云南省德宏州艾滋病疫情变化分析及防治经费分配与利用研究

发布时间：2018-07-29 19:29

【摘要】：背景：德宏州是我国艾滋病防治重点地区,2004年以来国家每年投入1100万元专项经费。近几年来病例报告数据显示经性途径感染的比例有所上升,并超过经吸毒感染的比例。准确掌握疫情流行形势和现有经费分配与使用效果,能够帮助决策者合理配置资源。目的：对德宏州艾滋病疫情模式的变化趋势作出判断,并对其艾滋病经费的来源、分配以及使用效果进行评估,提出未来资源需求投入的建议方案。方法：对历年病例报告、检测、哨点监测以及经性途径传播专项调查数据进行分析,并利用AEM模型和workbook模型对传播模式的变化做出判断。采用调查表调查德宏州经费来源、分配及实际使用情况,利用SEX 2.0软件和发病率法分别计算暗娼人群干预和美沙酮维持治疗的效果并计算成本效果比。利用NEAR系统对2008-2012年资源需求及效果进行评价。结果：2005-2007年病例报告中经性传播的比例为39.1%、46.9%、65.5%。AEM模型结果显示2005-2007年,经性传播新发感染人数构成比超过经吸毒传播,但二者均在50%左右。Workbook法估计现存活的HIV感染者中50.3%为经注射吸毒传播,48.4%为经性传播。德宏艾滋病疫情的传播呈现经注射吸毒和经性途径并重的模式。当地影响艾滋病传播流行的因素复杂。2000-2007年德宏州艾滋病防治经费共计8059.7万元,其中中央转移支付经费中预防干预分配经费最多,占40.7%。暗娼干预的实际单位成本为294.8元,其成本效果比为13283元/避免1例HIV感染者。美沙酮维持治疗的成本效果比为60574元/避免l例HIV感染者。德宏州2008-2012年艾滋病防治资源需求共计1.58亿元,只增加吸毒人群干预资源投入方案避免的HIV感染者人数为1112人,其成本效果比为74146元/避免1例HIV感染者。按五年行动计划覆盖率要求增加各领域投入方案所避免的HIV感染者人数为1636人,其成本效果比为96353元/避免1例HIV感染者。结论：德宏州艾滋病流行已转变为经性途径和注射吸毒传播两种途径并重局面。现有艾滋病防治经费分配结构基本合理,但总量不足。暗娼人群干预和美沙酮维持治疗具有良好的成本效果。
[Abstract]:Background: Dehong is a key area of AIDS prevention and treatment in China. Since 2004, the state has invested 11 million yuan per year in special funds. Case report data in recent years show that the proportion of sexually transmitted infections has increased and exceeded the rate of drug-related infections. Accurate understanding of epidemic situation and the effect of allocation and use of existing funds can help decision-makers to allocate resources reasonably. Objective: to judge the changing trend of epidemic pattern of AIDS in Dehong prefecture, evaluate the source, distribution and effect of AIDS funds, and put forward some suggestions for the investment of resources in the future. Methods: the data of past years' case report, detection, sentinel monitoring and sexual transmission were analyzed. AEM model and workbook model were used to judge the change of transmission mode. The source, distribution and actual use of funds in Dehong were investigated by questionnaire. The effects of intervention and methadone maintenance treatment were calculated by SEX 2.0 software and incidence method, respectively, and the cost-effectiveness ratio was calculated. The NEAR system is used to evaluate the resource demand and effect in 2008-2012. Results the proportion of sexually transmitted infections in the case reports from 2005 to 2007 was 39.1% and 46.9%. The results of the AEM model showed that the proportion of new sexually transmitted infections in 2005-2007 was higher than that through drug use. But both of them were estimated at 50%. Workbook method. 50.3% of the surviving HIV patients were infected by injecting drug use. 48.4% of them were sexually transmitted. The spread of Dehong AIDS epidemic presents the pattern of injecting drug use and sexual approach. The local factors affecting the spread and epidemic of AIDS are complex. The total funds for AIDS prevention and control in Dehong Prefecture from 2000 to 2007 amounted to 80.597 million yuan, of which the allocation of funds for prevention and intervention was the largest among the funds for central transfer payment, accounting for 40.770 yuan. The actual unit cost of intervention was 294.8 yuan, the cost effect ratio was 13283 yuan / one case of HIV infection was avoided. The cost-effectiveness ratio of methadone maintenance therapy was $60574 / one case of HIV infection avoided. The total resource demand for AIDS prevention and treatment in Dehong from 2008 to 2012 was 158 million yuan. The number of HIV infected persons who only increased the resource input of intervention resources for drug users to avoid was 1112, and the cost effectiveness ratio was 74146 yuan / one case of HIV infection. According to the requirement of five-year action plan coverage, the number of HIV infected persons avoided by increasing the coverage of each field is 1636, and the cost effectiveness ratio is 96353 yuan / one case of HIV infection is avoided. Conclusion: the prevalence of AIDS in Dehong has changed into two ways: sexual approach and injecting drug use transmission. The existing AIDS prevention and treatment fund allocation structure is basically reasonable, but the total quantity is insufficient. The intervention of prostitutes and methadone maintenance therapy have good cost effect.
【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】：2009
【分类号】：R183

【参考文献】