凉山彝族聚居区育龄妇女HIV感染及影响艾滋病母婴传播干预因素研究

发布时间：2018-07-04 20:07

本文选题：凉山 + 彝族聚居区　；参考：《复旦大学》2013年硕士论文

【摘要】：四川省凉山州是中国最大的彝族聚居区,自1995年报告第一例因共用针具吸毒导致的HIV感染者以来,疫情发展迅速,现已成为我国艾滋病感染最严重的地区之一。由于当地交通不便、经济文化发展相对落后,居民对艾滋病的危害认识不清,防护意识不足,随着艾滋病性传播比例的提高,近年来当地女性感染者的数量不断增加,但由于多方面原因,没有主动进行检测,导致新发感染难以及时发现,或即使检测出HIV阳性并被告知,仍然一如既往的毫无保护措施的进行性生活、怀孕生子,使得当地经母婴传播感染的儿童数量不断增加,感染儿童多在早期死亡,育龄妇女再度生育,造成生育-感染-死亡-再生育的恶性循环,已成为了一个严重的社会学问题,同时也使得艾滋病母婴传播干预工作开展异常艰难。本研究在凉山某彝族聚集县选取2个乡镇,进行育龄妇女HIV感染和生育状况横断面调查、艾滋病母婴传播影响因素定性访谈,以了解当地育龄妇女HIV感染和生育,以及影响当地艾滋病母婴传播的因素。并根据调查结果制定干预措施,对干预乡镇开展了初步干预,通过与对照的比较进行了初步干预效果评价。整个研究分为3部分：第一部分凉山彝族聚集区育龄妇女HIV/AIDS感染和生育状况横断面调查目的了解凉山彝族聚集区育龄妇女HIV/AIDS流行和生育现状,为艾滋病母婴传播干预工作提供依据。方法根据已知疫情,在凉山某彝族聚集县抽取2个乡镇,对15-49岁的所有育龄妇女进行HIV筛查和问卷调查,收集调查对象的社会人口学基本资料、HIV感染相关危险因素和生育状况。结果本研究共调查1826名育龄妇女,全部为彝族,平均年龄33.77±7.89岁,文化程度以文盲为主；共发现HIV/AIDS病例70例,育龄妇女人群HIV平均感染率为3.83%,感染率高的乡镇育龄妇女人群感染率达6.35%,最严重的行政村感染率达9.52%；HIV感染人群分居／寡居的比例高于未感染人群(χ2＝2.91,P0.001)；新检出感染人群性病史的比例也高于既往感染人群(P=0.001)新检出感染者23人(32.86%),既往感染47人(67.14%),包括已发病AIDS病人6人(8.57%)。被调查育龄妇女总和生育率为4.21,HIV阳性妇女总和生育率3.28；孕妇HIV感染率2.29%。结论彝族聚居区育龄妇女HIV感染水平相对较高,新检出感染严重,较高的总和生育率和孕妇HIV感染率提示存在较高的艾滋病母婴传播风险。第二部分凉山彝族聚居区艾滋病母婴传播干预影响因素研究目的了解影响四川省凉山彝族聚居区艾滋病母婴传播干预实施的因素,为制定适合当地的艾滋病母婴干预措施提供依据。方法采用个人深入访谈的定性研究方法,围绕影响当地艾滋病母婴传播控制工作实施的影响因素,对凉山州某彝族聚居县妇幼卫生工作负责人、妇产科医务人员、村妇幼保健员、村医生、HIV阳性妇女和HIV阴性育龄妇女进行访谈。结果研究共对101名调查对象开展个人深入访谈,访谈结果显示影响当地艾滋病母婴传播干预的因素主要包括交通不便,阳性孕产妇家庭经济困难和育龄妇女对艾滋病母婴传播危害认识不足等8个方面,其中超生与新农合报销之间的矛盾、喂养卫生问题为相对特殊的原因。结论应从加强乡镇卫生院的服务能力,开展对阳性孕妇家庭特殊医疗补助,加强艾滋病母婴传播危害宣传等方面来降低当地艾滋病母婴传播的危害。第三部分凉山彝族聚居区艾滋病母婴传播初步干预措施及效果研究目的验证发现的艾滋病母婴传播影响因素的准确性,探索一种适合凉山彝族聚居区的、行之有效的艾滋病母婴传播干预模式。方法结合艾滋病母婴传播影响因素调查结果,制定适合当地的艾滋病母婴干预措施,在2个干预乡开展彝语“面对面”宣教、“人盯人”促进和适当的经济激励措施开展艾滋病母婴传播干预,选取一个匹配的对照乡镇,实施国家规定的常规艾滋病母婴传播干预措施。结果干预乡孕期保健率(χ2=16.33,P0.001)和住院分娩率(χ2=17.87,P0.001)增长明显高于对照乡,分别是对照乡的1.30倍和2.25倍；干预乡HIV阳性产妇住院分娩率(χ2=4.63,P--0.031)、孕产期抗病毒治疗率(χ2=4.63,P=0.031)和阳性产妇所生婴儿的抗病毒治疗率(χ=6.36,P=0.012)与干预前相比均有提高,均达80.95%。结论根据发现的影响因素制定的相应干预措施能有效地提高当地孕产妇的住院分娩率、HIV阳性孕产妇的发现率以及抗病毒治疗率,表明研究发现的艾滋病母婴传播影响因素准确,制定的干预措施有效。
[Abstract]:Since 1995 , the epidemic has developed rapidly and has become one of the most seriously affected areas in China .

In this study , two villages and towns were selected in some Yi ethnic groups in LiangShan , the cross - sectional survey of HIV infection and reproductive status of women of childbearing age was conducted , and the factors influencing the spread of HIV infection and fertility of mother - to - child transmission of AIDS and the factors affecting mother - to - child transmission of local AIDS were studied .

Cross - sectional survey of HIV / AIDS infection and reproductive status among women of childbearing age in Yi nationality area of Yi nationality in the first part

Objective To investigate the prevalence of HIV / AIDS and the current situation of HIV / AIDS among women of the Yi nationality in the Yi nationality area , and to provide the basis for the prevention of mother - to - child transmission . Methods According to the known epidemic situation , the HIV screening and questionnaire survey were carried out for all women of childbearing age at the age of 15 - 49 years . The results showed that 1826 women of childbearing age were all Yi , the average age was 33.77 卤 7.89 years , and the degree of culture was mainly illiterate .
Among the 70 cases of HIV / AIDS , the average infection rate of HIV among women of childbearing age was 3.83 % , and the infection rate of rural women with high infection rate was 6.35 % , and the infection rate of the most serious administrative villages was 9.52 % .
The proportion of living / widow among HIV - infected individuals was higher than that in the uninfected population ( 蠂2 = 2.91 , P0.001 ) ;
The prevalence of STD in newly infected individuals was higher than that in the previous infected population ( P = 0.001 ) , 23 ( 32.86 % ) , 47 ( 67.14 % ) , including 6 ( 8.57 % ) of AIDS patients . The total fertility rate was 4.21 , and the total fertility rate of HIV positive women was 3.28 ;
Conclusion The HIV infection rate of pregnant women is 2.29 % . Conclusion The HIV infection level of women in the Yi nationality area is relatively high , the newly detected infection is serious , the higher the total fertility rate and the HIV infection rate of pregnant women suggest that there is a higher risk of mother - to - child transmission .

Study on the Influence Factors of HIV Mother - to - Child Transmission Intervention in Yi People ' s Settlement Area of the Second Part

Objective To explore the factors influencing the intervention of mother - to - child transmission of AIDS mother - to - child transmission in the Yi nationality region of Sichuan Province , and to provide the basis for the development of local AIDS mother - to - child interventions . The results show that the factors that affect the transmission and control of mother - to - child transmission in the local AIDS group include transportation inconvenience , positive pregnant women ' s family economic difficulties and insufficient awareness of mother - to - child transmission of AIDS . The conclusion should be to strengthen the service ability of township health institutions , carry out special medical subsidy for positive pregnant women , strengthen the propaganda of mother - to - child transmission of AIDS , and so on , and reduce the harm of local AIDS mother - to - child transmission .

A Study on the Initial Intervention Measures and Effects of the Third Part of the Mother - to - Child Transmission of AIDS in the Yi Ethnic People ' s Republic of China

Objective To verify the accuracy of the factors affecting mother - to - child transmission of HIV / AIDS , and to explore an effective mode of intervention for mother - to - child transmission of AIDS , which is suitable for the intervention of mother - to - child transmission of AIDS .
Conclusions According to the factors affecting the birth rate of HIV positive pregnant women , the rate of discovery of HIV positive pregnant women and the rate of antiviral therapy can be improved effectively . The results show that the factors influencing the transmission of HIV positive pregnant women are accurate and the intervention measures are effective .
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.91

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