浙江省HIV感染者检测发现滞后及其影响因素研究

发布时间：2018-06-07 01:17

本文选题：艾滋病病毒 + 发现滞后　；参考：《复旦大学》2014年硕士论文

【摘要】：目的(1)通过横断面调查,了解浙江省HIV感染者检测发现滞后的状况和流行病学特征；(2)通过单因素和多因素Logistic回归分析,识别影响HIV发现滞后的独立危险因素和保护因素；(3)通过定性研究,了解HIV发现滞后的原因及对策；(4)结合定量和定性研究结果,探讨促进HIV感染者早期发现的对策与措施。方法(1)收集、整理并分析浙江省2010-2012年通过国家艾滋病综合防治信息系统上报的HIV感染者。并对浙江省2012年新报告的HIV感染者采用随机抽样的方法开展横断面调查,调查内容包括艾滋病知识知晓情况、HIV感染的风险意识、HIV检测可及性、就医情况、社会歧视、对当地艾滋病流行形势的知晓情况、检测后进一步救治政策和服务的知晓情况等。(2)采用定性访谈方法,对市县疾控中心艾滋病防治工作人员就HIV发现滞后的原因及对策进行个人深入访谈。(3)定量调查资料采用EpiData31软件进行数据录入和SPSS19.0软件进行单因素和多因素非条件Logistic回归分析。(4)定性访谈资料分析则先把录音转录成文字,再根据访谈提纲的条目进行归纳总结。结果(1)浙江省2010-2012年新报告的HIV感染者中,发现滞后的比例在30%左右。调查的1223例HIV感染者中,385例存在发现滞后,占31.5%。发现滞后病例的平均年龄为(41.8±13.6)岁,男性占79.2%,已婚有配偶占60.3%,初中及以下文化程度占66.5%,本省户籍占76.6%。感染途径以异性传播为主,占67.5%,检测类别以临床就诊者检测为主,占59.2%。(2)385例发现滞后的病例,有71.4%在确诊阳性之前听说过艾滋病,其中有55.6%知道正确使用安全套可以减少艾滋病的传播；60.5%的发现滞后病例从未想过自己会感染HIV;确诊阳性前是否知道哪里可以检测HIV的比例分别为49.9%、46.5%；只有27.3%的发现滞后病例确诊阳性之前出现艾滋病相关症状,出现症状后及时就医的占21.0%；75.3%的发现滞后病例确诊阳性之前担心检测阳性会受到歧视；确诊阳性之前估计当地每1万个人当中感染HIV的人数不到1人的占48.1%,1-10人的占36.4%；有67.0%的病例在确诊阳性之前没有听说过“四免一关怀”政策。(3)确诊阳性之前出现艾滋病相关症状、年龄在40岁及以上、婚姻状况为已婚有配偶、本省户籍是HIV发现滞后的危险因素；检测类别为自愿咨询检测、专题调查的病例发现滞后的可能性较低。结论(1)浙江省存在HIV感染者检测发现滞后的状况,但低于全国水平。确诊阳性前出现艾滋病相关症状,年龄在40岁及以上、婚姻状况为已婚有配偶、本省户籍是病例发现滞后的危险因素,应该作为HIV感染者发现滞后的预防和干预因素。样本来源于自愿咨询检测、专题调查发现滞后的风险较小,提示开展自愿咨询检测和专题调查有利于早期发现感染者。(2)建议采取以下措施以利于早期发现HIV感染者：加大艾滋病宣传力度,促进普通人群对艾滋病相关知识和流行形势的了解,提高HIV感染的风险意识和主动检测意识；扩大艾滋病自愿咨询检测覆盖面,鼓励医院门诊的医务人员主动提供HIV检测咨询,提高检测服务的可及性；各级疾控中心针对高危人群积极开展专题调查；推进阳性者配偶/固定性伴的告知和检测工作。
[Abstract]:Objective (1) through cross-sectional investigation, the status and epidemiological characteristics of detection and discovery of HIV infected persons in Zhejiang province were investigated. (2) independent risk factors and protective factors affecting HIV discovery were identified by single factor and multiple factor Logistic regression analysis. (3) the reasons and Countermeasures of the lag of HIV discovery were understood through the definite study. (4) combination of the factors and countermeasures. The quantitative and qualitative results were used to explore the countermeasures and measures to promote the early detection of HIV infection. Methods (1) collect, collate and analyze the HIV infected persons reported by the National AIDS comprehensive prevention and control information system for 2010-2012 years in Zhejiang Province, and carry out a cross-sectional survey on the new reported HIV infected persons in Zhejiang Province in 2012 by random sampling method. The investigation included the knowledge of AIDS knowledge, the awareness of the risk of HIV infection, the accessibility of HIV detection, the medical situation, social discrimination, the awareness of the local AIDS epidemic situation, the awareness of the further treatment policy and service after testing. (2) the method of qualitative interview was adopted to the AIDS prevention and control workers in the CDC. HIV found the reasons for the lag and the personal in-depth interview. (3) the quantitative survey data used EpiData31 software for data entry and SPSS19.0 software for single factor and multi factor non conditional Logistic regression analysis. (4) qualitative interview data analysis was first transcribed to text words, and then summed up according to the items of the interview outline. Results (1) among the HIV infected people in 2010-2012 years in Zhejiang Province, the rate of lag was found to be around 30%. Among the 1223 cases of HIV infection, 385 cases were found lagging, the average age of the 31.5%. discovery lagging cases was (41.8 + 13.6), men accounted for 79.2%, married couples accounted for 60.3%, junior middle school and below were 66.5%, and the provincial domicile. The main route of 76.6%. infection was heterosexual transmission, accounting for 67.5%. The detection category was mainly detected by clinical patients, accounting for 59.2%. (2), 385 cases were found lags, and 71.4% had heard of AIDS before the diagnosis was positive. 55.6% of them knew that the correct use of condoms could reduce the spread of AIDS; 60.5% of the delayed cases had never thought of self. It would be infected with HIV; whether the proportion of HIV could be detected before the diagnosis was 49.9%, 46.5%; only 27.3% of the cases of delayed cases were found to have AIDS related symptoms before the diagnosis was positive, and 21% were found in timely medical treatment, and 75.3% of the cases with delayed diagnosis were discriminated against before they were positive. Before the diagnosis was positive, less than 1 of the local 10 thousand people were estimated to be infected with HIV and 1-10 were 36.4%. 67% of the cases had not heard of the "four - one - one care" policy before the diagnosis was positive. (3) there were AIDS related symptoms before the diagnosis was positive. The age was 40 years old and above, marriage was married and spouses were in the province. The household registration is the risk factor of HIV discovery lag; the detection category is voluntary counseling and testing, the possibility of the case finding lag is low. Conclusion (1) there is a delay in detection of HIV infected persons in Zhejiang Province, but it is lower than the national level. Marriage has spouses, the provincial household registration is a dangerous factor in case discovery lag. It should be found as a lagging prevention and intervention factor for HIV infected people. The samples are derived from voluntary counseling and testing, and the special survey found that the lag is less risk. It suggests that voluntary counseling and testing and special investigation are beneficial to the early detection of infected people. (2) the following measures are suggested. To facilitate the early detection of HIV infection: increase the publicity of AIDS, promote the knowledge of AIDS related knowledge and epidemic situation, improve the risk awareness and active detection consciousness of HIV infection, expand the coverage of AIDS voluntary counseling and testing, and encourage the medical staff in the hospital outpatient to provide HIV examination and consultation, and improve The accessibility of testing services, CDC at all levels, actively carry out thematic surveys for high-risk groups, and promote the notification and testing of spouses / fixed partners of positive persons.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

【共引文献】