2019年浙江省温州市艾滋病感染诊断治疗服务链特征分析

Characteristics of HIV infection diagnosis and treatment care continuum in Wenzhou, Zhejiang, 2019

目的 分析2019年浙江省温州市艾滋病感染诊断治疗服务链中诊断发现率、链接率、保持率、登记治疗率、维持治疗率、病毒抑制率及相关因素,为精准防控提供参考依据。方法 通过中国疾病预防控制信息系统收集截至2019年温州市现存活艾滋病病毒感染者/艾滋病患者(HIV/AIDS)信息,采用Spectrum v5.753软件估计HIV/AIDS数,采用多因素logistic回归模型分析温州市艾滋病感染诊断治疗服务链各环节(链接、保持、登记治疗、维持治疗和病毒抑制)影响因素。结果 截至2019年底,温州市估计现存活HIV/AIDS 5 750(5 078~6 473)例,诊断发现率为76.2%(67.7%~86.2%)(“第一个90%”)。分别与服务链的上一环节相比,链接率、保持率及登记治疗率为99.1%、97.2%、98.9%。维持治疗率为91.5%(“第二个90%”),病毒抑制率为95.9%(“第三个90%”)。多因素logistic回归分析显示,监管场所来源HIV/AIDS在各环节均容易脱失,OR值(95%CI)分别为0.23(0.08~0.64)、0.32(0.17~0.62)、0.33(0.18~0.60)、0.33(0.20~0.54)、0.49(0.31~0.78)。已婚有配偶/有固定性伴是各环节的保护因素,OR值(95%CI)分别为4.45(1.65~12.04)、2.50(1.51~4.15)、2.29(1.47~3.56)、2.49(1.76~3.51)、1.69(1.29~2.22)。初中、高中或中专、大专及以上是病毒抑制环节的保护因素,OR值(95%CI)分别为1.32(1.05~1.66)、1.51(1.11~2.06)和1.55(1.12~2.15)。结论 2019年温州市艾滋病感染诊断治疗服务链薄弱环节是诊断发现环节。需继续深化扩大检测策略和措施的落实,并提高高危人群及重点人群检测意愿和服务可及性。

Objective To analyze the detection rate, previous CD4 detection rate, retention rate, registered antiviral therapy(ART) rate, ART maintenance rate, viral load suppression rate and related factors in HIV infection diagnosis and treatment care continuum in Wenzhou of Zhejiang province in 2019, and provide a insights into precise control of AIDS. Methods The case information of people living with human immunodeficiency virus/acquired immunodeficiency syndrome(PLWHA) in Wenzhou were collected, and the multivariate logistic regression model was used to analyze the related factors. Results By the end of 2019, a total of 5 750 PLWHA(5 078–6 473) had been estimated to live in Wenzhou, and the detection rate was76.2%(67.7%–86.2%). Compared with the previous chain in the HIV infection diagnosis and treatment, the previous CD4detection rate, retention rate and registered ART rate were 99.1%, 97.2%, and 98.9%, respectively. The ART maintenance rate was 91.5%, and the viral load suppression rate was 95.9%. Multivariate logistic regression analysis showed that PLWHA in correctional places were more likely to loss retention in each chain, and the ORs were 0.23(95% CI: 0.08–0.64), 0.32(95% CI:0.17–0.62), 0.33(95% CI: 0.18–0.60), 0.33(95% CI: 0.20–0.54) and 0.49(95% CI: 0.31–0.78), respectively. Marriage/cohabitating was a protective factor for the retention in each chain, and the ORs were 4.45(95% CI: 1.65–12.04), 2.50(95%CI: 1.51–4.15), 2.29(95% CI: 1.47–3.56), 2.49(95% CI: 1.76–3.51) and 1.69(95% CI: 1.29–2.22), respectively. The education levels of senior high school, technical secondary school and college or above were the protective factors for virus load suppression, and the ORs were 1.32(95% CI: 1.05–1.66), 1.51(95% CI: 1.11–2.06) and 1.55(95% CI: 1.12–2.15), respectively.Conclusion In 2019, the weak chain in HIV infection diagnosis and treatment in Wenzhou was the disease detection. It is necessary to strengthen the implementation of HIV testing strategies and measures and improve the willingness and service accessibility of high-risk and key groups for HIV testing.