南宁市艾滋病抗病毒治疗基层防控服务模式效果分析

Analysis on effect of grassroots prevention and control service model of AIDS antiviral treatment in Nanning City

目的分析基层艾滋病防控工作模式在推广应用不同时期中,新报告人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS病例)的抗病毒治疗(ART)情况及变化趋势,以探索提高南宁市新报告病例ART和及时ART的有效措施。方法利用国家艾滋病综合防治数据信息系统,收集2017—2019年南宁市新报告HIV/AIDS病例的基本情况和接受ART的相关信息,分析基层艾滋病防控工作模式推广应用不同时期病例报告当年接受ART和及时ART情况。结果病例报告当年接受ART的比例由2017年推广前的74.2%提升至2019年推广后的84.6%,呈逐期(逐年)上升的趋势(χ^(2)=53.167,P<0.01)。及时ART比例由2017年推广前的77.8%提升至2019年推广后的86.5%,也呈逐期(逐年)上升的趋势(χ^(2)=31.925,P<0.01)。病例在确证后9个月以上才开始接受ART的比例由2017年推广前的5.4%下降到2019年推广后的0.3%,呈逐期下降的趋势(χ^(2)=83.460,P<0.01)。多因素分析结果显示,及时接受CD4细胞检测是推广前病例及时ART的有利因素;初中及以上文化和及时接受CD4细胞检测是推广期病例及时ART的有利因素,首次检测CD4细胞计数<200个/μL是推广期病例及时ART的不利因素;病例来源为检测咨询和及时接受CD4细胞检测是推广后病例及时ART的有利因素。结论推广应用和实施基层艾滋病综合防控工作模式后,南宁市新报告病例ART和及时ART的比例均得到了有效的提升,且当地各县(区)的各个机构已把该工作模式作为常规工作开展,使扩大治疗的各项措施越来越好地得到完成和实施,表明该模式具有可推广性和可持续性,应进一步推广。

Objective To analyze the antiviral treatment(ART) status and change trend among newly reported human immunodeficiency virus(HIV) infection/AIDS patients(referred to as HIV/AIDS cases) in different periods of promotion and application of grassroots prevention and control service model of AIDS, explore effective measures to improve ART and timely ART in newly reported cases in Nanning City. Methods Using the national AIDS comprehensive prevention and control data information system, the basic data and receiving ART information of newly reported HIV/AIDS cases in Nanning City from 2017-2019 were collected, to analyze the situation of receiving ART in the year of case report and timely ART in different periods of promotion and application of grassroots AIDS prevention and control service model. Results The proportion of patients receiving ART in the year of case report increased from 74.2% before promotion in 2017 to 84.6% after promotion in 2019, showing an increasing trend year by year(χ^(2)=53.167,P<0.01). The proportion of timely ART increased from 77.8% before promotion in 2017 to 86.5% after promotion in 2019,showing an increasing trend year by year (χ^(2)=31.925,P<0.01). The proportion of patients who began to received ART more than 9 months after confirmation decreased from 5.4% before promotion in 2017 to 0.3% after promotion in 2019, showing a trend of gradual decline(χ^(2)=83.460, P<0.01). Multivariate analysis showed that the timely detection of CD4 cells was a favorable factor for timely ART before promotion. The education level of junior high school or above and the timely detection of CD4 cells were favorable factors for timely ART of the cases in the promotion period. The first detection of CD4 cell count <200/μL was the unfavorable factor for the timely ART of the cases in the promotion period. The case source is test consultation and the timely detection of CD4 cells were favorable factors for timely ART after promotion. Conclusion After the promotion and implementation of the grassroots AIDS prevention and control service model, the proportion of ART in newly reported cases and timely ART in Nanning City have been effectively increased. And the institutions of counties(districts) in the area have carried out the work mode as a routine work, so that the measures of expanding treatment are more and more completed and implemented, which shows that the model has the generalizability and sustainability, and should be further promoted.