艾滋病不同流行区预防母婴传播的策略研究

Study on the strategies for prevention of AIDS mother-to-child transmission in different AIDS prevalence areas

目的：评价不同艾滋病流行区实施母婴阻断措施的工作效率,为制定不同流行区域的干预策略提供理论依据。方法：采用成本效果和成本效用分析方法评价2008-2010年新疆维吾尔自治区2个艾滋病高流行区（A区和B区）和1个中流行区（C区）实施母婴传播阻断措施的工作效率,并整理分析相关数据。结果：2008-2010年3个地区实施母婴阻断干预措施直接避免感染人数分别为84名、68名和22名,终止妊娠避免感染的费用分别为7 677.61元、10 774.03元和26 391.53元,药物阻断避免感染的费用分别为14 331.21元、17 364.10元和27 321.12元,避免直接经济损失分别为18 373 559元、15 179 698元和5 140 299元;直接避免减少伤残调整生命年（DALY）损失分别为1 723.08健康人年、1 432.44健康人年和477.48健康人年。结论：在艾滋病高流行区实施母婴传播阻断措施的经济学效益高于中流行区,终止妊娠措施的经济学效益高于抗病毒治疗措施,针对艾滋病不同流行区域应实施不同防治重点组合策略。

Objective： To evaluate the work efficiency of AIDS mother - to - child transmission block measures in different AIDS prevalence areas, provide a theoretical basis for making intervention strategies in different AIDS prevalence areas. Methods： Cost - effectiveness analysis method and cost - utility analysis method were used to evaluate the work efficiencies of AIDS mother - to - child transmission block measures in two AIDS high prevalence areas （area A and area B） and AIDS middle prevalence area （area C ） of Xinjiang Uygur Autonomous Region, the related data were summarized and analyzed. Results： From 2008 to 2010, 84, 68 and 22 cases in the three areas avoided HIV infection directly after implementation of AIDS mother - to - child transmission block measures, respectively, the costs of terminating pregnancy to avoid HIV infection were 7 677. 61 Yuan, 10 774. 03 Yuan and 26 391.53 Yuan, respectively; the costs of drugs block were 14 331.21 Yuan, 17 364. 10 Yuan and 27 321.12 Yuan, respectively; the direct economic losses avoided were 18 373 559 Yuan, 15 179 698 Yuan and 5 140 299 Yuan, respectively; the DALY losses avoided were 1 723.08, 1 432. 44 and 477.48, respectively. Conclusion： The economic efficiencies of implementation of AIDS mother - to - child transmission block measures in AIDS high prevalence areas are higher than those in HIV low prevalence areas, the economic efficiency of terminating pregnancy is higher than that of antiviral treatment, the combined strategies with different prevention and treatment key points should be conducted in different AIDS prevalence areas.