美沙酮维持治疗门诊服药人员HCV感染及相关卫生服务利用情况研究

发布时间：2018-05-14 23:01

本文选题：美沙酮维持治疗门诊 + 注射吸毒人群　；参考：《中国疾病预防控制中心》2016年硕士论文

【摘要】：目的：了解社区美沙酮维持治疗(MMT)门诊服药人员丙型肝炎病毒(HCV)感染状况及相关卫生服务利用情况,并探讨影响相关服务利用的因素。方法：本研究采用横断面研究的方法,在云南、甘肃两省的4所MMT门诊招募符合研究纳入标准的服药人员开展问卷调查,了解其人口学信息、毒品滥用及参加药物维持治疗情况、酒精使用情况、对丙型肝炎认知情况以及HCV抗体(抗-HCV)阳性服药人员对丙型肝炎相关卫生服务利用情况等。同时通过MMT门诊信息管理系统,收集调查对象最近一次HCV、HIV检测结果。结果：1.本研究共收集618份有效调查问卷,调查对象平均年龄为41.8±8.9岁,男性占86.1%(532/618)；汉族占80.6%(498/618)；初中及以下文化程度者占62.6%(387/618)；与家人/朋友同住者占84.0%(519/618)：月收入1000元者占38.3%(237/18),≥2000元者占44.8%(277/618)：参加医保或新农合者占85.1%(526/618)。2.根据MMT门诊管理系统中调查对象最近一次抗-HCV、抗-HIV检测结果,54.2%(335/618)抗-HCV阳性,14.9%(92/618)抗-HIV阳性。14.2%(88/618)同时合并HIV/HCV感染,26.3%(88/335)的抗-HCV阳性者合并HIV感染,95.7%(88/92)HIV感染者的抗-HCV阳性。3.调查对象的吸毒年限以15-20年为主,占24.6%(152/618)；53.9%(333/618)曾静脉注射吸毒；57.8%(357/618)调查对象为低危险水平酒精使用。4.调查对象对丙型肝炎相关知识的总知晓率为12.5%(77/618)。95.7%表示听说过丙型肝炎,对有关丙型肝炎传播途径信息的知晓率在50%以上,对丙型肝炎的危害及能够治愈的知晓率不足50%。抗-HCV阳性调查对象对丙型肝炎相关知识的认知好于抗-HCV阴性者(x2=29.52,P0.0001)。5.335例抗-HCV阳性的调查对象中,74.6%(250/335)知晓自身抗-HCV阳性状态,34.9%(117/335)因HCV感染到医疗机构就诊。就诊时,15.2%(51/335)接受了HCV核酸(RNA)检测,13.4%(45/335)接受了干扰素治疗,3.0%(10/335)表示丙型肝炎已治愈。6.知晓自身抗-HCV阳性状态的250例调查对象中,46.8%(117/250)因丙型肝炎就诊。在德宏门诊就诊(OR=33,95%CI:1.7-6.5),与家人／朋友共同居住(0R=6.1,95%CI:2.3-16.5),丙型肝炎相关知识认知良好(OR=4.6,95%CI:1.9-10.9),首次知晓抗-HCV阳性时是否被建议进一步诊治(OR=8.5,95%CI:4.2-17.1)和有丙型肝炎相关症状体征(OR=5.0,95%CI:2.5-10.0)是促进知晓HCV感染状态的调查对象因此就诊的因素。7.知晓自身抗-HCV阳性状态的250例调查对象中,27.2%(68/250)接受了丙型肝炎治疗。在德宏门诊就诊(OR=4.8,95%CI.2.3-10.1),大专及以上文化程度(OR=7.6, 95%CI：1.7-34.3),与家人／朋友共同居住(OR=14.2,95%CI:2.4-83.3),首次知晓抗-HCV阳性时是否被建议进一步诊治(OR=6.0,95%CI:2.7-13.3)和有丙型肝炎相关症状体征(OR=5.2,95%CI:2.6-10.5)是促进知晓HCV感染状态调查对象接受丙型肝炎治疗的因素。结论：本研究所调查的MMT门诊服药人员中,抗-HCV阳性者超过一半,但1/4抗-HCV阳性者不知晓自身的感染状态。250例知晓自身感染状态的调查对象中,因HCV感染就诊者不到一半,接受丙型肝炎治疗(包括干扰素治疗及传统的保肝治疗)者不到1/3。影响MMT门诊HCV感染者利用丙型肝炎相关卫生服务的主要因素是文化程度,居住状态,丙型肝炎相关知识认知情况,首次知晓抗-HCV阳性时是否被建议进一步诊治,是否有丙型肝炎相关症状体征以及地方的药费减免政策。建议提高MMT门诊服药人员及工作人员对丙型肝炎相关知识的认知程度：建立完善的丙型肝炎检测、咨询、转诊和治疗卫生服务网络；利用已建立的艾滋病防治平台开展丙型肝炎防治工作。
[Abstract]:Objective: to understand the status of hepatitis C virus (HCV) infection and related health services in the community of community methadone maintenance treatment (MMT) outpatient service (MMT), and to explore the factors affecting the utilization of related services. Methods: a cross-sectional study was used in this study to recruit the research inclusion criteria in 4 MMT outpatients in two provinces of Gansu. The drug users carried out a questionnaire survey to understand their demographic information, drug abuse and drug maintenance treatment, alcohol use, the cognition of hepatitis C and the use of HCV antibody (anti -HCV) positive drugs for hepatitis C related health services. At the same time, the information management system of the MMT outpatient service was used to collect the subjects. Results of the latest HCV and HIV results. Results: 1. the 618 valid questionnaires were collected in this study. The average age was 41.8 + 8.9 years, male accounted for 86.1% (532/618), Han accounted for 80.6% (498/618), 62.6% (387/618), and 84% (519/618) with family / friends, and 38.3 monthly income of 38.3 (38.3), and 38.3 monthly income of 38.3 % (237/18), more than 2000 yuan accounted for 44.8% (277/618): participation in medical insurance or new farmers' 85.1% (526/618).2. based on the MMT outpatient management system in the recent anti -HCV, anti -HIV test results, 54.2% (335/618) anti -HCV positive, 14.9% (92/618) against -HIV positive.14.2%, 26.3% Combined with HIV infection, 95.7% (88/92) HIV infected people with anti -HCV positive.3. had 15-20 years of drug use, accounting for 24.6% (152/618); 53.9% (333/618) had intravenous drug use; 57.8% (357/618) investigated the total awareness rate of low risk alcohol using.4. survey subjects for hepatitis C related knowledge was 12.5% (77/618).95.7%. The rate of knowledge about the transmission routes of hepatitis C was above 50%, and the risk of hepatitis C was more than 50%, and the awareness of hepatitis C was less than that of -HCV positive. The knowledge of hepatitis C related knowledge was better than that of anti -HCV negative (x2=29.52, P0.0001).5.335 anti -HCV positive subjects, 74.6 % (250/335) knew its anti -HCV positive state, 34.9% (117/335) was diagnosed with HCV infection to medical institutions. At the time of treatment, 15.2% (51/335) received HCV nucleic acid (RNA) detection, 13.4% (45/335) received interferon therapy, and 3% (10/335) indicated that hepatitis C has been cured in 250 cases of awareness of the anti -HCV positive state of.6., 46.8% (117/250) because C OR=33,95%CI:1.7-6.5, OR=33,95%CI:1.7-6.5, family / friend living (0R=6.1,95%CI:2.3-16.5), knowledge of hepatitis C related knowledge (OR=4.6,95%CI:1.9-10.9), whether it was recommended for the first time when anti -HCV positive (OR= 8.5,95%CI:4.2-17.1) and hepatitis C associated symptoms (OR=5.0,9). 5%CI:2.5-10.0) was a survey of the status of HCV infection. 250 of the 250 subjects who knew their own anti -HCV positive status, 27.2% (68/250) received hepatitis C treatment. In the Dehong outpatient clinic (OR=4.8,95%CI.2.3-10.1), college and above (OR=7.6, 95%CI:1.7-34.3), and family / friends Common residence (OR=14.2,95%CI:2.4-83.3), for the first time, it is suggested that further diagnosis and treatment of anti -HCV positive (OR=6.0,95%CI:2.7-13.3) and hepatitis C associated symptoms (OR=5.2,95%CI:2.6-10.5) are the factors to promote the treatment of hepatitis C in the knowledge of the state of HCV infection. Conclusion: the MMT outpatient medication investigated in this study Among the people, more than half of the anti -HCV positive people were found, but the 1/4 anti -HCV positive people did not know the status of the infection in the.250 cases of their own. In the case of HCV infection, less than half of the patients were treated with hepatitis C (including interferon therapy and traditional liver preservation), which did not affect the HCV infection in the MMT clinic using C The main factors for hepatitis related health services are the degree of education, the state of residence, the knowledge of hepatitis C related knowledge, the first awareness of whether the treatment of anti -HCV positive, the symptoms and signs of hepatitis C, and the local drug reduction policy are recommended. It is recommended to raise the level of hepatitis C in MMT outpatient service personnel and staff. The cognitive degree of inflammation related knowledge: establish a perfect hepatitis C test, consultation, referral and treatment of health service network; use the established AIDS prevention and control platform to carry out hepatitis C prevention and control work.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R512.63

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