摘要
目的了解云南省德宏傣族景颇族自治州(简称德宏州)美沙酮维持治疗(MMT)者在2011—2016年间艾滋病病毒(HIV)新发感染率及其影响因素。方法将德宏州2011—2016年所有入组MMT且HIV检测阴性的海洛因成瘾者纳入队列观察其HIV阳转情况,计算HIV新发感染率并运用COX比例风险回归模型分析其影响因素。结果共有5 048名海洛因成瘾者符合队列纳入标准,截至2016年12月,共有827名(16.4%)入组MMT后从未接受过HIV随访检测,属于"失访",另有4 221人(83.6%)接受过至少一次HIV随访检测,累积随访观察人年11 484.96人年,期间15人发生HIV抗体阳转,HIV新发感染率为1.3/1 000人年。运用COX比例风险模型多因素分析显示,在控制混杂因素的影响后,入组时年龄≥35岁MMT者HIV感染风险显著低于≤24岁年龄组者[调整比值比(aHR)=0.05, 95%可信区间(CI):0.01～0.59],初中及以上文化程度者HIV感染风险显著低于小学及以下者(aHR=0.29, 95%CI:0.09～0.88),入组MMT前有注射吸毒史者HIV感染风险显著高于无注射吸毒史者(aHR=11.07, 95%CI:2.19～55.98)。结论德宏州MMT门诊在减少HIV经吸毒途径传播中成效显著,要继续加强随访和HIV的检测力度,尤其要重点关注年轻、教育程度较低以及入组前有注射毒品行为者。
Objective To determine the incidence and determinants of HIV infection among heroin addicts receiving methadone maintenance treatment(MMT)between 2011 and 2016 in Dehong prefecture of Yunnan province.Methods All heroin addicts who were HIV negative at initiation of MMT in Dehong between 2011 and 2016 were included in the analysis.HIV incidence rate was calculated.Cox proportional hazard regression model was used to explore the factors associated with risks of HIV incidence.Results A total of 5 048 MMT clients were included.827(16.4%)clients enrolled in MMT who had never received HIV testing at follow-up visits were considered as'dropout from follow-up'.The other 4 221(83.6%)clients had received at least one HIV testing at follow-up visits and were observed for a total of 11 484.96 person-years.15 clients were detected as HIV seroconversion,resulting in an overall HIV incidence of 1.3/1000 person-years.Multivariate analysis showed that age≥35 years(vs age≤24)(adjusted hazard ratio[aHR]=0.05,95%confidence interval[CI]:0.01-0.59),and at least junior middle education(vs illiterate or primary education)(aHR=0.29,95%CI:0.09-0.88)were associated with decreased risks of HIV seroconversion while history of injection drug use(IDU)prior to MMT was associated with increased risks of HIV seroconversion(aHR=11.07,95%CI:2.19-55.98).Conclusion MMT program in Dehong prefecture is effective in reducing HIV transmission through drug use.HIV testing program should be strengthened among MMT clients,particularly young MMT clients,those with lower educational level and a history of IDU.
作者
李林
宁晨曦
唐仁海
叶润华
杨跃诚
杨顺生
官平珍
杨光文
龙玉存
赵乙澳
尹棉松
段松
何纳
LI Lin;NING Chenxi;TANG Renhai;YE Runhua;YANG Yuecheng;YANG Shunsheng;GUAN Pingzhen;YANG Guangwen;LONG Yucun;ZHAO Yi’ao;YIN Miansong;DUAN Song;HE Na(Department for STD and AIDS Prevention and Control,Dehong Prefecture Center for Disease Control and Prevention,Mangshi 678400,China;Department of Epidemiology,School of Public Health,and Key Laboratory of Public Health Safety of Ministry of Education,Fudan University,Shanghai 200032;Bureau of AIDS Prevention and Control in Dehong Prefecture,Mangshi 678400;Clinic of Community-based Methadone Maintenance Treatment,Mangshi Center for Disease Control and Prevention,Mangshi 678400;Clinic of Community-based Methadone Maintenance Treatment,Ruili Center for Disease Control and Prevention,Ruili 678600;Clinic of Community-based Methadone Maintenance Treatment,Longchuan Center for Disease Control and Prevention,Longchuan 678700;Clinic of Community-based Methadone Maintenance Treatment,Yingjiang Center for Disease Control and Prevention,Yingjiang 679300;Clinic of Community-based Methadone Maintenance Treatment,Lianghe Center for Disease Control and Prevention,Lianghe 679200)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2019年第4期380-383,405,共5页
Chinese Journal of Aids & STD
基金
国家重点地区艾滋病防治项目
国家"十二五"科技重大专项(2013ZX1004-906)~~
