构建动力学模型评价中国艾滋病防治效果

发布时间：2018-03-28 16:52

本文选题：艾滋病流行　切入点：中国　出处：《中国疾病预防控制中心》2014年博士论文

【摘要】：背景当前我国艾滋病领域推广的预防干预措施包括安全套、针具交换、美沙酮维持治疗、检测与治疗。我国前期模型已分析了检测与治疗对我国艾滋病流行的影响,但没有将耐药因素纳入到模型研究中。国外艾滋病动力学模型比较发现不安全性行为及检测治疗对艾滋病流行的影响程度存在不一致意见。因此有必要将目前预防干预措施全部纳入到艾滋病动力学模型中进行综合分析,以了解这些措施如何影响我国艾滋病流行趋势。目的分析当前预防干预措施对我国艾滋病流行趋势的影响,并评价不同干预措施、同一措施下不同干预水平对流行的影响,为艾滋病防控措施的制定提供参考依据。方法采用确定性动力学模型对我国艾滋病流行状况进行模拟,模型参数的获取主要来自发表的文献。本研究的对象包括男男性行为者(MSM)、男性静脉吸毒者(MIDU)、嫖客、男性一般人群、女性静脉吸毒者(FIDU)、女性性工作者(FSW)、女性一般人群。本研究主要输出参数为年存活HIV/AIDS人数、年HIV新发感染人数。动力学模型的编程通过Matlab7.8.0实现,数据的整理及分析主要通过R软件。结果在当前干预措施下,我国全人群存活HIV/AIDS人数、HIV新发感染人数均呈上升趋势,到2020年预测值分别达107.1万、10.4万。除IDU人群外其他人群存活HIV/AIDS人数、新发感染人数到2020年均呈上升趋势,而IDU人群存活HIV/AIDS人数、新发感染人数均呈下降趋势。在存活HIV/AIDS人数及新发感染人数中经性传播所致的感染人数所占比例均呈上升趋势,尤其是男男同性传播所占比例增长较快。在2020年男男性行为者在存活HIV/AIDS人数或新发感染人数中的比例分别被估计为22%、28%。嫖客、MSM及FSW人群坚持使用安全套比例的变化对该人群及全人群新发感染人数影响较大；IDU人群针具交换、美沙酮维持治疗等措施仅对该人群新发感染人数影响较大；检测与治疗能降低全人群新发感染人数。MSM、 FSW及嫖客人群的坚持使用安全套比例均高于75%时能控制我国艾滋病的流行。敏感性分析发现MSM人群无保护性肛交比例、FSW人群坚持使用安全套比例、嫖客人群坚持使用安全套比例、IDU人群获取清洁针具的比例、美沙酮维持治疗覆盖率、检测率、治疗覆盖率、耐药率均为新发感染人数的敏感性参数。结论我国全人群存活HIV/AIDS人数、HIV新发感染人数到2020年仍呈上升趋势,性传播途径的高危人群是今后防控的重点。不安全性行为是导致我国艾滋病流行的最主要原因,以推广使用安全套为基础的综合性预防干预措施可控制我国艾滋病的流行。
[Abstract]:Background the current preventive interventions in the field of AIDS in China include condoms, needle exchange, methadone maintenance treatment, detection and treatment. However, the factors of drug resistance were not included in the model study. The comparison of foreign AIDS dynamics models found that unsafe sex and the influence of testing treatment on the prevalence of HIV / AIDS were inconsistent. All preventive interventions were integrated into the AIDS dynamics model for comprehensive analysis, To understand how these measures affect the AIDS epidemic in China. Objective to analyze the influence of prevention and intervention measures on the epidemic trend of AIDS in China, and to evaluate the influence of different intervention measures and different intervention levels on the prevalence of AIDS in China, so as to provide a reference for the formulation of AIDS prevention and control measures. Methods A deterministic dynamic model was used to simulate the prevalence of HIV / AIDS in China. The parameters of the model were obtained mainly from published literature. Male general population, female intravenous drug users, female sex workers, female general population. The main output parameters of this study are the number of surviving HIV/AIDS and the number of newly infected HIV. The dynamic model is programmed by Matlab7.8.0. Data collation and analysis mainly through R software. Results under the current intervention measures, the number of people surviving HIV/AIDS and the number of new HIV infections in the whole population of China were all on the rise, and the predicted values by 2020 were 1.071 million and 104000 respectively. The number of new infections increased by 2020, while the number of HIV/AIDS survived and the number of new infections decreased in IDU population. The proportion of sexually transmitted infections in the number of HIV/AIDS survivors and the number of newly infected persons increased. In particular, the proportion of men who have sex with men has increased rapidly. In 2020, the proportion of men who have sex with men in the number of people living with HIV/AIDS or in the number of new infections is estimated to be 220.The change in the proportion of men who have sex with men who insist on condom use is estimated at 220.The proportion of men who have sex with men is estimated to be 22 / 28 in 2020. The number of new infections in this population and the whole population was significantly affected by needle exchange in IDU population. The effect of methadone maintenance treatment on the number of new infections in this population was significant. Detection and treatment can reduce the number of newly infected persons. MSM, FSW and the rate of persistent condom use among clients are higher than that of 75% in controlling the prevalence of AIDS in China. The sensitivity analysis shows that the proportion of unprotected anal sex in MSM population is higher than that in MSM population. The proportion of people who insist on using condoms, The proportion of clients who insist on condom use and IDU population get clean needle, methadone maintenance treatment coverage, detection rate, treatment coverage rate, drug resistance rate are the sensitive parameters of the number of new infections. Conclusion the number of people living with HIV/AIDS and the number of new HIV infections in the whole population in China are still on the rise in 2020. The high risk population of sexual transmission route is the focus of prevention and control in the future. Unsafe sex is the main cause of AIDS epidemic in China. Comprehensive prevention and intervention based on the promotion of condom use can control the prevalence of AIDS in China.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R512.91

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