本文選題：艾滋病流行　切入點(diǎn)：中國　出處：《中國疾病預(yù)防控制中心》2014年博士論文

【摘要】：背景當(dāng)前我國艾滋病領(lǐng)域推廣的預(yù)防干預(yù)措施包括安全套、針具交換、美沙酮維持治療、檢測與治療。我國前期模型已分析了檢測與治療對我國艾滋病流行的影響,但沒有將耐藥因素納入到模型研究中。國外艾滋病動力學(xué)模型比較發(fā)現(xiàn)不安全性行為及檢測治療對艾滋病流行的影響程度存在不一致意見。因此有必要將目前預(yù)防干預(yù)措施全部納入到艾滋病動力學(xué)模型中進(jìn)行綜合分析,以了解這些措施如何影響我國艾滋病流行趨勢。 目的分析當(dāng)前預(yù)防干預(yù)措施對我國艾滋病流行趨勢的影響,并評價不同干預(yù)措施、同一措施下不同干預(yù)水平對流行的影響,為艾滋病防控措施的制定提供參考依據(jù)。 方法采用確定性動力學(xué)模型對我國艾滋病流行狀況進(jìn)行模擬,模型參數(shù)的獲取主要來自發(fā)表的文獻(xiàn)。本研究的對象包括男男性行為者(MSM)、男性靜脈吸毒者(MIDU)、嫖客、男性一般人群、女性靜脈吸毒者(FIDU)、女性性工作者(FSW)、女性一般人群。本研究主要輸出參數(shù)為年存活HIV/AIDS人數(shù)、年HIV新發(fā)感染人數(shù)。動力學(xué)模型的編程通過Matlab7.8.0實現(xiàn),數(shù)據(jù)的整理及分析主要通過R軟件。 結(jié)果在當(dāng)前干預(yù)措施下,我國全人群存活HIV/AIDS人數(shù)、HIV新發(fā)感染人數(shù)均呈上升趨勢,到2020年預(yù)測值分別達(dá)107.1萬、10.4萬。除IDU人群外其他人群存活HIV/AIDS人數(shù)、新發(fā)感染人數(shù)到2020年均呈上升趨勢,而IDU人群存活HIV/AIDS人數(shù)、新發(fā)感染人數(shù)均呈下降趨勢。在存活HIV/AIDS人數(shù)及新發(fā)感染人數(shù)中經(jīng)性傳播所致的感染人數(shù)所占比例均呈上升趨勢,尤其是男男同性傳播所占比例增長較快。在2020年男男性行為者在存活HIV/AIDS人數(shù)或新發(fā)感染人數(shù)中的比例分別被估計為22%、28%。嫖客、MSM及FSW人群堅持使用安全套比例的變化對該人群及全人群新發(fā)感染人數(shù)影響較大；IDU人群針具交換、美沙酮維持治療等措施僅對該人群新發(fā)感染人數(shù)影響較大；檢測與治療能降低全人群新發(fā)感染人數(shù)。MSM、 FSW及嫖客人群的堅持使用安全套比例均高于75%時能控制我國艾滋病的流行。敏感性分析發(fā)現(xiàn)MSM人群無保護(hù)性肛交比例、FSW人群堅持使用安全套比例、嫖客人群堅持使用安全套比例、IDU人群獲取清潔針具的比例、美沙酮維持治療覆蓋率、檢測率、治療覆蓋率、耐藥率均為新發(fā)感染人數(shù)的敏感性參數(shù)。 結(jié)論我國全人群存活HIV/AIDS人數(shù)、HIV新發(fā)感染人數(shù)到2020年仍呈上升趨勢,性傳播途徑的高危人群是今后防控的重點(diǎn)。不安全性行為是導(dǎo)致我國艾滋病流行的最主要原因,以推廣使用安全套為基礎(chǔ)的綜合性預(yù)防干預(yù)措施可控制我國艾滋病的流行。
[Abstract]:Background the current preventive interventions in the field of AIDS in China include condoms, needle exchange, methadone maintenance treatment, detection and treatment. However, the factors of drug resistance were not included in the model study. The comparison of foreign AIDS dynamics models found that unsafe sex and the influence of testing treatment on the prevalence of HIV / AIDS were inconsistent. All preventive interventions were integrated into the AIDS dynamics model for comprehensive analysis, To understand how these measures affect the AIDS epidemic in China. Objective to analyze the influence of prevention and intervention measures on the epidemic trend of AIDS in China, and to evaluate the influence of different intervention measures and different intervention levels on the prevalence of AIDS in China, so as to provide a reference for the formulation of AIDS prevention and control measures. Methods A deterministic dynamic model was used to simulate the prevalence of HIV / AIDS in China. The parameters of the model were obtained mainly from published literature. Male general population, female intravenous drug users, female sex workers, female general population. The main output parameters of this study are the number of surviving HIV/AIDS and the number of newly infected HIV. The dynamic model is programmed by Matlab7.8.0. Data collation and analysis mainly through R software. Results under the current intervention measures, the number of people surviving HIV/AIDS and the number of new HIV infections in the whole population of China were all on the rise, and the predicted values by 2020 were 1.071 million and 104000 respectively. The number of new infections increased by 2020, while the number of HIV/AIDS survived and the number of new infections decreased in IDU population. The proportion of sexually transmitted infections in the number of HIV/AIDS survivors and the number of newly infected persons increased. In particular, the proportion of men who have sex with men has increased rapidly. In 2020, the proportion of men who have sex with men in the number of people living with HIV/AIDS or in the number of new infections is estimated to be 220.The change in the proportion of men who have sex with men who insist on condom use is estimated at 220.The proportion of men who have sex with men is estimated to be 22 / 28 in 2020. The number of new infections in this population and the whole population was significantly affected by needle exchange in IDU population. The effect of methadone maintenance treatment on the number of new infections in this population was significant. Detection and treatment can reduce the number of newly infected persons. MSM, FSW and the rate of persistent condom use among clients are higher than that of 75% in controlling the prevalence of AIDS in China. The sensitivity analysis shows that the proportion of unprotected anal sex in MSM population is higher than that in MSM population. The proportion of people who insist on using condoms, The proportion of clients who insist on condom use and IDU population get clean needle, methadone maintenance treatment coverage, detection rate, treatment coverage rate, drug resistance rate are the sensitive parameters of the number of new infections. Conclusion the number of people living with HIV/AIDS and the number of new HIV infections in the whole population in China are still on the rise in 2020. The high risk population of sexual transmission route is the focus of prevention and control in the future. Unsafe sex is the main cause of AIDS epidemic in China. Comprehensive prevention and intervention based on the promotion of condom use can control the prevalence of AIDS in China.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R512.91

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