义乌市2016—2020年报告HIV/AIDS病例流动特征分析

Migration characteristics among HIV/AIDS patients reported in Yiwu City from 2016 to 2020

目的了解浙江省义乌市2016—2020年报告艾滋病病毒感染者和艾滋病患者(HIV/AIDS)确证后流动及随访治疗情况,为优化流动人口艾滋病防控策略提供依据。方法通过中国疾病预防控制信息系统艾滋病综合防治信息系统收集义乌市2016—2020年报告HIV/AIDS病例的人口学、随访和治疗资料,分析HIV/AIDS病例确证后流动特征、抗病毒治疗和转归情况,并采用Cox比例风险回归模型分析HIV/AIDS病例确证后流动的影响因素。结果义乌市2016—2020年报告的1189例HIV/AIDS病例纳入分析。男性988例,占83.10%;非浙江省户籍806例,占67.79%。流出义乌市441例,占37.09%,流动率为17.73/100人年;其中流出浙江省366例,跨省流动比例为30.78%。非浙江省户籍病例中,流出义乌市395例,占49.01%;其中返回户籍省份337例,占85.32%,以云南省、四川省、贵州省和湖南省为主。少数民族(HR=1.375,95%CI:1.044~1.811)、离退休人员(HR=3.605,95%CI:1.771~7.335)、学生(HR=8.969,95%CI:4.095~19.645)、非浙江省户籍(HR=4.545,95%CI:3.164~6.529)、经流动人口或从业人口体检发现(HR=1.318,95%CI:1.006~1.727)的病例确证后流动的可能性较高;已婚有配偶(HR=0.721,95%CI:0.569~0.913)、初中及以上学历(HR:0.428~0.753,95%CI:0.280~0.952)的病例确证后流动的可能性较低。流动病例中,失访26例,占5.90%;死亡49例,占11.11%。流动病例未接受抗病毒治疗、由HIV感染者进展为AIDS患者和病毒未抑制的比例均高于未流动病例(P<0.05)。结论义乌市2016—2020年报告的HIV/AIDS病例中,非浙江省户籍、未婚、文化程度较低、离退休人员、学生、经流动人口或从业人员体检发现病例确证后流动风险较高,且流动不利于抗病毒治疗和随访的延续性,可影响疾病转归。

ObjectiveTo investigate the migration characteristics and follow-up treatment among HIV/AIDS patients after HIV confirmation in Yiwu City,Zhejiang Province from 2016 to 2020,so as to provide insights into the optimization of the HIV/AIDS control strategy among floating populations.Methods graphics,follow-up and treatment data in Yiwu City from 2016 to 2020 were captured from the HIV/AIDS Prevention and Control Information System of Chinese Disease Control and Prevention Information System.The migration characteristics,antiretroviral therapy and outcomes of HIV/AIDS patients were analyzed after HIV confirmation,and the factors affecting the migration of HIV/AIDS patients after HIV confirmation were identified using a Cox proportional hazard regression model.ResultsA total of 1189 HIV/AIDS patients were enrolled,including 988 men(83.10%)and 806 cases without Zhejiang provincial household registration(67.79%).There were 441 patients(37.09%)migrating out of Yiwu City after HIV confirmation,with a migration rate of 17.73/100 person-years,and there were 366 patients migrating out of Zhejiang Province,with a cross-province migration rate of 30.78%.Among participants without Zhejiang provincial household registration,395 patients(49.01%)migrated out of Yiwu City,including 337 patients(85.32%)returning to their household registration provinces,which mainly included Yunnan,Sichuan,Guizhou and Hunan.Cox proportional hazard regression analysis showed a high risk of migration among minority ethnic populations(HR=1.375,95%CI:1.044-1.811),retires(HR=3.605,95%CI:1.771-7.335),students(HR=8.969,95%CI:4.095-19.645),patients without Zhejiang provincial household registration(HR=4.545,95%CI:3.164-6.529)and patients identified through physical examination of floating populations or employees(HR=1.318,95%CI:1.006-1.727),and a low risk among married patients with spouses(HR=0.721,95%CI:0.569-0.913)and with an educational level of junior high school and above(HR:0.428~0.753,95%CI:0.280-0.952).Among all floating HIV/AIDS patients,there were 26 cases lost to follow-up(5.90%)and 49 deaths(11.11%).In addition,the proportion of absence of antiretroviral therapy,HIV infection progressing into AIDS patients and failure in HIV inhibition were all greater among floating HIV/AIDS patients than among non-floating patients(P<0.05).Conclusions Zhejiang provincial household registration,unmarried patients,patients with a low education level,retirees,students,and patients identified through physical examination of floating populations or employees in Yiwu City from 2016 to2020,and migration does not facilitate the sustainability of antiretroviral therapy and follow-up,which may affect the prognosis of HIV/AIDS.