本文選題：男男性接觸者(MSM)　切入點(diǎn)：人類免疫缺陷病毒感染者/艾滋病病人　出處：《南京醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究旨在通過對(duì)同伴推動(dòng)抽樣法(respondent-driven sampling, RDS)的采用,了解江蘇省南京市男男性接觸者(MSM)人群HIV/AIDS及梅毒的感染狀況,了解該人群HIV的流行狀況、人口統(tǒng)計(jì)學(xué)特征、性行為特征,從而比較全面地掌握該人群疾病感染的情況,為今后的預(yù)防干預(yù)措施的指定與落實(shí)提供比較可靠的理論依據(jù)。另外,本研究對(duì)RDS方法的招募效果、招募的平衡性等進(jìn)行了合理的評(píng)價(jià),以檢驗(yàn)RDS方法是否比較準(zhǔn)確的招募到了具有代表性的樣本。 方法:采用RDS,對(duì)南京市430名MSM進(jìn)行問卷調(diào)查和血清學(xué)檢測(cè)。在調(diào)查結(jié)束后,用EpiData 3.0軟件建立數(shù)據(jù)庫,數(shù)據(jù)的錄入采用雙軌錄入。數(shù)據(jù)庫錄入后使用Excel工作表進(jìn)行清洗(邏輯性檢測(cè)、缺漏項(xiàng)回訪等),重新賦值和生成新的變量后進(jìn)行統(tǒng)計(jì)分析;用RDSAT5.6軟件分別計(jì)算相關(guān)指標(biāo)的粗構(gòu)成比和調(diào)整構(gòu)成比,并分析相關(guān)指標(biāo)的趨同性、導(dǎo)出相關(guān)變量的權(quán)重;用NetDraw軟件繪制招募圖;導(dǎo)出的權(quán)重系數(shù)和原數(shù)據(jù)庫合并后導(dǎo)入SPSS16.0軟件進(jìn)行Logistic回歸分析、t檢驗(yàn)。 結(jié)果:(1) 2008年5月-8月,本研究共招募了430名MSM,其中MSM人群HIV感染率為4.7%(粗率),校正后為6.6% (95%CI:3.0,10.4);梅毒感染率為11.9%,校正后梅毒感染率為12.6%(95%CI:8.1,18.3),HIV和梅毒合并感染校正率為2.9%(95%CI:0.3,5.3);通過乘數(shù)法及社區(qū)訪談,最終估計(jì)南京市MSM人群總數(shù)為25,000人,范圍在20,000-32,000人;(2)雙性戀人群相關(guān)性行為比同性戀人群更危險(xiǎn);梅毒、無保護(hù)性肛交、首次發(fā)生男男性行為的年齡是感染HIV的危險(xiǎn)因素(P0.05);感染HIV、具有排尿痛或燒灼感、尿道分泌物異常、生殖器或肛門出現(xiàn)皮膚破損或增生物的人感染梅毒的風(fēng)險(xiǎn)更高,職業(yè)為公司職員的人罹患梅毒的風(fēng)險(xiǎn)比其他人群更高,預(yù)防干預(yù)措施是感染梅毒的一個(gè)保護(hù)因素;(3)離異或喪偶、在過去6個(gè)月和固定性伴以外的同性發(fā)生性行為、性角色為“0”、最近一次發(fā)生性行為之前曾經(jīng)飲酒、在過去6個(gè)月有多個(gè)性伴是發(fā)生無保護(hù)性肛交的危險(xiǎn)因素;(4)波次平衡和周次平衡均可用于衡量RDS招募的平衡性;RDS招募的有效性分析顯示RDS是招募MSM人群的有效方法。 結(jié)論:(1)南京市MSM人群HIV、梅毒感染率較高,情況不容樂觀,我們需要加強(qiáng)對(duì)MSM人群的宣傳和干預(yù),加強(qiáng)對(duì)MSM人群的檢測(cè),促進(jìn)陽性感染者的發(fā)現(xiàn),控制傳染源,減緩HIV蔓延的趨勢(shì);(2)通過對(duì)RDS招募的樣本進(jìn)行分析,我們可以發(fā)現(xiàn),RDS是招募MSM等隱蔽性人群,獲得相對(duì)具有代表性的樣本的有效方法。
[Abstract]:Objective: through the study of respondent driven sampling (respondent-driven sampling, RDS) by the understanding of Jiangsu city of Nanjing province MSM (MSM) infection in the population of HIV/AIDS and syphilis, understand the epidemic situation of HIV in this population, demographic characteristics, behavior characteristics, to fully grasp the situation of infectious diseases the crowd, for future intervention to provide a reliable theoretical basis and implementation. In addition, the research results of RDS recruitment methods, such as the balance of the recruitment for a reasonable evaluation, to test whether the RDS method is more accurate in recruiting a representative sample.
Methods: using RDS, by questionnaire survey and serological testing of 430 MSM in Nanjing city. At the end of the investigation, the establishment of a database with EpiData 3 software, the input data with dual input. After using Excel database entry work table for cleaning (logic detection, missing item return visit etc.), statistical analysis and re assignment the formation of new variables; the related indices were calculated respectively by RDSAT5.6 software and the adjustment of crude composition ratio, and analysis of the related index of convergence, weights are derived related variables; draw recruitment chart with the NetDraw software; the weight coefficients are derived and the original database merged into SPSS16.0 software for Logistic regression analysis and t test.
Results: (1) -8 months of May 2008, this study recruited a total of 430 MSM, the MSM population HIV infection rate was 4.7% (crude), after correction for 6.6% (95%CI:3.0,10.4); the infection rate of syphilis was 11.9%, after correction of syphilis infection rate was 12.6% (95%CI:8.1,18.3), HIV and syphilis infection rate and correction 2.9% (95%CI:0.3,5.3); through the multiplier method and community interviews, the final estimated population size of MSM in Nanjing was 25000, in the range of 20000-32000 people; (2) bisexual population correlation behavior is more dangerous than gay people; syphilis, unprotected anal intercourse, the first occurrence of MSM age is a risk factor for HIV infection (P0.05); HIV infection, with pain or burning urination, urethral secretion abnormalities, genital or anal skin damage or increase the risk of living people infected with syphilis at higher risk for the company staff occupation of people suffering from syphilis is higher than the rest of the population, prevention The intervention was a protective factor of syphilis infection; (3) divorced or widowed, had sex in the past 6 months and same-sex fixed partners outside the role as "0" before the last sex was drinking in the past 6 months have multiple sexual partners were risk factors unprotected anal intercourse; (4) the waves of balance and balance can be used to measure the RDS week balance recruitment; effective RDS recruitment analysis shows that RDS is an effective method for the recruitment of MSM people.
Conclusion: (1) HIV MSM group in Nanjing City, syphilis infection rate is higher, the situation is not optimistic, we need to strengthen the propaganda and intervention of the MSM population, strengthen the inspection of the MSM population, promote positive infection, source of infection, slowing the spread of HIV trend; (2) through the recruitment of RDS the sample analysis, we can find that the RDS MSM is recruiting hidden people, effective way to obtain representative samples.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R512.91;R181.3

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