thong tin va dddc ho trd chuyen mon rat thap, nhat la vdi td van HIV td nguyen
Bang 1 Ty le CSYT du'dc ho tra, giam sat hoat dpng phong chSng HIV/AIDS
Chi so
Du'Oc tap huan
Co san tai lieu
Dtroc cung cap bleu mau
Du'dc phan hoi thong tin
Du'dc giam sat chuyen mon
Tu* van tir nguyen
48,8 28,9 2,0 7,3 5,4
Du* phong lay truyen me con
53,3 61,0 10,4 22,7 11,3
IV BAN LUAN
Y te tu' nhan d Viet Nam hinh thanh tu' cuoi
nhu'ng nam 1980 va da du'dc luat hoa thong qua
Phap lenh hanh nghe y te tu' nhan ban hanh lan
dau nam 1993, lan thi? hai nam 2003 [3] Ngoai
ra Dang va Nha nu'dc cung co nhieu chu trifdng,
the nham tao dieu l<len phat trien mang lUdi y te tir nhan Trong bol canh do y te tu" nhan da phat trie'n tu'dng doi nhanh chong Y te tu' nhan da trd thanh mpt bp phan khpng the tach rdi trong h§ thong y te Viet Nam va co nhu'ng dong gop quan trpng trong cung cap djch vu chSm soc sik khoe
cho ngu'di dan [2] Tuy nhien sir tham gia dia
Trang 4cac Cd sd y te tu" nhan hien nay chu yeu chi mdi
tap trung trong viec cung cap cac djch vu dieu t n
Chu:a co cac nghien CLTU danh gia ve vai trn cua y
te tu" nhan trong cong tac y te diT phong va cac
chudng trinh y te quoc gia Trong khi do, d nhieu
nu'dc tren the gidi, y te tu* nhan cung tham gia tich
cue trong cong tac du* phong va hdp tac cong tu'
d^ gop phan quan trpng trpng viec thu'c hien cong
tac cham soc SLTC khoe d i / phong noi chung va
tnang phong chong HIV/AIDS noi chung [ 5 ]
Ket qua nghien CCTU cho thay vai tro cua y te
tu" nhan trong phong chong HIV/AIDS tai cac dja
phu'dng tham gia nghien CLTU con han che, chu
yeu tap trung vao mang du" phong V i hoat dpng
tu" van va xet nghiem chi mdi co 34,5% cac cd sd
CO cung cap djch vu tu" van va chi cd 8,3% cac cd
sd CO thi/c hien xet nghiem test nhanh HIV Mpt
ly do khien viec lam xet nghiem test nhanh HIV
tu" nguyen it du'dc cac phong kham quan tam bdi
djch vu nay da du'dc trien khai d nhieu cd sd y te
cong [1], Hdn nuci cac cd sd y te tu' hoat dpng
vdi muc dich ldi nhuan thong qua thu phi dich vu
trong cac djch vu nay rat kho thu phi Cac cd sd
y te tu" nhan co nhieu thuan ldi hdn trong viec
thu hut doi tu'dng den t U van HIV t y nguyen bdi
tfnh thuan tien va kha nang bi mat [ 5 ] Neu tang
cu'dng cac djch vu nay tai cac cd sd y te tif se
t5ng kha nSng tiep can cua khach hang va gdp
phan dang ke cho cong tac phong chong
HIV/AIDS [ 4 ]
Cong tac phong chong lay truyen tir me sang
con cung du'dc trien khai tai cac cti sd y te tu",
trong do chu yeu la hoat dong tu' van (31,8% cac
phong kham da khoa va 8 9 , 1 % cac phong kham
san) Mac du thupc cac dja ban du'dc ho trd ciia
Quy To^n cau song chi co 9 , 1 % cac PKOK va
28,3% cac phong kham san khoa thifc hien viec
xet nghiem sang Ipc cho phu nu' mang thai Con
s6 nhy rat thap so vdi ty le 43,4% phu nu' mang
thai d khu vi/c thanh thj va 69,6% d khu vu'c
ndng thon trong mpt nghien cu'u gan day co di
kham thai tai cac cd sd y te tu' nhan [ 6 ] Trong
khi 66 muc tieu cua chu'dng trinh la tat ca phu nu'
mang thai phai du'dc sang Ipc HIV tru'dc sinh va
trong nSm 2012 co hdn mpt trieu lu'dt phu nQ'
mang thai du'dc sang Ipc HIV Bii lai, cd 54,5%
cac phong kham da khoa va 73,9% cac phong
kham san gidi thieu phu nu* den cac cd sd y te
khac de lam xet nghiem
Vdi dich vu dieu trj va ch3m sdc benh nhan
HIV/AIDS, c^c'cd sd y te t\f nhan cung chi mdi
tham gia chii yeu vao viec chuyen gul benh nhan
(47,3% so cd sd) Cong tac dieu tri tap trung chii yeu vao dieu tri cac benh lay truyen qua dUdng sinh due (18,6%) va dieu trj nhiem trijng cd hpi (14,4%) So phong kham co sang loc benh lao cho benh nhan nhiem HIV/AIDS chi chiem t / le thap (cao nhat cung chi la 22,7% d cac PKOK) Mac du CO khoang 10% so cd sd cd tu' van ve dieu tri ARV song chu'a co phdng kham nao tham gia dieu t n do hoat dpng nay chi mdi du'dc trien khai d cac cd sd y te cong vdi khoang 70.000 ngu'di du'dc dieu trj tfnh den cuoi nam 2012 [1], Mac dii SI/ tham gia ciia cac cd sd y te t i / trong phong chong HIV/AIDS dang timg bu'dc dddc quan tam, song cac hoat dpng giam sat ho trd hien van het sii'c han che Ket qua nghien cirtj cho thay chi mdi co khoang tren du'di mpt nira so
cd sd du'dc tap huan ve phong ch6ng_ HIV/AIDS
va chi mdi co 28,9% so cd sd co san tai lieu
hu'dng dan tu* van HIV tiX nguyen va 61,0% co tai
lieu hu'dng dan tu' van lay truyen tir me sang con Chu'dng trinh phong chong HIV/AIDS doi hdi
cac cC sd y te tham gia phai bao cao ket qua hoat dpng ca ve tif van va dieu trj song sd cd sd
du'dc cung cap bieu mau ciia chu'dng trinh cung chi mdi dat 2,0% vdi tu' van HIV tir nguyen va 10,4% vdi tu' van lay truyen tir me sang con Mac dii ty le cd sd thu'c hien viec chuyen giri benh nhan la 47,3% tuy nhien chi co 7,3% du'dc phan hoi thdng tin vdi tu' 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 me sang con cijng chi la 11,3% Cac chi so nay dcac dia phUdng khac khong du'dc ho trd ciia Quy Toan cau chac chan con thap hdn Oieu nay doi
hoi cac cd quan chirc nang can tang cu'dng hoat
dpng giam sat, ho trd chuyen mon ky thuat cho cac cd sd y te tu' de hp tham gia ti'ch ci/c va co hieu qua hdn nUa trong cac hoat dpng ciia chu'dng trinh Tru'dc het can phai cd cac quy dmh
ve vai tro, chirc nang nhiem vy ciia cac cd sd y
te tu' nhan trong chu'dng trinh; xay duTng mo hinh
to chirc chuan, dao tao can bp, cung cap bieu
thuat va giam sat de dam bao cac hoat dpng dien ra theo dung yeu cau
V KET LUAN Sir tham gia ciia cac cd sd y te tU vao hoat dpng phong chdng HIV/AIDS tai cac tinh tham gia nghien cu'u van con han che Cac cd sd y te
Trang 5tif nhan chii yeu tham gia tiX van HIV tu" nguyen
(34,5%) va tu' van d y phong lay truyen HIV tCr
me sang con ( 8 9 , 1 % so phdng kham san) Chi
8,3% cac cd sd thyc hien dirpc viec xet nghiem
t y nguyen va 2 9 , 1 % cac phong kham san xet
nghiem sang Ipc HIV cho phu n y mang thai
Cong tac dieu tri chii yeu la dieu tri nhiem triing
qua du'dng sinh due (18,6%) va nhiem triing cd
hpi (14,4%), cac tru'dng hdp khac du'dc chuyen
giri (47,3%) va chu'a tham gia dieu tri ARV Chi
mdi khoang tren du'di 5 0 % cac cd sd y te tu"
du'dc tap huan ve phong chdng HIV/AIDS va cd
san tai lieu hu'dng dan Ty le cd sd du'dc cung
cap bieu mau, phan hoi thong tin va du'dc giam
sat ho t r d ky thuat chi dat myc rat thap
V I KHUYEN N G H !
Can tang cu'dng vai tro va nang lyc cua cac
cd sd y t u nhan trong phdng chong HIV/AIDS
thong qua viec quy djnh ve chye nang, nhiem vu,
xay dyng mo hinh, cung cap thong tin, cap nhat
kien thyc ve sang Ipc, tu" van ve HIV/AIDS, xay
d y n g he thong bieu m l u bao cao, phdi hdp cong-tu" va tang cu'dng giam sat ho t r d ky thuat
TAI LIEU T H A M KHAO
1 Bg Y te (2013), Bao cao chung tong quan nganh
y te nam 2013 Nha xuat ban y hoc
£ Tran Thj Mai Oanh va cong su' (2013), Danh
gia thyc trang va de xuat giai phap nham tSng cu'dng phoi hop cong tiT trong ITnh vyc y te Viln Chien luoc va chinh sach y te
J Uy ban thu'dng vu Quoc hoi, Phap lenh ve hanh nghe y dUtfc tu" nhan 2003
4 Harvard School of Public Health (2009) An
Overview of Public Private Partnerships in Health
5 Sheikh, K., et al (2005) Urban private
practitioners; potential partners in the care of patients with HIV/AIDS Natl Med J India,18(l); p 32-5
6 Toan K Tran et al (2012) Factors associated
with antenatal care adequacy in rural and urban contexts - results from two health and demographic surveillance sites in Vietnam BMC Health Services Research, 12:40
7 UNAIDS (2013) UNAIDS report on the global
AIDS epidemic 2013
RAN DOC VA DOC TO CUA CAC LOAI RAN DOC TAI VIET NAM
Trinh Xuan Kiem*, Tran Thj Ngan**, Le KhSc Quyen*
T O M TAT
RSn dpc gay nan cho ngu'di van dang la van de y
hoc ton tai d cac nirdc nhiet ddi dang phat trien nhU
Viet Nam Tuy nhien, ran dgc d5c trung cho moi viing
dja ly khac nhau Can du'dc nghien ciru, phan loai, xac
djnh chirc nang sinh hpc, dpc hpc cac loai rSn dpc co
tam quan trpng y hpc tai moi quoc gia Theo hu'dng
dan ciia To chye Y te tlie gidi (WHO) va cac chuyen
gia hang dau the gidi, ket qua nghien ciru da xac lap
10 loai) la nguyen nhan thu'dng xuyen gay nan cho
ngu'di tai Viet Nam, Lao va Campuchia (Sangl) Dong
chet 50% (LDso) cua noc tyng loai ran dpc da dirpc
xac djnh (Bang 2) 06 clifnh la cO sd khoa hgc eiia cae
chiTdng tnnh tiep theo, dac biet che tao huyet thanh
khang nge dac hieu, thiet thyc phuc vu cap cyu tren
lam sang
Tu'khda: RSn dpc va LD50
S U M M A R Y VENOMOUS SNAKES A N D T H E I R
T O X I N S I N V I E T N A M
Venomous snakes of medical importance and snake bites are a big medical problem, but it was neglected in tropical countries such as Vietnam However, snakes are characterized for each different geographical region of the World The method for research was applied by WHO guidelines and techniques of the famous international specialists The results, Elapidae and Viperidae families, content 10
toxicologica! functions with LD50 for each venom were
the particular species of greatest medical importance is
* Vien nghien c&u phat trien cdng nghe ndng thdn
** bai hoc Y Hal phdng
*** Benh vien Viet - Phap TP Hd Chi Minh
Phan bi$n khoa hgc: GS.TS Hoang VSn Lu'dng