EPP/Spectrum模型在凉山州艾滋病疫情估计中的应用

Application of EPP/Spectrum model in the estimation of AIDS epidemic in Liangshan

目的通过艾滋病疫情估计来评估凉山州艾滋病疫情状况及趋势,为凉山州艾滋病防治工作提供依据。方法利用EPP/Spectrum模型,将凉山州艾滋病病毒(human immunodeficiency virus,HIV)感染者较集中的布拖县、昭觉县、美姑县、越西县四个区县作为一个亚流行区,分别拟合凉山州及四个区县的各类人群的流行曲线,对凉山州15岁以上人群HIV感染率、新发感染率及趋势进行估计。结果估计凉山州15岁以上人群HIV感染率呈逐年上升,2019年底凉山州HIV感染率为1.32%(95%CI:1.18%~1.50%),四个区县为3.87%;15岁以上人群新发感染率在2017年前逐年上升。估计注射吸毒新发感染病例数从2010年3010例下降到2019年的1340例;非婚非商业异性传播新发感染病例数从2010年1180例上升到2019年的2798例。注射吸毒人群感染率在2008年后上升速度变慢,非婚非商业异性传播的一般人群感染率加速上升。结论注射吸毒传播的新发感染病例数持续下降,与凉山州加强艾滋病防治协同公安部门开展禁毒防艾工作有关,但非婚非商业异性传播已成为凉山州艾滋病疫情的主要传播途径,在一般人群中需要进一步加强等有针对性的健康教育措施,提高人群防艾意识。

Objective To assess the application of estimation and projection package(EPP)/spectrum model in the estimation of HIV/AIDS epidemic in Liangshan,and to provide scientific evidence for the control and prevention of HIV/AIDS.Methods Based on the EPP/Spectrum model analysis,four districts of Butuo county,Zhaojue county,Meigu county and Yuexi county were classified as sub-epidemic areas,which were fitted with the epidemic curves of sub-populations in Liangshan and in four districts.The overall HIV infection rate and infection rate of newly diagnosed cases and disease trend among individuals over 15 years old were estimated.Results The estimated HIV infection rate among residents over the age of 15 years increased annually which would be 1.32%(95%CI:1.18%-1.50%)in Liangshan and 3.86%in the four endemic districts by the end of 2019.Meanwhile,the estimated newly infected rate of HIV increased annually before 2017.The total number of newly infected cases caused by drug injection decreased from 3010 in 2010 to 1340 in 2019 while increased from 1180 in 2010 to 2798 in 2019 due to non-marital and non-commercial heterosexual transmission.The HIV infection rate increased slowly among injecting drug users while increased rapidly among individuals with non-marital and non-commercial heterosexual transmission.Conclusions The number of newly infected HIV cases through drug injection decreases consistently due to the campaign on anti-drug and HIV/AIDS prevention launched by local government.However,non-marital and non-commercial heterosexualtransmission has become the main transmission route in Liangshan prefecture,which is the main cause of the epidemic rise.Therefore,health education should be strengthened to improve awareness of HIV/AIDS prevention among local residents.