Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention (CDCs) System in China, 2008-2017 / 生物医学与环境科学（英文）

Objective@#Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention. Using the Centers for Disease Control and Prevention (CDCs) system of China as an example, we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017, with the aim of providing information for policymakers to support resource allocation and address growing health inequities.@*Methods@#We used three standard public health workforce inequality indices - Gini coefficient, Theil L, and Theil T - and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces, visualized with geographical tools.@*Results@#The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017, and was consistently lower than the National Health Commission's (NHC) recommended critical shortage threshold of 1.75. The workforce distribution inequality indices varied by regional socioeconomic and health system development. Geographic clustering of CDCs workforce distribution was evident, with H-H and L-L clusters in western China and the Guangdong-Fujian region, respectively.@*Conclusions@#Our study addressed key issues for government and policymakers in allocation of public health human resources. There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era, alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low-low cluster areas.

Cost-effectiveness of female sex worker interventions by using SEX 2.0 Tool in Dehong prefecture, Yunnan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To perform cost-effectiveness analysis of interventions in female sex workers in Dehong prefecture in China, with an aim of providing evidence for rational resource allocation in female sex worker interventions in the future.</p><p><b>METHODS</b>The data of expenses for female sex worker interventions in Dehong from 2005 - 2007 were obtained through questionnaire survey. Meanwhile, the data from baseline survey in 2004, from surveillance of female sex workers from 2005 through 2007 as well as from the special survey on sexual transmission in 2007 were collected. Intervention effectiveness was estimated by using SEX 2.0 Tool recommended by UNAIDS. The cost-effectiveness ratio is calculated as the total cost divided by the number of estimated non-HIV patients due to these interventions.</p><p><b>RESULTS</b>The total cost for female sex worker interventions is 916 400 RMB from 2005 through 2007, and a total of 3297 female sex workers were effectively intervened in these three years. Thus, the actual intervention cost for each female sex worker (unit cost) is 277.9 RMB. If all the intervention work is performed as required, the predicted unit cost for female sex worker intervention would be 500.5 RMB. During the period of 2005 through 2007, 69 female sex workers had been successfully prevented from HIV infection; therefore, the cost-effectiveness ratio is 13 282 RMB.</p><p><b>CONCLUSION</b>Intervention among female sex workers is highly cost-effective.</p>

Current situation and influential factors concerning the sexual transmission of HIV in Dehong prefecture, Yunnan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the current situation of the sexual transmission of HIV in Dehong prefecture, analyze the influential factors, and provide support for drafting pertinent preventive interventions in the future.</p><p><b>METHODS</b>We had analyzed the data of case report from 2005 to 2007, and the prostitutes surveillance data from 2003 to 2007. A special survey was conducted from October 26 to November 7, 2007. Totally 685 people including prostitutes, the clients of prostitutes, people who were HIV positive and their partners, key insiders were interviewed in order to better understand the influential factors related to sexual transmission of HIV.</p><p><b>RESULTS</b>Among 1636 cases reported from January 1 to September 20, 2007, 52% were infected through sexual transmission. Among 586 cases infected through sexual transmission, 40.6% had commercial sexual behavior and 28.6% had unmarried sexual behavior. And the average rate of condom use was below 30%. The prostitutes' surveillance data from 2003 to 2007 showed that the HIV positive rate in prostitutes was 3.3% - 5.5%. The rate of condom use in the last month was 29.4% - 84.4% during commercial sexual activity, but it was 9.5% - 34.8% with fixed sexual partners. Although the rate of HIV and AIDS-related knowledge among prostitutes was 95.0%, there were still many misunderstanding regarding certain aspects of HIV and AIDS awareness.</p><p><b>CONCLUSION</b>Sexual transmission has become one of the main transmission routes of HIV in Dehong prefecture. The main factors involved in the sexual transmission of HIV in Dehong prefecture might include the wide spreading of sexual services, cohabitation among unmarried couples, having multiple partners, casual sexual behavior, and the low rate of condom use.</p>

Analysis of the epidemiologic patterns of HIV transmission in Dehong prefecture, Yunnan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To uncover the transmission patterns of the HIV epidemic in Dehong prefecture.</p><p><b>METHODS</b>The reviewed case reports, data of sentinel surveillance, testing and special survey were analyzed by SAS 8.0 program. The transmission patterns were modeled by utilizing data including sizes of the whole population and the high risk groups, high risk behavior data from 1989 to 2007, and the population index such as sex ratio and fertility rate.</p><p><b>RESULTS</b>In 2005, case reports showed the proportion of people infected with HIV through sexual contact was 39.1%, and 46.9% in 2006. Among 1636 cases reported between January 1 to September 20, 2007, the proportion of people infected with HIV through sexual contact was 52%. From 1989 to 2007, the proportion of HIV infection among drug users was declining, while HIV infection through sexual contact was rising after standardizing the population tested/surveyed. The Asian Epidemic Model has shown that the proportions of incident HIV infections through sexual transmissions were 50.6%, 52.3% and 52.7% respectively from 2005 to 2007. Correspondingly, the proportions of incident cases by injecting drug user were 48.9%, 47.2% and 46.7% respectively during this period. Moreover, the Workbook method has shown that, among adults living with HIV in 2007, 50.3% were infected through injecting drugs and 48.4% through unsafe sexual activity.</p><p><b>CONCLUSION</b>The rapid rise in HIV infections through injecting drug in Dehong prefecture has been initially curbed. HIV epidemic has already witnessed a change from predominantly through drug injecting-related activity to an almost equally fuelled epidemic by sexual and drug-related transmission.</p>

Resource allocation analysis for international cooperation program for HIV/AIDS prevention and control / 中华预防医学杂志

<p><b>OBJECTIVE</b>To provide evidence for resource allocation and cooperation between domestic and international HIV/AIDS programs in China by analyzing the needs and current levels of resource input in provinces.</p><p><b>METHODS</b>National and provincial international cooperation program investment and allocation data from 2000 to 2006 were collected. Several factors in each province were analyzed through multiple regression analysis in order to determine whether they had a statistical correlation to the distribution of international HIV/AIDS program resources in China, including: the Gross Domestic Product (GDP), the number of accumulated people living with HIV/AIDS, and the number of accumulated people living with AIDS. Then the Z values were calculated at each provincial level and compared with related international investment. The resource allocation in different program areas were compared with the level of resource input by international and central government HIV/AIDS prevention and control programs through Chi-square test.</p><p><b>RESULTS</b>The international cooperation program investment at local level from 2000 to 2006 were 4893, 24 669, 50 567, 52 950, 112 143, 363 396 and 247 045 thousand RMB respectively, and at national level were 3007, 19 726, 29 035, 37 530, 77 500, 105 786 and 77 035 thousand RMB respectively. There was a statistical correlation between international HIV/AIDS program resource input and the accumulated number of people living with AIDS (R is 0.56 and 0.69 accordingly, and P < 0.01 both). However, there was no statistical correlation between international resource input and the GDP of each province. International HIV/AIDS cooperation programs did not invest in each province according to its practical needs (R = 0.066, P = 0.725). The international cooperation program investments and needs in different province could not meet completely. The ranks of Z value in Guangdong, Shandong and Jiangsu were 3, 5 and 6, but the ranks of international cooperation program in those provinces were 18, 13 and 28 respectively. The investment proportion for national investment in surveillance and testing, advocacy education and intervention, care and support, and others were 22.4%, 19.7%, 36.8% and 21.1% respectively in 2005, and for international cooperation program were 11.5%, 20.8%, 10.4% and 57.4%. For national investment in 2006 were 18.6%, 23.8%, 32.6% and 25.0%, and international cooperation program were 14.0%, 34.3%, 17.1% and 34.6% respectively. The Chinese government and international programs therefore had different priorities in 2005 (chi(2) = 35.09, P < 0.01) and 2006 (chi(2) = 9.26, P = 0.026).</p><p><b>CONCLUSIONS</b>International HIV/AIDS cooperation programs should be better integrated with national programs and combined with epidemic situation and GDP to decide the amount and areas of the investment in order to ensure that they supplement Chinese HIV/AIDS prevention and control activities effectively. The advantages that can be gained from technical support provided by international programs should be further emphasized in line with China's HIV/AIDS prevention and control priorities.</p>