我国社区美沙酮维持治疗海洛因成瘾者艾滋病病毒新发感染研究
发布时间：2018-08-29 10:19
【摘要】：背景 海洛因成瘾人群是我国艾滋病传播的主要高危人群之一。美沙酮维持治疗(MMT)对预防海洛因成瘾人群中艾滋病的传播效果明显。我国开展社区MMT7年多来,参加MMT海洛因成瘾者中仍会有HIV新发感染发生,分析其感染HIV的原因及影响因素,对进一步降低该人群中HIV新发感染率具有重要意义。 目的 1.描述我国参加MMT海洛因成瘾者HIV新发感染情况。 2.探讨参加MMT海洛因成瘾者发生HIV感染的原因及影响因素。 研究方法 对2004至2011年我国接受MMT海洛因成瘾者(以下称“治疗人员”)动态队列数据进行分析,描述HIV新发感染分布,分析与新发感染相关的因素。根据HIV新发感染病例分布,选择HIV新发病例较多的MMT门诊,利用定性研究方法,访谈门诊工作人员和参加MMT期间感染HIV的海洛因成瘾者,探索性调查HIV新发感染的原因；根据定性研究结果,采用1：1匹配病例对照研究方法,设计定量调查表,调查治疗人员一般情况、偷吸毒品行为、性行为、MMT相关情况以及感染HIV原因,定量分析(单因素分析和条件Logistic多因素)各种因素与HIV感染的关联强度(OR值)。根据定性和定量调查的结果,结合全国治疗人员HIV新发感染情况,综合分析其治疗期间感染HIV的原因及影响因素。 研究结果 1.2004-2011年我国治疗人员HIV新发感染率为0.28/100人年(0.27-0.30/100人年),新发感染率存在地区差异,最高省份1.76/100人年,疫情严重地区感染绝对人数和新发感染率较高。女性、年龄较小、少数民族、吸毒时间长、既往曾注射吸毒和共用注射器、参加MMT依从性差的人群感染HIV风险高。 2.定性调查显示,参加MMT期间感染HIV的主要直接原因是共用注射器吸毒行为和性行为。治疗期间偷吸毒品行为诱发因素多种多样,主要包括毒瘾影响、毒友影响、心理因素、空闲时间多、缺乏家庭和社会支持环境等原因。通过性行为感染HIV的传染源(性行为对象)主要有相对固定性伴(配偶或固定的男／女朋友)和不固定的性伴,不固定性伴也以既往认识的人为主,偶有通过既往不认识性伴感染。 3.病例对照研究单因素分析结果显示参加MMT期间感染HIV危险因素包括：参加MMT期间偷吸毒品(OR=5.00)、偷吸毒品时有共用注射器行为(OR=4.60),参加MMT前曾经有共用注射器吸毒史(OR=15.50)、参加MMT前吸毒时间长(P=0.02)、参加MMT期间每天空闲时间较多(5小时以上VS.5小时以内OR=2.22)；保护性因素包括：参加MMT依从性好(P0.0001)、已婚(OR=0.33)、与家人住一起(OR=0.05)。多因素分析结果显示参加MMT依从性好是感染HIV的保护因素(OR=0.61),参加MMT期间偷吸毒品方式为单纯注射是危险因素(OR=154.4),吸毒时间长也是危险因素(OR=1.21)。未发现服用美沙酮剂量、性行为等与HIV感染相关。 研究结论 我国参加MMT海洛因成瘾者HIV新发感染率低于社区海洛因成瘾者HIV发病率水平,治疗初期HIV新发感染病例较多,海洛因成瘾人群中艾滋病疫情较为严重的地区新发感染病例较多。共用注射器吸毒和性行为是参加MMT海洛因成瘾者感染的最主要直接原因。不同地区的疫情程度、海洛因成瘾者参加MMT前的吸毒史、吸毒方式与治疗期间HIV感染有一定关系。治疗依从性好是保护因素，，可以降低感染HIV的风险。使用毒品的诱发因素较多,其中毒瘾较重、吸毒朋友的影响、缺乏社会和家庭支持、负而情绪等均会诱发吸毒行为。社会、家庭、心理方面支持和干预的是帮助海洛因成瘾者恢复正常的生活和社会功能、减少参加MMT海洛因成瘾者吸毒行为,进而降低HIV新发感染率的重要因素。
[Abstract]:background
Heroin addicts are one of the major high-risk groups for HIV transmission in China. Methadone maintenance therapy (MMT) has a significant effect on the prevention of HIV transmission among heroin addicts. In the past seven years, new HIV infections still occur among heroin addicts participating in MMT. The causes and influencing factors of HIV infection are analyzed. It is of great significance to further reduce the new infection rate of HIV in this population.
objective
1. describe the new HIV infection in MMT heroin addicts in China.
2. to explore the causes and influencing factors of HIV infection in MMT heroin addicts.
research method
The dynamic cohort data of MMT heroin addicts (hereinafter referred to as "treatment personnel") from 2004 to 2011 in China were analyzed to describe the distribution of new HIV infections and analyze the factors related to new HIV infections. To explore the causes of new HIV infections among heroin addicts who had been infected with HIV during MMT, a 1:1 matched case-control study was used to design a quantitative questionnaire to investigate the general situation of the treatment staff, drug addiction, sexual behavior, MMT-related conditions and the causes of HIV infection. Analysis and Conditional Logistic Multivariate Factor (OR) Correlation Strength of Various Factors with HIV Infection (OR Value). According to the results of qualitative and quantitative investigation, combined with the new HIV infection situation of the national treatment staff, comprehensive analysis of the causes and influencing factors of HIV infection during treatment.
Research results
1. From 2004 to 2011, the new HIV infection rate of the treatment personnel in China was 0.28/100 person-year (0.27-0.30/100 person-year). There were regional differences in the new HIV infection rate. The highest provinces were 1.76/100 person-year. The absolute number of HIV infection and the new HIV infection rate were higher in the areas where the epidemic was serious. People with poor MMT compliance had a high risk of HIV infection.
2. Qualitative investigation shows that the main direct cause of HIV infection during MMT is drug abuse and sexual behavior by sharing syringes. Drug abuse during treatment is induced by a variety of factors, including drug addiction, drug friends, psychological factors, more leisure time, lack of family and social support environment. The main sources of infection (sexual partners) are relatively fixed sexual partners (spouses or fixed male/female partners) and non-fixed sexual partners, non-fixed sexual partners are also known to the people in the past, occasionally through the past did not know the sexual partner infection.
3. The univariate analysis of case-control study showed that the risk factors of HIV infection during MMT included: drug smuggling (OR = 5.00), sharing syringes (OR = 4.60), sharing syringes (OR = 15.50) before MMT, long time before MMT (P = 0.02), and daily leisure during MMT. The protective factors included good compliance with MMT (P 0.0001), married (OR = 0.33) and living with family (OR = 0.05). Multivariate analysis showed that good compliance with MMT was the protective factor for HIV infection (OR = 0.61), and simple injection was the risk factor during MMT. Long time of drug use was also a risk factor (OR = 1.21). There was no correlation between the dose of methadone, sexual behavior and HIV infection.
research conclusion
The incidence of new HIV infections in MMT heroin addicts in China is lower than that in community heroin addicts. There are more new HIV infections in the initial stage of treatment. There are more new HIV infections in areas where the HIV epidemic is more serious among heroin addicts. The main direct cause is the degree of epidemic in different areas, the history of heroin addicts before taking part in MMT, and the way of drug use is related to HIV infection during treatment. Good compliance is a protective factor, which can reduce the risk of HIV infection. Social, family and psychological support and intervention are important factors to help heroin addicts recover their normal life and social functions, reduce their drug abuse behavior and reduce the incidence of new HIV infection.
【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】：2012
【分类号】：R749.64;R512.91
本文编号：2210900
[Abstract]:background
Heroin addicts are one of the major high-risk groups for HIV transmission in China. Methadone maintenance therapy (MMT) has a significant effect on the prevention of HIV transmission among heroin addicts. In the past seven years, new HIV infections still occur among heroin addicts participating in MMT. The causes and influencing factors of HIV infection are analyzed. It is of great significance to further reduce the new infection rate of HIV in this population.
objective
1. describe the new HIV infection in MMT heroin addicts in China.
2. to explore the causes and influencing factors of HIV infection in MMT heroin addicts.
research method
The dynamic cohort data of MMT heroin addicts (hereinafter referred to as "treatment personnel") from 2004 to 2011 in China were analyzed to describe the distribution of new HIV infections and analyze the factors related to new HIV infections. To explore the causes of new HIV infections among heroin addicts who had been infected with HIV during MMT, a 1:1 matched case-control study was used to design a quantitative questionnaire to investigate the general situation of the treatment staff, drug addiction, sexual behavior, MMT-related conditions and the causes of HIV infection. Analysis and Conditional Logistic Multivariate Factor (OR) Correlation Strength of Various Factors with HIV Infection (OR Value). According to the results of qualitative and quantitative investigation, combined with the new HIV infection situation of the national treatment staff, comprehensive analysis of the causes and influencing factors of HIV infection during treatment.
Research results
1. From 2004 to 2011, the new HIV infection rate of the treatment personnel in China was 0.28/100 person-year (0.27-0.30/100 person-year). There were regional differences in the new HIV infection rate. The highest provinces were 1.76/100 person-year. The absolute number of HIV infection and the new HIV infection rate were higher in the areas where the epidemic was serious. People with poor MMT compliance had a high risk of HIV infection.
2. Qualitative investigation shows that the main direct cause of HIV infection during MMT is drug abuse and sexual behavior by sharing syringes. Drug abuse during treatment is induced by a variety of factors, including drug addiction, drug friends, psychological factors, more leisure time, lack of family and social support environment. The main sources of infection (sexual partners) are relatively fixed sexual partners (spouses or fixed male/female partners) and non-fixed sexual partners, non-fixed sexual partners are also known to the people in the past, occasionally through the past did not know the sexual partner infection.
3. The univariate analysis of case-control study showed that the risk factors of HIV infection during MMT included: drug smuggling (OR = 5.00), sharing syringes (OR = 4.60), sharing syringes (OR = 15.50) before MMT, long time before MMT (P = 0.02), and daily leisure during MMT. The protective factors included good compliance with MMT (P 0.0001), married (OR = 0.33) and living with family (OR = 0.05). Multivariate analysis showed that good compliance with MMT was the protective factor for HIV infection (OR = 0.61), and simple injection was the risk factor during MMT. Long time of drug use was also a risk factor (OR = 1.21). There was no correlation between the dose of methadone, sexual behavior and HIV infection.
research conclusion
The incidence of new HIV infections in MMT heroin addicts in China is lower than that in community heroin addicts. There are more new HIV infections in the initial stage of treatment. There are more new HIV infections in areas where the HIV epidemic is more serious among heroin addicts. The main direct cause is the degree of epidemic in different areas, the history of heroin addicts before taking part in MMT, and the way of drug use is related to HIV infection during treatment. Good compliance is a protective factor, which can reduce the risk of HIV infection. Social, family and psychological support and intervention are important factors to help heroin addicts recover their normal life and social functions, reduce their drug abuse behavior and reduce the incidence of new HIV infection.
【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】：2012
【分类号】：R749.64;R512.91
【引证文献】
相关硕士学位论文 前1条
1 罗玉璇;阻碍阿片类物质依赖者参与社区美沙酮维持治疗因素探究[D];昆明医科大学;2016年
本文编号：2210900
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