Opportunities and barriers for providing HIV testing through community health centers in mainland China: a nationwide cross-sectional survey.

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.

A survey of anxiety and depression symptoms among primary-care physicians in China.

OBJECTIVE: Anxiety and depression disorder are the most prevalent mental health problems. However, few studies are available pertaining to these problems among Chinese doctors, especially the assessment of the anxiety and depression symptoms among primary-care providers. The aim of this study was to assess the anxiety and depression symptoms among Chinese primary-care physicians and their associated factors. METHODS: A cross-sectional study was conducted among 451 primary-care physicians in Shanghai China (effective response rate was 79.8%). There were 177 male physicians and 274 female physicians with average age of 37.8 (SD +/- 11.1) years. Questionnaire pertaining to depression disorder was indicated by the Zung Self-Rating Depression Scale (SDS) and anxiety disorder was indicated by the Zung Self-Rating Anxiety Scale (SAS). RESULTS: The average SAS and SDS standard scores of the primary-care physicians were 41.1 +/- 11.5 and 46.5 +/- 11.8 respectively. Both of the scale scores were higher than those of Chinese national norms (P both < 0.001). SDS standard score > or = 53 and SAS standard score > or = 50 were regarded as screening-positive criteria. SAS and SDS screening positive rates of primary-care physicians were 18.0% and 31.7% respectively. In addition, married/cohabited and divorced/widowed physicians aged over 30 years with educational background of junior college had higher risks of anxiety and depression disorders. CONCLUSIONS: Chinese primary-care physicians were at considerably high risk of anxiety and depression disorders, which was worthy of attention during healthcare system reform in China.