我國社區(qū)美沙酮維持治療海洛因成癮者艾滋病病毒新發(fā)感染研究
發(fā)布時間：2018-08-29 10:19
【摘要】：背景 海洛因成癮人群是我國艾滋病傳播的主要高危人群之一。美沙酮維持治療(MMT)對預(yù)防海洛因成癮人群中艾滋病的傳播效果明顯。我國開展社區(qū)MMT7年多來,參加MMT海洛因成癮者中仍會有HIV新發(fā)感染發(fā)生,分析其感染HIV的原因及影響因素,對進一步降低該人群中HIV新發(fā)感染率具有重要意義。 目的 1.描述我國參加MMT海洛因成癮者HIV新發(fā)感染情況。 2.探討參加MMT海洛因成癮者發(fā)生HIV感染的原因及影響因素。 研究方法 對2004至2011年我國接受MMT海洛因成癮者(以下稱“治療人員”)動態(tài)隊列數(shù)據(jù)進行分析,描述HIV新發(fā)感染分布,分析與新發(fā)感染相關(guān)的因素。根據(jù)HIV新發(fā)感染病例分布,選擇HIV新發(fā)病例較多的MMT門診,利用定性研究方法,訪談門診工作人員和參加MMT期間感染HIV的海洛因成癮者,探索性調(diào)查HIV新發(fā)感染的原因；根據(jù)定性研究結(jié)果,采用1：1匹配病例對照研究方法,設(shè)計定量調(diào)查表,調(diào)查治療人員一般情況、偷吸毒品行為、性行為、MMT相關(guān)情況以及感染HIV原因,定量分析(單因素分析和條件Logistic多因素)各種因素與HIV感染的關(guān)聯(lián)強度(OR值)。根據(jù)定性和定量調(diào)查的結(jié)果,結(jié)合全國治療人員HIV新發(fā)感染情況,綜合分析其治療期間感染HIV的原因及影響因素。 研究結(jié)果 1.2004-2011年我國治療人員HIV新發(fā)感染率為0.28/100人年(0.27-0.30/100人年),新發(fā)感染率存在地區(qū)差異,最高省份1.76/100人年,疫情嚴重地區(qū)感染絕對人數(shù)和新發(fā)感染率較高。女性、年齡較小、少數(shù)民族、吸毒時間長、既往曾注射吸毒和共用注射器、參加MMT依從性差的人群感染HIV風(fēng)險高。 2.定性調(diào)查顯示,參加MMT期間感染HIV的主要直接原因是共用注射器吸毒行為和性行為。治療期間偷吸毒品行為誘發(fā)因素多種多樣,主要包括毒癮影響、毒友影響、心理因素、空閑時間多、缺乏家庭和社會支持環(huán)境等原因。通過性行為感染HIV的傳染源(性行為對象)主要有相對固定性伴(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認識的人為主,偶有通過既往不認識性伴感染。 3.病例對照研究單因素分析結(jié)果顯示參加MMT期間感染HIV危險因素包括：參加MMT期間偷吸毒品(OR=5.00)、偷吸毒品時有共用注射器行為(OR=4.60),參加MMT前曾經(jīng)有共用注射器吸毒史(OR=15.50)、參加MMT前吸毒時間長(P=0.02)、參加MMT期間每天空閑時間較多(5小時以上VS.5小時以內(nèi)OR=2.22)；保護性因素包括：參加MMT依從性好(P0.0001)、已婚(OR=0.33)、與家人住一起(OR=0.05)。多因素分析結(jié)果顯示參加MMT依從性好是感染HIV的保護因素(OR=0.61),參加MMT期間偷吸毒品方式為單純注射是危險因素(OR=154.4),吸毒時間長也是危險因素(OR=1.21)。未發(fā)現(xiàn)服用美沙酮劑量、性行為等與HIV感染相關(guān)。 研究結(jié)論 我國參加MMT海洛因成癮者HIV新發(fā)感染率低于社區(qū)海洛因成癮者HIV發(fā)病率水平,治療初期HIV新發(fā)感染病例較多,海洛因成癮人群中艾滋病疫情較為嚴重的地區(qū)新發(fā)感染病例較多。共用注射器吸毒和性行為是參加MMT海洛因成癮者感染的最主要直接原因。不同地區(qū)的疫情程度、海洛因成癮者參加MMT前的吸毒史、吸毒方式與治療期間HIV感染有一定關(guān)系。治療依從性好是保護因素，，可以降低感染HIV的風(fēng)險。使用毒品的誘發(fā)因素較多,其中毒癮較重、吸毒朋友的影響、缺乏社會和家庭支持、負而情緒等均會誘發(fā)吸毒行為。社會、家庭、心理方面支持和干預(yù)的是幫助海洛因成癮者恢復(fù)正常的生活和社會功能、減少參加MMT海洛因成癮者吸毒行為,進而降低HIV新發(fā)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.
【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】：2012
【分類號】：R749.64;R512.91
本文編號：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.
【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】：2012
【分類號】：R749.64;R512.91
【引證文獻】
相關(guān)碩士學(xué)位論文 前1條
1 羅玉璇;阻礙阿片類物質(zhì)依賴者參與社區(qū)美沙酮維持治療因素探究[D];昆明醫(yī)科大學(xué);2016年
本文編號：2210900
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