艾滋病歧视背景下少数民族地区医务工作者卫生系统反应性的前瞻性研究：调整患者期望的测量

消除艾滋病歧视是促进高危人群进入艾滋病医疗服务的关键。而以病人为中心的医疗照顾及对病人赋权是行之有效的策略。2015-2016年前期研究发现云南省艾滋病患者就医期望八个领域均低于非艾滋病患者，调整患者期望及社会经济因素后非艾滋病患者就医感受仍较艾滋病患者差即使艾滋病患者有较高的内化歧视得分。影响卫生系统反应性的原因仅仅源自患者？有证据表明与卫生服务提供者合作可减少医疗机构中的歧视。卫生系统反应性的八个领域体现了满足患者就诊期望的需求。课题组假设“卫生系统反应性存在多角度的影响因素，改善关键可能是医务工作者；针对他们开发卫生系统反应性模块的干预策略，可能减少艾滋病歧视”。本研究拟1）基于Vignette发展卫生系统反应性简化量表，保证测量准确及推广；2）使用卫生系统反应性模块的干预策略，通过为期2年的随访研究，以期提高卫生系统反应性，降低艾滋病歧视；3）明确卫生系统反应性多角度的影响因素。

The key problem of improvement of access to HIV healthcare is the block of HIV/AIDS stigma, meanwhile the effective pathway may be to provide the patient-centered healthcare and empowerment of patients. In 2015-2016 in Yunnan, our study found that there were lower expectation of HIV patients among eight domains of HSR than non-HIV patients. Meanwhile, there were lower experiences` perception among non-HIV patients among six domains than HIV patients even adjusted with patients` expectations and socio-economic factors especially higher score of internalized stigma among HIV patients. Are influencing factors of HSR just relative to patients? Existing evidence suggested that cooperation with healthcare providers reduced HIV/AIDS stigma in healthcare setting. While, the eight domains of health system responsiveness (HSR) fully reflects the needs to meet the patients` expectations. Thus, we hypothesized that the influencing factors of HSR are multi-angle and healthcare providers are maybe the key population to improve responsiveness. We also hypothesized that development of intervention strategies based on health system responsiveness module may reduce HIV/AIDS discrimination. Therefore, the study aims: 1) based on vignette measurement to develop simplified scale about health system responsiveness to evaluate quality of healthcare and broad application; 2) The intervention strategies from health system responsiveness module may reduce HIV/AIDS discrimination through a two-year follow-up study; 3) to explore the multi-angle influencing factors of HSR.