结核分枝杆菌和艾滋病病毒双重感染防治合作模式与效果

Analysis of cooperation model and effect of TB/HIV co-infection

目的探讨我国不同地区结核分枝杆菌（简称结核杆菌）和艾滋病病毒（HIV）双重感染防治工作合作模式,以及在不同合作模式下发现结核杆菌和HIV双重感染患者的效果。方法选择河南、云南、四川和广西4省（自治区）的6个县（市）,调查各县（市）结核病（TB）和艾滋病防治相关医疗卫生机构分布现状和功能特征;对6县（市）2006年9月至2007年2月新登记的2396例TB患者中的2135例进行了HIV检测,检出HIV阳性68例;对3879例HIV感染者和艾滋病（AIDS）患者由医务人员进行面对面的TB可疑症状问卷调查,问卷调查阳性1751例,其中发现TB患者250例,双向筛查发现TB和AIDS双重感染患者318例。结果 6县（市）结核杆菌和HIV双重感染防治合作模式主要包括两种类型,一种是在同一机构内TB和AIDS防治相关科室间的合作模式（简称机构内合作）,另一种是在疾病预防控制机构和医疗机构等多机构间的合作模式（简称机构间合作）。在两种合作模式中,3个机构内合作的县（市）,HIV感染者与AIDS患者的转诊到位率均达到100.0%（54/54,159/159,335/335）;3个机构间合作的县（市）中,有1个县（市）HIV感染者与AIDS患者的转诊到位率达到100.0%（39/39）,另2个县（市）分别为91.0%（343/377）和99.9%（786/787）。6个县（市）TB患者中HIV检测率为89.1%（2135/2396）（33.0%~100.0%）。6个县（市）HIV感染者与AIDS患者中结核病检出率为14.3%（250/1751）（1.6%~22.9%）,在TB患者中HIV阳性检出率平均为3.2%（68/2135）（1.0%~6.5%）。在发现的318例结核杆菌和HIV双重感染患者中,从HIV感染者与AIDS患者中发现TB患者占78.6%（250/318）（54.9%~98.6%）。结论因地制宜建立结核杆菌和HIV双重感染防治合作模式,是做好结核杆菌和HIV双重感染患者发现的重要前提。

Objective To explore the cooperation models in different regions and their effects on TB/HIV case finding.Methods Six counties of 4 provinces including Henan,Yunnan,Sichuan and Guangxi were selected to investigate the distribution and function of TB and HIV related institutions.2135 of 2396 new registered TB patients in 6 counties from Sep.2006 to Feb.2007 were tested for HIV infection,68 cases were detected HIV positive,and 3879 cases of HIV/AIDS were administered face-to-face TB questionnaires,1751 cases were detected as positive questionnaire and among them,250 cases were TB patients.Through the two-way screening,318 cases were detected as TB/HIV cases.Results There were two patterns of cooperation model in these 6 counties.One is inter-division cooperation within the same institution;the other is inter-institution cooperation between disease control institutions and medical agencies.In 3 counties with inter-division cooperation model,referral in place rate of HIV/AIDS patients all reached 100.0%（54/54,159/159,335/335）;In other 3 counties with inter-institution cooperation,this rate was 100.0%（39/39）,91.0%（343/377） and 99.9%（786/787）respectively.In these 6 counties,the HIV testing rate of TB patients was 89.1%（2135/2396）（33.0%~100.0%）,the detection rate of TB cases was 14.3%（250/1751）（1.6%~22.9%） in people living with HIV/AIDS,and the HIV/AIDS detection rate in TB patients was an average of 3.2%（68/2135）（1.0%~6.5%）.TB/HIV case detection through TB screening among HIV/AIDS contributed 78.6%（250/318）（54.9%~98.6%） of the total 318 cases detected.Conclusion To establish the cooperation model is the prerequisite for TB/HIV case detection.