基于重庆艾滋病时空数据的综合评价和影响因素分析

Evaluation of HIV / AIDS prevention and control work based on spatial-temporal data in Chongqing

目的回顾性分析重庆市2006-2012年艾滋病防控工作开展及效果,探索HIV/AIDS在重庆地区的时空聚集性。方法从重庆市38个区县的传染病上报系统和哨点监测数据库中,收集重庆市38个区县从2006年到2012年的HIV/AIDS疫情统计数据和艾滋病防控经济指标。采用Person相关系数进行线性趋势检验,分析指标间的相关性。采用Satscan软件对HIV携带者数进行时空聚集性分析。结果 2006-2012年重庆市男男性行为者、注射吸毒者和暗娼人群的HIV感染率分别为15.62%（95%CI：14.41%～16.86%）、8.42%（95%CI：7.82%～9.03%）和0.18%（95%CI：0.10%～0.25%）。同期重庆市艾滋病防控总投入、接受咨询和检测的人数和注射吸毒人群人均干预人次数均呈现增长趋势（均有P〈0.05）,但高危人群安全套使用率并未呈现增长趋势（均有P〉0.05）,高危人群HIV感染率未呈现下降趋势（均有P〉0.05）。HIV携带者数主要聚集区在中西部和中南部的区县,时间聚集在2010-2012年。结论虽然重庆市2006-2012年对于艾滋病高危人群的艾滋病预防控制工作得到了开展,但高危人群的安全性行为没有得到加强,HIV的感染率没有下降,防控效果不理想。HIV/AIDS的流行呈现时空聚集性,空间聚集区为中西部和中南部的区县,并随时间呈现上升趋势。

Objective To analyze interventions that targeted HIV/AIDS in Chongqing in the period of 2006 - 2012 and explored the spatial-temporal clustering of HIV/AIDS. Methods A comprehensive collection of HIV/AIDS epidemic statistics and data regarding the economic investment used for AIDS prevention and treatment were conducted from the 38 districts and counties were conducted from the Chongqing infectious disease reporting system and sentinel surveil- lance databases in Chongqing from 2006 to 2012. The pearson correlation coefficient was used in linear-trend analysis and correlation analysis of relationships among indices. Temporal-spatial clustering analysis was performed on the people with HIV infection using Satscan software. Results From 2006 to 2012, the HIV infection rates among man who have sex with man, intravenous drug users and female sex workers in Chongqing were 15.62% （95% CI： 14.41% -16. 86% ） , 8.42% （95% CI： 7.82%-9.03% ）, and 0.18% （95% CI： 0. 10%-0. 25% ）, respectively. In the same period, the total funding for AIDS prevention and control, the number of individuals receiving counseling and testing and per capita intervention times of intravenous drug users tended to increasing （all P 〈 0. 05 ）, however, the condom use rates among high-risk groups did not show an upward trend （ all P 〉 0. 05 ） and the risk of HIV infection among high-risk groups did not show a downward trend （ all P 〉 0. 05 ）. The number of HIV carriers mainly gathered in the mid-western and south-central parts of Chongqing. The time windows were primarily distributed in 2010 -2012. Conclusions Although the prevention and control efforts to target the AIDS high-risk groups were strengthened in Chongqing during 2006 - 2012, safe sex practices did not significantly improve among the high-risk groups, the HIV infection rates did not decrease, and the effects of the prevention and control efforts were not productive. The Chongqing HIV/AIDS epidemic presented temporal-spatial clustering, and the HIV/AIDS prevalence was primarily clustered in the mid-western and south-central counties, showing an upward trendover time.