HIV感染者及艾滋病患者检测发现晚的原因调查分析

Analysis on late diagnosis reasons of newly diagnosed HIV/AIDS patients

目的调查检测发现晚HIV感染者、艾滋病患者特征以及导致检测发现晚的主要原因。方法利用艾滋病综合防治数据信息系统数据，选择河南驻马店市、南阳市和周口市，广西柳州市和钦州市灵山县，广东广州市和深圳市，以及云南德宏州共4省（区）8个市（州、县）为调查地点，对其2009年1月1日至2010年6月30日新检测发现的HIV感染者及艾滋病患者进行核实，共有3912例调查对象符合要求，其中晚发现患者2496例，早发现感染者1416例。并对其行为史、HIV检测史和检测晚的原因进行问卷调查。晚发现患者指：在报告的年度内，CD4〈200个／mm3或者诊断为艾滋病患者。对晚发现患者的特征分析采用单因素和多因素logistic回归分析。结果晚发现患者中仅有14．2％（350／2469）曾有“去做HIV检测”的想法，其中68．8％（150／218）的人因担心检测阳性受到歧视而未能及时检测。在没有“去做HIV检测”想法的晚发现患者当中，“从未想过自己会感染HIV”和“从未听说过艾滋病”的比例分别为69．7％（1476／2116）和18．1％（383／2116）。晚发现患者中出现艾滋病相关症状就诊后，仅有40．0％（590／1475）的医疗机构提供了HIV检测服务，而其中又有54．5％（322／590）的人未被告知检测结果。与早发现感染者相比，晚发现患者主要特征是年龄在50岁以上（OR；4．14，95％CI：3．09～5．55）、小学文化（OR=1．29，95％c，：1．10～1．52）、文盲（OR=2．15，95％CI：1．25～2．82）、传播途径为既往采血（浆）（OR=2．91，95％CI：2．27～3．74）和输血或血制品（OR：2．79，95％C1：2．11～3．68），检测发现主要来自检测咨询机构和医疗机构，分别占45．4％（1130／1528）和38．3％（954／1469）。结论HIV感染者、艾滋病患者检测发现晚最主要原因是主动检测意识差和担心受到歧视，同时，医疗机构主动提供HIV抗体检测意识低也影响了感染者的及早发现。

Objective To understand the characteristics of HIV/AIDS patients with late diagnosis and find the factors associated with late HIV detection. Methods HIV late diagnosed patients and early diagnosed patients, which were identltied and classified by definition in advance, were selected from the case reporting database of HIV/AIDS Comprehensive Response Information Management System in eight counties of four provinces（Zhumadian, Nanyang, and Zhoukou of Hennan province; Liuzhou and Lingshan county of Guangxi autonomous region; Guangzhou and Shenzhen of Guangdong province; Dehong of Yunnan province） between January 1, 2009 and June 30, 2010. A total of 3912 eligible patients were investigated, including 2496 late diagnosis and 1416 early diagnosis. The structured questionnaires were used to obtain information on behaviors, HIV detection history and reason of late detectionfor all eligible HIV/AIDS patients. Late diagnosed patients were defined by CD4 T-cell counts less than 200 ce!ls/mm3 or diagnosis as AIDS within the reported year after the first HIV positive test. The univariate and multivariate logistic regression methods were used to analyze the characteristics of HIV/AIDS late diagnosed patients. Results Only 14. 2% （ 350/2469） of them have ever had the awareness of ＂to go for HIV testing＂, 68. 8% （ 150/218）of which did not put it into practice within one month because of discrimination and stigma. Among those HIV late diagnosed patients without the awareness of ＂to go for HIV testing＂, the proportions of ＂never worried about HIV infection＂ or ＂never heard of AIDS＂ were 69. 7% （1476/2116） and 18. 1% （383/2116）, respectively. When those HIV late diagnosed patients visited health settings because of AIDS related symptoms, only 40. 0% （590/1475） of them received the HIV testing service. Furthermore, 54. 5% （322/590） of those received HIV testing were not informed the results. Compared with early diagnosed patients, patients with late diagnosis were over 50 years old（ OR = 4. 14,95% CI：3.09 -5.55 ） , primary school education （OR = 1.29,95% CI：I. 10- 1.52） and illiteracy（ OR = 2. 15,95% CI： 1.25 -2. 82）, Routes of transmission from former illegal blood or plasma （ OR = 2. 91,95% C1：2. 27 - 3.74 ） and transfusion of blood/blood products （OR= 2.79,95% CI： 2. 11 -3.68 ）. Late diagnosed patients were identified mainly from voluntary counseling and testing （ 45. 4% , 1130/1528 ） and medical institutions （ 38. 3%, 954/1469 ） . Conclusion The main reasons for late diagnosis of HIV infection are low initiative of HIV testing and discrimination and stigma. Furthermore, the low awareness of medical institutions to actively provide HIV testing affects the early diagnosis of HIV infections.