凉山州乡级艾滋病综合防治模式实证研究

发布时间：2018-08-01 15:36

【摘要】：(一)背景：我国农村少数民族地区艾滋病疫情严重,2011年全国报告农村地区HIV感染者／病人占54.7%。但是农村地区HIV感染者／病人仍存在失访、检测率低、抗病毒治疗率低等诸多问题。实际上,农村地区HIV/AIDS病例综合管理现状亟需改善。在澳大利亚、加拿大、美国、英国有报导社区艾滋病综合防治管理成功实践,提示综合管理模式胜于单一模式。凉山州是彝族聚集地,HIV/AIDS流行形势严峻,疫情主要分布在农村地区。凉山州借鉴国内县-乡-村三级医疗卫生保健服务网络参与艾滋病防治经验,形成了乡级艾滋病综合防治模式,有效促进了农村地区艾滋病病例管理。为及时总结乡级综合管理模式,发现问题、总结经验为其他艾滋病疫情严重的农村地区HIV/AIDS病例管理提供借鉴意义。 (二)目的：从艾滋病防治政策环境改善、人财物投入、乡级综合防治模式形成及防治效果4个方面总结凉山州乡级艾滋病综合防治模式的经验。 (三)方法：在西部艾滋病疫情聚集农村地区,选择实施乡级艾滋病综合防治方案的县域及1个重点乡开展调查。采用资料收集法和定性访谈了解当地艾滋病防治的政策环境改善、人财物投入、乡级艾滋病综合防治模式形成过程。应用卡方检验、Logistic回归分析等统计学方法评价实施乡级综合防治模式后的效果及影响因素。 (四)结果： 1.凉山州人民政府出台了《凉山州艾滋病防治管理办法》、《凉山州艾滋病防治五年规划》、“七大工程”、“一批中心”“百千万工程”计划以及布拖县人民政府《布拖县乡级艾滋病综合防治实施方案》,形成了政府主导、多部门合作、全社会参与的防治局面,明显改善了州县艾滋病防治环境。 2.各级政府投入大量人力、财力、物力,促成乡级艾滋病综合防治模式的实施。 3.现场核实病例数据库与艾滋病综合防治数据信息系统疫情库相比,病例性别、年龄构成比差异有无统计学意义(P0.05)。但是疫情数据库质量方面存在6%(30/500)无详细地址,3.2%(16/500)是重复报告病例,10.6%(53/500)填报虚假姓名,还删除了33例现存病例。所报告病例72.6%(363/500)没有填写第1次和第2次HIV筛查结果,69.8%(349/500)无填写WB确认结果、WB检测日期、WB检测单位。 4.该乡HIV感染者及AIDS有430例,存活者382例。58.9%(225/382)存活HIV感染者及AIDS接受随访干预,58.4%(223/382)接受CD4检测,6.8%(26/382)接受高效抗逆转录病毒治疗(highly active antiretroviral therapy, HAART),2010年3.9%(15/382)死于艾滋病。实施乡级综合管理模式后,该乡存活HIV感染者及AIDS接受随访干预率显著高于乡级综合管理前(x2=44.727P0.001),接受CD4检测率显著高于乡级综合管理前(χ=136.604,p0.001),高效抗逆转录病毒治疗(highly active antiretroviral therapy, HAART)率显著高于乡级综合管理前(x2=7.595,P0.001),2010年艾滋病病死率低于2008年艾滋病病死率(x2=5.685,P=0.96)。 5.对接受抗病毒治疗的影响因素：年龄、性别、文化水平、婚姻状态、住家距离、是否外出、是否吸毒、随访状态、CD4检测进行Logistic逐步回归筛选危险因素,Logistic回归方程为y=-2.9104-0.7569X6+1.6933X9。最终进入危险因素的有CD4检测、是否外出、接受随访。接受随访与CD4检测存在共线关系,被移除。年龄、性别、文化水平、婚姻状态、住家距离、是否吸毒6个因素未进入回归方程。外出组与没有外出组接受抗病毒治疗的优势比OR点估计值为0.469,外出是不利于接受抗病毒治疗的因素；CD4检测的OR点估计值为5.437,是促进接受抗病毒治疗的因素。 6.对84例HIV感染者／病人开展问卷调查,被调查对象平均年龄34.8岁(34.8±11.5),以男性、彝族、已婚、务农者为主,67.9%(57/84)初中水平,36.9%(31/84)最近6个月有外出务工史,96.4%(81/84)的医学随访依靠村长或者村书记联系通知。 7.对HIV感染者／病人、阳性家属、乡村青年关于孕妇入院产前检查、入院分娩、抗病毒药物母婴阻断认知的比较。在入院产前检查、抗病毒药物母婴阻断认知上阳性家属与HIV感染者/病人、乡村青年存在显著差异(P0.01)。但在孕妇入院分娩上没有差异(P0.05)。 8.对乡级管理模式效果进行访谈印证,共访谈卫生局长、乡长、疾控中心副主任、卫生院长、医务人员共8名,100%认为乡医、村医走家串户频率明显增加,100%认为乡级管理促进了艾滋病宣传教育,100%认为村民自救意识增强。访谈8名感染者/病人,87.5%接受过乡医提供的免费检测、提供药物、安全套服务,80%的女性感染者认为应当到医院分娩,20%的女性感染者由于没钱,不置可否。 (五)结论：州县政府出台办法、政策、方案,加大人财物的投入,有效改善艾滋病防治环境,为乡级综合防治模式创造了先决条件。实施乡级艾滋病综合防治模式后,促进掌握准确的艾滋病疫情信息,HIV感染者/病人接受随访干预、CD4检测、接受高效抗逆转录病毒治疗发生显著变化。抗病毒治疗的主要受CD4检测、是否外出、接受随访影响,年龄、性别、文化水平、婚姻状态、住家距离、是否吸毒均不是接受抗病毒治疗的危险因素。艾滋病病例的医学随访主要依靠村长或者村书记联系通知。乡级综合防治模式通过动员村干部和家支头人参与艾滋病防治,可有效缓解基层卫生人力资源严重不足的压力。
[Abstract]:(I) background:
The epidemic situation of AIDS in rural minority areas in China is serious. In 2011, the country reported that HIV infected persons / patients accounted for 54.7%. in rural areas, but HIV infected persons / patients in rural areas still have a lot of problems. In fact, the current situation of comprehensive management of HIV/ AIDS cases in rural areas needs to be improved. In Australia, the status of the comprehensive management of HIV/ AIDS needs to be improved. Asia, Canada, the United States and the United Kingdom have reported the successful practice of comprehensive management of AIDS prevention and control in the community, which suggests that the comprehensive management model is better than the single mode. Liangshan is a gathering place for the Yi people. The epidemic situation of HIV/AIDS is severe and the epidemic is mainly distributed in the rural areas. The three level medical and health service network of County Township Village in Liangshan is used for reference to AIDS. The prevention and control experience has formed a comprehensive prevention and control model of rural AIDS, which effectively promotes the management of AIDS cases in rural areas. It provides a reference for the HIV/AIDS case management of other rural areas with serious AIDS epidemic.
(two) objective:
From the improvement of the AIDS prevention and control policy environment, the investment of human and property, the formation of the pattern of comprehensive prevention and control of township level and the effect of prevention and control in 4 aspects, the experience of the comprehensive prevention and control model of AIDS in Liangshan prefecture level was summarized.
(three) methods:
In the western region of AIDS epidemic gathering in rural areas, the county and 1 key townships were selected to carry out the county level AIDS prevention and control scheme. The information collection method and qualitative interview were used to understand the improvement of the policy and environment of AIDS prevention and control, the investment of people and property, the formation process of the rural AIDS comprehensive prevention and control model, and the application of chi square test, Logisti C regression analysis and other statistical methods were used to evaluate the effect and influencing factors of Township Comprehensive Prevention and control mode.
(four) results:
1. the Liangshan state people's government has promulgated the "AIDS prevention and control measures in Liangshan", "the five year plan of AIDS prevention and control in Liangshan", "seven major projects", "a number of central" "hundreds of millions of projects" and the people's Government of Bu Tuo County, the implementation of the comprehensive prevention and control of AIDS in the county level in Bu Tuo County, which has formed the government leading, multi sector cooperation and the whole society. Participation in the prevention and control situation has significantly improved the AIDS prevention and control environment in Prefecture and county.
2. governments at all levels invested a large amount of manpower, financial resources and material resources to facilitate the implementation of township AIDS comprehensive prevention and control mode.
3. compared with the epidemic database of AIDS comprehensive prevention and control data information system, there were no statistical significance (P0.05). But there were 6% (30/500) without detailed address for the quality of the epidemic database, 3.2% (16/500) were repeated report cases, 10.6% (53/500) filled false names, and 33 cases were deleted. The existing cases. The reported case 72.6% (363/500) did not fill out the first and second HIV screening results, 69.8% (349/500) did not fill in the WB confirmation results, the WB test date, and the WB detection unit.
4. HIV infected people and 430 cases of AIDS, 382 survivors of.58.9% (225/382) surviving HIV infection and AIDS follow-up intervention, 58.4% (223/382) receiving CD4 detection, 6.8% (26/382) receiving high performance antiretroviral therapy (highly active antiretroviral), 3.9% died of AIDS in 2010. Implementation of the township level comprehensive management model After that, the survival rate of HIV infected people and AIDS was significantly higher than that before the township level comprehensive management (x2=44.727P0.001), and the rate of acceptance of CD4 was significantly higher than that before the township level comprehensive management (=136.604, p0.001), and the rate of high performance antiretroviral therapy (highly active antiretroviral therapy, HAART) was significantly higher than that before the township level comprehensive management (x2=7.5) (x2=7.5) 95, P0.001), the mortality rate of AIDS in 2010 was lower than that in 2008 (x2=5.685, P=0.96).
5. the factors affecting the treatment of antiviral therapy: age, sex, cultural level, marital status, home distance, going out, drug use, follow-up status, Logistic stepwise regression screening for risk factors, Logistic regression equation for y=-2.9104-0.7569X6+ 1.6933X9. to eventually enter the risk factors of CD4 detection, whether to go out, answer whether to go out, Logistic Follow up. There was a linear relationship between follow-up and CD4 detection. Age, sex, cultural level, marital status, home distance, 6 factors of drug use did not enter the regression equation. The advantage of outgoing group and non outgoing group to receive antiviral treatment was 0.469, and outgoing was unfavorable to the factors of receiving antiviral treatment; CD4 The OR point estimated value of detection is 5.437, which is the factor to promote antiviral treatment.
6. of 84 patients / patients with HIV infection were investigated with a questionnaire. The average age was 34.8 years (34.8 + 11.5). The subjects were male, Yi, married, peasant, 67.9% (57/84) junior high school, 36.9% (31/84) had a history of migrant workers in the last 6 months, and 96.4% (81/84) medical follow-up depended on the village chief or village secretary contact notice.
7. pairs of HIV infected persons / patients, positive family members, rural youth about antenatal examination of pregnant women, hospitalized delivery, maternal and infant antiviral drugs to block cognitive comparison. There is no difference (P0.05).
8. interview with the results of the township level management model, a total of 8 people were interviewed by the director of health, the township head, the deputy director of the CDC, the health director and the medical staff, and 100% believed that the village doctors had a significant increase in the frequency of the village doctors, and 100% believed that the township level management promoted AIDS propaganda and education, and 100% believed that the villagers' self-help consciousness was enhanced. The interview of 8 infected persons / diseases People, 87.5% have received free tests provided by the township doctors, provide drugs, condom service, and 80% of the female infected people think that they should be delivered to the hospital, and 20% of the female infected people are not able to pay because they have no money.
(five) conclusion:
State and county government issued measures, policies, programs, and the input of adults and property, effectively improved the environment of AIDS prevention and control, created a prerequisite for the comprehensive prevention and control model of the township level. After the implementation of the comprehensive prevention and control model of rural level AIDS, the information of the epidemic situation of AIDS was promoted. The HIV infected persons / patients received follow-up intervention, CD4 test and high effective resistance. A significant change in the treatment of transcriptional viruses. The antiviral treatment is mainly tested by CD4, whether or not to go out, to be affected by follow-up, age, sex, cultural level, marital status, home distance, and whether drug use is not a risk factor for the treatment of antiviral treatment. The medical follow-up of AIDS cases relies mainly on village leaders or village secretary contact notifications. By mobilizing village cadres and family leaders to participate in the prevention and treatment of AIDS, the comprehensive prevention and treatment model can effectively alleviate the pressure of serious shortage of health human resources at the grass-roots level.
【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】：2013
【分类号】：R512.91

【参考文献】