预防艾滋病母婴传播资源投入与利用研究

发布时间：2018-05-13 13:41

本文选题：艾滋病 + 母婴传播　；参考：《中国疾病预防控制中心》2008年博士论文

【摘要】： 背景我国投入了大量的资源来遏制艾滋病的流行,且不断加大投入力度,但仍然不能满足全方位开展艾滋病防治工作的需求。预防艾滋病母婴传播是有效减少新发HIV感染的干预措施,但随着女性受艾滋病影响程度的增加,需要不断增加资源的投入以应对预防艾滋病母婴传播工作所面临的巨大需求。然而目前国内缺乏关于预防艾滋病母婴传播资源投入与利用的研究,缺乏从经济学的角度对干预措施的评价,缺乏指导资源投入、优化、合理配置与利用的科学依据。研究目的本研究紧密结合我国实际,主要从项目全成本角度对预防艾滋病母婴传播资源投入进行了描述,对干预措施进行了经济学评价与分析,对资源投入与利用的影响因素进行分析并对服务需求进行预测。为卫生决策部门科学制定适合我国国情,经济、有效、可行的预防艾滋病母婴传播相关策略提供依据。研究方法通过现场调查收集2003年～2006年广西贺州八步区、新疆伊宁市、云南陇川县和瑞丽市预防艾滋病母婴传播资源投入状况,以及项目实施期间孕产妇HIV抗体筛查情况,以及为HIV感染孕产妇及其所生婴儿提供干预服务的情况,对各项干预措施进行成本测算,并通过计算每发现1例HIV感染孕产妇、避免1例儿童新发感染HIV和挽救1个残疾调整寿命年(DALY)的成本对项目进行成本效果分析。运用偏相关分析方法对可能影响资源投入的6个经验因素及运用主成分分析拟合的3个综合因素进行相关分析。构建“需求指数1”,运用多元线性回归构建资源需求预测模型。通过现场调查获得有关参数信息,建立决策树模型,比较不同服务策略的差异,并进行敏感度分析,。研究结果 2003～2006年研究地区共投入艾滋病母婴传播防治资源折合人民币4,440,951元,国家财政投入是主要来源,占85.58%。运用这些资源,共为7,064人次提供了预防艾滋病母婴传播能力培训;为75,797名(63.75%)孕产妇提供了免费的HIV抗体筛查,筛查率逐年上升(P＜0.001);通过项目确诊485例HIV感染孕产妇,其中126人自愿终止妊娠,359人分娩,活产婴儿355例;项目为213例(59.33%)分娩产妇和283例(79.72%)HIV感染母亲所生婴儿提供了免费的抗病毒药物,为87.8%的随访婴儿提供了免费的奶粉。依据HIV母婴传播率为13.8%进行估计,项目地区共避免95例儿童感染HIV,挽救2,375个DALYs。依照全成本核算的角度,每例孕产妇HIV抗体筛查平均费用为人民币36.51元,孕产期明确1例HIV感染孕产妇的平均成本为5,512.03元,每避免1例儿童感染HIV的成本是46,747元,每挽救1个DALY的成本是1,870元人民币,折合231美元。但项目中HIV感染母亲所生婴儿超额死亡抵消了19.6%的项目所挽回DALYs损失。研究地区预防艾滋病母婴传播资源投入逐年增长,不同地区间资源投入有差异,与地区人均国民收入(P＜0.01)、地区人口规模(P＜0.01)、女性HIV感染水平(P＜0.1)与服务需求(P＜0.05)等指标相关(P＜0.1)。4个研究地区资源流向构成差异有显著性(P＜0.001)。在人群HIV感染率为0.036%是常规提供孕产期HIV抗体筛查,项目成本效益均等。“提供免费的HIV检测,孕妇可以知情拒绝检测(opt-out)”的筛查策略净现值指数在成人HIV感染水平和母婴传播率的不同点值均高于自愿选择HIV检测策略。主要结论研究地区预防艾滋病母婴传播资源投入随着需求而增长,资源流向基本合理,但资源流向模式尚未成熟。预防艾滋病母婴传播资源利用取得了良好的效果,服务覆盖面不断扩大,干预措施效果明确,有效减少儿童艾滋病的新发感染。预防艾滋病母婴传播干预措施成本控制良好,以较低的成本避免了新发儿童HIV感染;应适时扩大预防艾滋病母婴传播干预服务的覆盖面,“提供免费的HIV检测,孕妇可以知情拒绝检测”策略具有更高的效率。地区人口规模、女性HIV流行水平及妇幼卫生服务需求等因素影响预防艾滋病母婴传播资源的投入。然而,我国预防艾滋病母婴传播干预服务需求巨大,整体投入尚显不足;HIV感染孕产妇所生婴儿超额死亡是预防艾滋病母婴传播项目面临的巨大挑战。
[Abstract]:background
China has invested a lot of resources to curb the epidemic of AIDS, and continued to increase investment, but still can not meet the needs of the overall development of AIDS prevention and control work. Prevention of mother to child transmission of AIDS is an effective intervention to reduce the new HIV infection. However, as women are affected by the increase in the impact of AIDS, it is necessary to increase resources In order to cope with the huge demand for the prevention of mother to child transmission of AIDS, there is a lack of research on the investment and utilization of AIDS mother to child transmission resources in China, the lack of evaluation of intervention measures from the perspective of economics, and the lack of scientific basis for guiding the investment, optimization and rational allocation and utilization of AIDS.
research objective
This study is closely combined with the reality of our country, mainly from the point of full cost of the project to describe the input of mother to child transmission of AIDS prevention, the economic evaluation and analysis of the intervention measures, the analysis of the factors affecting the investment and utilization of resources and the pre test of the service demand. National, economic, effective and feasible strategies to prevent mother to child transmission of HIV / AIDS are provided.
research method
Through field investigation, we collected the status of mother to child transmission of AIDS in the eight step area of Hezhou in Guangxi from 2003 to 2006, Yining city of Xinjiang, Longchuan County of Yunnan and Ruili, as well as the status of HIV antibody screening for pregnant and parturient women during the project implementation, and the intervention services for HIV infected pregnant and parturient women and their babies. By calculating the cost of 1 cases of HIV infected pregnant and lying in women, 1 cases of children's newly infected HIV and 1 disability adjusted life years (DALY) were avoided, and the cost-effectiveness analysis of the project was carried out. By using partial correlation analysis, the 6 empirical factors which could affect the resource input and the 3 synthesis of the application of principal component analysis were used. The factors are analyzed. The "demand index 1" is constructed, and the resource demand forecasting model is constructed by multiple linear regression. The relevant parameters information is obtained through the field survey, the decision tree model is established, the difference of different service strategies is compared, and the sensitivity analysis is carried out.
Research results
In the 2003~2006 years, the prevention and treatment of mother to child transmission of AIDS in the 2003~2006 years was 4440951 yuan. The national financial input was the main source, accounting for the use of these resources. A total of 7064 people were provided with training for the prevention of mother to child transmission of AIDS, and a free screening rate of HIV antibodies was provided for 75797 (63.75%) pregnant women. Year by year (P < 0.001); 485 cases of pregnant and parturients were diagnosed by HIV infection through the project, of which 126 were voluntarily terminated in pregnancy, 359 were delivered and 355 were born, and 213 cases (59.33%) gave birth to mothers and 283 (79.72%) HIV infected mothers to provide free antiviral drugs for 87.8% infants, which provided free milk powder for 87.8% infants. Based on HI V mother to child transmission rate was estimated at 13.8%. In the project area, 95 cases of children infected with HIV were avoided, and 2375 DALYs. were saved according to the total cost accounting. The average cost of HIV antibody screening for each pregnant woman was RMB 36.51 yuan. The average cost of pregnant and maternal HIV infection pregnant and lying in pregnant women was 5512.03 yuan, and the cost of avoiding 1 children infected with HIV was avoided. It was 46747 yuan, and the cost of saving 1 DALY was 1870 yuan and $231. But the excess death of HIV infected mothers in the project offset the DALYs loss of 19.6% of the projects.
The research area to prevent mother to child transmission of AIDS is increasing year by year, the resource input is different in different regions, the per capita national income (P < 0.01), the area population size (P < 0.01), the level of female HIV infection (P < 0.1) and service demand (P < 0.05), etc. (P < 0.1), there are significant differences in the distribution of resource flows in the research areas of the region (P < 0.1). Sex (P < 0.001). The rate of HIV infection in the population was 0.036% in the routine provision of prenatal HIV antibody screening, and the cost and benefit of the project was equal. The net present value index of the screening strategy of free HIV detection, pregnant woman's informed rejection test (opt-out) was higher than that of voluntary HIV detection at both the level of adult HIV infection and the maternal and infant transmission rate. Strategy.
Main conclusions
The research area to prevent mother to child transmission of AIDS is increasing with the demand, the flow direction is basically reasonable, but the flow pattern of resources is not mature. Prevention of mother to child transmission of AIDS has achieved good results, the coverage of services is expanding, the effect of intervention measures is clear, and the prevention of new infection of AIDS in children is effectively reduced. The cost control of AIDS mother to child transmission intervention is good, and the new children's HIV infection is avoided at a lower cost; the coverage of the prevention of mother to child transmission of AIDS should be expanded in a timely manner. The strategy of "providing free HIV testing, pregnant women can be informed and refusing to detect" has higher efficiency. The scale of regional population and the prevalence of female HIV The needs of maternal and child health services and other factors affect the investment in preventing mother to child transmission of AIDS. However, there is a huge demand for the prevention of mother to child transmission of AIDS in China, and the overall investment is still insufficient. The excess death of HIV infected pregnant and lying in women is a great challenge to prevent mother to child transmission of AIDS.

【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】：2008
【分类号】：R183

【参考文献】