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Objective:To investigate the situation of patients with human immunodeficiency virus (HIV) infection who re-engaging treatment after dropping-out during anti-retroviral therapy (ART), and the influencing factors of ART re-engagement in Yunnan Province.Methods:The total dropping-out cases of ART up to December 31, 2018, including cases of lost-of-follow-up and withdrawing medications in Yunnan Province were included. The status of drop-out and demographic data were collected from survey questionnaires and the extracted medical-visiting records from the China National Free Antiretroviral Treatment Program Database of Chinese Center for Disease Control and Prevention. Chi-square test was used in statistical analysis and logistic regression was applied in analyzing factors related with re-engagement.Results:Among the total 6 075 cases with HIV infection which were recorded with the status of drop-out during ART in Yunnan Province, 5 340(87.9%) cases were confirmed drop-out, 540(8.9%) cases were false dropping-out due to belated medical visiting records, 109(1.8%) cases provided invalid answers or had no response to survey questionnaire, and 86(1.4%) cases failed to report results. Among 5 340 confirmed drop-out cases, the findings showed that 923(17.3%) cases were tracked and successfully re-initiated ART, 2 327(43.6%) cases could not be contacted, 1 443(27.0%) cases refused ART, 100(1.9%) cases died, 39(0.7%) cases came back for treatment by self-willing, 91(1.7%) cases were detained, and 417(7.8%) cases were in other situations. Tracking the dropping-out cases were through the workers based on the health facilities including ART clinics, centers for disease control and prevention and the community-based organizations. They tracked the dropping-out cases by phone, through household visiting or face-to-face communication. Statistically significant differences were found in the proportion of patients re-engagement by gender, re-engagement age, route of infection, education level and time from entry to last loss ( χ2=6.14, 21.26, 8.24, 17.69, 12.75, respectively, all P<0.050). The logistic regression suggested that the protective factors related with the re-engagement included female (adjusted odds ratio (a OR)=1.34, 95% confidence interval ( CI) 1.12 to 1.61, P=0.002), re-engagement age≤30 year-old (a OR=1.78, 95% CI 1.25 to 2.55, P<0.001), age of 31 to 60 year-old (a OR=1.33, 95% CI 1.01 to 1.76, P=0.043), education level with primary school to high school or technical secondary school (a OR=1.56, 95% CI 1.21 to 2.01, P<0.001), the period>24 months between first initiating ART and dropping-out (a OR=1.37, 95% CI 1.11 to 1.70, P=0.004). Conclusions:The program of tracking and re-engagement for ART dropping-out patients in Yunnan Province needs multi-department participation and investing large resources, but the success rate of tracking and re-engagement is not high. The protective factors related with re-engagement are female, re-engagement age≤60 year-old, education level with primary school to high school or technical secondary school, the period>24 months between first initiating ART and dropping-out.
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The paper expounds the ethics problems caused by doctor's selling activities in consulting room,which means the conflicts between doctors and patients, purchase pressure implied in seeking medical ad vice, disgrace to the aim of medical service etc. Furthermore puts forward some suggestions about strengthening management, stopping doctors' selling activities:1. to curb doctors' selling activities in consulting room; 2. to formulate health law and regulations, standardize medical behavior; 3. to deepen health reformation, improve investment mechanism.