title: Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis.
abstract: BACKGROUND
  The growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China.
  
  
  METHODS
  A qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors' views on shifting the HIV/AIDS case management services to CHSCs.
  
  
  RESULTS
  It is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs' wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA's fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services.
  
  
  CONCLUSIONS
  Shifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be implemented alongside with other efforts and resources such as increasing public funding, planned team building, professional training, coordination with other sectors and education on privacy protection as well as non-discrimination to make this approach more effective and sustainable. Policy makers need to ensure both political feasibility and resources accessibility to facilitate this shifting process.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. mafc.key@163.com.
authors.forename: Fuchang
authors.initials: F
authors.lastname: Ma
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. fanlv@vip.sina.com.
authors.forename: Fan
authors.initials: F
authors.lastname: Lv
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. xupeng2007@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Xu
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. zhangdapeng@chinaaids.cn.
authors.forename: Dapeng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. meng_sn@hotmail.com.
authors.forename: Sining
authors.initials: S
authors.lastname: Meng
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. julahong@chinaaids.cn.
authors.forename: Lahong
authors.initials: L
authors.lastname: Ju
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. jhh235@163.com.
authors.forename: Huihui
authors.initials: H
authors.lastname: Jiang
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. malp1710@163.com.
authors.forename: Liping
authors.initials: L
authors.lastname: Ma
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. jpsun@chinaaids.cn.
authors.forename: Jiangping
authors.initials: J
authors.lastname: Sun
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China. wuzy@263.net.
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000163:Acquired Immunodeficiency Syndrome; D000288:Administrative Personnel; D000293:Adolescent; D000328:Adult; D019090:Case Management; D002681:China; D003141:Communicable Diseases; D003151:Community Health Centers; D003695:Delivery of Health Care; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy*; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D036301:Qualitative Research; D014481:United States; D019037:Urban Health Services; D055815:Young Adult