云南省德宏州利用PITC策略发现的HIV感染者特征及卫生服务利用分析

Characteristics and health service utilization of HIV positive individuals detected through free PITC strategy in Dehong prefecture

目的了解2013年云南省德宏州乡镇卫生院经医务人员主动提供艾滋病检测咨询(provider-initiated HIV testing and counselling,PITC)发现的HIV感染者特征及卫生服务利用状况。方法对PITC新发现HIV感染者与既往感染者特点及艾滋病卫生服务利用状况分析,应用Logistic回归分析HIV早发现影响因素。结果经PITC发现HIV感染者179例,76例(42.5%)为新发现感染者。相对于既往感染者,新发现感染者较年轻、外籍比例较高、AIDS患者比例较低。新发现感染者抗病毒治疗率及咨询服务接受率均低于既往感染者。但两者在是否坚持使用安全套以及是否受到抗机会感染药物支持、经济支持、结核病检查等艾滋病相关卫生服务的比例均无统计学差异(均有P>0.05)。58.8%(97/165)为早发现感染者。多因素回归分析显示,女性早发现率高于男性,具有统计学意义(OR=2.40,P=0.006);≥45岁年龄组早发现率小于<35岁年龄组,差异有统计学意义(OR=0.25,P<0.001);外籍人口早发现率低于中国籍,具有统计学意义(OR=0.46,P=0.044)。结论德宏州乡镇卫生院实施免费PITC可发现一定数量的HIV感染者,但对PITC新发现感染者的咨询服务和抗病毒治疗工作有待加强。

Objective To examine characteristics and health service utilization of HIV-positive individuals detee- ted through Provider-Initiated HIV Testing and Counselling （PITC） in Dehong Prefecture of Yunan Province in 2013. Methods Newly diagnosed positives detected by PITC and formerly diagnosed positives were compared in terms of charac- teristics and utilization of health services. Correlates of early diagnosis were also analyzed through Logistic regression analy- sis. Results A total of 179 individuals were detected positive for HIV by PITC, of whom 76 （42. 5% ） were newly diag- nosed. Compared with the formerly diagnosed infections, the newly diagnosed were younger with more foreigners and less AIDS patients. The proportion of receiving antiretroviral therapy （ART） and counselling were significantly lower among the newly diagnosed infections, but the proportion of consistent condom use, having received antifungal drugs, economic sup- ports or tuberculosis examinations were not significantly different between the two groups. 58.8% （97/165） of the HIV-in- feeted individuals were defined as the early diagnosed infections. Multiple regression analysis indicated that women were more likely to be early diagnosed than men （ OR = 2.40 ,P = 0. 006 ）, ≥45 years old were less likely to be early diagnosed than 〈35 years old （OR =0. 25 ,P 〈0. 001 ） and foreigners were less likely to be diagnosed than Chinese （OR =0. 46,P = 0. 044）. Conclusions The free PITC strategy implemented in township hospitals in Dehong prefecture can identify a number of HIV infections. But more efforts are needed for providing counselling and ART to newly diagnosed HIV infections by PITC.