【摘要】：(一)背景： 我國農(nóng)村少數(shù)民族地區(qū)艾滋病疫情嚴(yán)重,2011年全國報(bào)告農(nóng)村地區(qū)HIV感染者／病人占54.7%。但是農(nóng)村地區(qū)HIV感染者／病人仍存在失訪、檢測(cè)率低、抗病毒治療率低等諸多問題。實(shí)際上,農(nóng)村地區(qū)HIV/AIDS病例綜合管理現(xiàn)狀亟需改善。在澳大利亞、加拿大、美國、英國有報(bào)導(dǎo)社區(qū)艾滋病綜合防治管理成功實(shí)踐,提示綜合管理模式勝于單一模式。涼山州是彝族聚集地,HIV/AIDS流行形勢(shì)嚴(yán)峻,疫情主要分布在農(nóng)村地區(qū)。涼山州借鑒國內(nèi)縣-鄉(xiāng)-村三級(jí)醫(yī)療衛(wèi)生保健服務(wù)網(wǎng)絡(luò)參與艾滋病防治經(jīng)驗(yàn),形成了鄉(xiāng)級(jí)艾滋病綜合防治模式,有效促進(jìn)了農(nóng)村地區(qū)艾滋病病例管理。為及時(shí)總結(jié)鄉(xiāng)級(jí)綜合管理模式,發(fā)現(xiàn)問題、總結(jié)經(jīng)驗(yàn)為其他艾滋病疫情嚴(yán)重的農(nóng)村地區(qū)HIV/AIDS病例管理提供借鑒意義。 (二)目的： 從艾滋病防治政策環(huán)境改善、人財(cái)物投入、鄉(xiāng)級(jí)綜合防治模式形成及防治效果4個(gè)方面總結(jié)涼山州鄉(xiāng)級(jí)艾滋病綜合防治模式的經(jīng)驗(yàn)。 (三)方法： 在西部艾滋病疫情聚集農(nóng)村地區(qū),選擇實(shí)施鄉(xiāng)級(jí)艾滋病綜合防治方案的縣域及1個(gè)重點(diǎn)鄉(xiāng)開展調(diào)查。采用資料收集法和定性訪談了解當(dāng)?shù)匕滩》乐蔚恼攮h(huán)境改善、人財(cái)物投入、鄉(xiāng)級(jí)艾滋病綜合防治模式形成過程。應(yīng)用卡方檢驗(yàn)、Logistic回歸分析等統(tǒng)計(jì)學(xué)方法評(píng)價(jià)實(shí)施鄉(xiāng)級(jí)綜合防治模式后的效果及影響因素。 (四)結(jié)果： 1.涼山州人民政府出臺(tái)了《涼山州艾滋病防治管理辦法》、《涼山州艾滋病防治五年規(guī)劃》、“七大工程”、“一批中心”“百千萬工程”計(jì)劃以及布拖縣人民政府《布拖縣鄉(xiāng)級(jí)艾滋病綜合防治實(shí)施方案》,形成了政府主導(dǎo)、多部門合作、全社會(huì)參與的防治局面,明顯改善了州縣艾滋病防治環(huán)境。 2.各級(jí)政府投入大量人力、財(cái)力、物力,促成鄉(xiāng)級(jí)艾滋病綜合防治模式的實(shí)施。 3.現(xiàn)場(chǎng)核實(shí)病例數(shù)據(jù)庫與艾滋病綜合防治數(shù)據(jù)信息系統(tǒng)疫情庫相比,病例性別、年齡構(gòu)成比差異有無統(tǒng)計(jì)學(xué)意義(P0.05)。但是疫情數(shù)據(jù)庫質(zhì)量方面存在6%(30/500)無詳細(xì)地址,3.2%(16/500)是重復(fù)報(bào)告病例,10.6%(53/500)填報(bào)虛假姓名,還刪除了33例現(xiàn)存病例。所報(bào)告病例72.6%(363/500)沒有填寫第1次和第2次HIV篩查結(jié)果,69.8%(349/500)無填寫WB確認(rèn)結(jié)果、WB檢測(cè)日期、WB檢測(cè)單位。 4.該鄉(xiāng)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接受隨訪干預(yù),58.4%(223/382)接受CD4檢測(cè),6.8%(26/382)接受高效抗逆轉(zhuǎn)錄病毒治療(highly active antiretroviral therapy, HAART),2010年3.9%(15/382)死于艾滋病。實(shí)施鄉(xiāng)級(jí)綜合管理模式后,該鄉(xiāng)存活HIV感染者及AIDS接受隨訪干預(yù)率顯著高于鄉(xiāng)級(jí)綜合管理前(x2=44.727P0.001),接受CD4檢測(cè)率顯著高于鄉(xiāng)級(jí)綜合管理前(χ=136.604,p0.001),高效抗逆轉(zhuǎn)錄病毒治療(highly active antiretroviral therapy, HAART)率顯著高于鄉(xiāng)級(jí)綜合管理前(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.對(duì)接受抗病毒治療的影響因素：年齡、性別、文化水平、婚姻狀態(tài)、住家距離、是否外出、是否吸毒、隨訪狀態(tài)、CD4檢測(cè)進(jìn)行Logistic逐步回歸篩選危險(xiǎn)因素,Logistic回歸方程為y=-2.9104-0.7569X6+1.6933X9。最終進(jìn)入危險(xiǎn)因素的有CD4檢測(cè)、是否外出、接受隨訪。接受隨訪與CD4檢測(cè)存在共線關(guān)系,被移除。年齡、性別、文化水平、婚姻狀態(tài)、住家距離、是否吸毒6個(gè)因素未進(jìn)入回歸方程。外出組與沒有外出組接受抗病毒治療的優(yōu)勢(shì)比OR點(diǎn)估計(jì)值為0.469,外出是不利于接受抗病毒治療的因素；CD4檢測(cè)的OR點(diǎn)估計(jì)值為5.437,是促進(jìn)接受抗病毒治療的因素。 6.對(duì)84例HIV感染者／病人開展問卷調(diào)查,被調(diào)查對(duì)象平均年齡34.8歲(34.8±11.5),以男性、彝族、已婚、務(wù)農(nóng)者為主,67.9%(57/84)初中水平,36.9%(31/84)最近6個(gè)月有外出務(wù)工史,96.4%(81/84)的醫(yī)學(xué)隨訪依靠村長或者村書記聯(lián)系通知。 7.對(duì)HIV感染者／病人、陽性家屬、鄉(xiāng)村青年關(guān)于孕婦入院產(chǎn)前檢查、入院分娩、抗病毒藥物母嬰阻斷認(rèn)知的比較。在入院產(chǎn)前檢查、抗病毒藥物母嬰阻斷認(rèn)知上陽性家屬與HIV感染者/病人、鄉(xiāng)村青年存在顯著差異(P0.01)。但在孕婦入院分娩上沒有差異(P0.05)。 8.對(duì)鄉(xiāng)級(jí)管理模式效果進(jìn)行訪談?dòng)∽C,共訪談衛(wèi)生局長、鄉(xiāng)長、疾控中心副主任、衛(wèi)生院長、醫(yī)務(wù)人員共8名,100%認(rèn)為鄉(xiāng)醫(yī)、村醫(yī)走家串戶頻率明顯增加,100%認(rèn)為鄉(xiāng)級(jí)管理促進(jìn)了艾滋病宣傳教育,100%認(rèn)為村民自救意識(shí)增強(qiáng)。訪談8名感染者/病人,87.5%接受過鄉(xiāng)醫(yī)提供的免費(fèi)檢測(cè)、提供藥物、安全套服務(wù),80%的女性感染者認(rèn)為應(yīng)當(dāng)?shù)结t(yī)院分娩,20%的女性感染者由于沒錢,不置可否。 (五)結(jié)論： 州縣政府出臺(tái)辦法、政策、方案,加大人財(cái)物的投入,有效改善艾滋病防治環(huán)境,為鄉(xiāng)級(jí)綜合防治模式創(chuàng)造了先決條件。實(shí)施鄉(xiāng)級(jí)艾滋病綜合防治模式后,促進(jìn)掌握準(zhǔn)確的艾滋病疫情信息,HIV感染者/病人接受隨訪干預(yù)、CD4檢測(cè)、接受高效抗逆轉(zhuǎn)錄病毒治療發(fā)生顯著變化。抗病毒治療的主要受CD4檢測(cè)、是否外出、接受隨訪影響,年齡、性別、文化水平、婚姻狀態(tài)、住家距離、是否吸毒均不是接受抗病毒治療的危險(xiǎn)因素。艾滋病病例的醫(yī)學(xué)隨訪主要依靠村長或者村書記聯(lián)系通知。鄉(xiāng)級(jí)綜合防治模式通過動(dòng)員村干部和家支頭人參與艾滋病防治,可有效緩解基層衛(wèi)生人力資源嚴(yán)重不足的壓力。
[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.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R512.91

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