Experience and lessons from health impact assessment guiding prevention and control of HIV/AIDS in a copper mine project,northwestern Zambia

Background:To avoid or mitigate potential project-related adverse health effects,the Trident copper project in Kalumbila,northwestern Zambia,commissioned a health impact assessment.HIV was identified a priority health issue based on the local vulnerability to HIV transmission and experience from other mining projects in Africa.Hence,an HIV/AIDS management plan was developed,including community and workplace interventions,with HIV testing and counselling(HTC)being one of the key components.We present trends in HTC data over a 4-year period.Methods:In 13 communities affected by the Trident project,HTC was implemented from 2012 onwards,using rapid diagnostic tests,accompanied by pre-and post-test counselling through trained personnel.In addition,HTC was initiated in the project workforce in 2013,coinciding with the launch of the mine development.HTC uptake and HIV positivity rates were assessed in the study population and linked to demographic factors using regression analysis.Results:In total,11,638 community members and 5564 workers have taken up HTC with an increase over time.The HIV positivity rate in the community was 3.0%in 2012 and 3.4%in 2015,while positivity rate in the workforce was 5.2%in 2013 and 4.3%in 2015.Females showed a significantly higher odds of having a positive test result than males(odds ratio(OR)=1.96,95%confidence interval(CI):1.55-2.50 among women in the community and OR=2.90,95%CI:1.74-4.84 among women in the workforce).HTC users in the 35-49 years age group were most affected by HIV,with an average positivity rate of 6.6%in the community sample and 7.9%in the workforce sample.These study groups had 4.50 and 4.95 higher odds of being positive,respectively,compared to their younger counterparts(15-24 years).Conclusions:While HTC uptake increased five-fold in the community and almost three-fold in the workplace,the HIV positivity rates were insignificantly higher in 2015 compared to 2012.Our data can be used alongside other surveillance data to track HIV transmission in this specific context.Guided by the health impact assessment,the HIV prevention and control programme was readily adapted to the current setting through the identification of socioeconomic and environmental determinants of health.

上海城市健康影响因素指标体系初步研究

目的探索和建立上海城市健康影响因素指标体系,推进健康影响评估工作的进程。方法阅研世界卫生组织(World Health Organization,WHO)和其他国家及地区的环境健康影响因素、健康效应及健康影响评估案例并梳理指标框架,参考我国和上海市实际建立城市健康影响因素和健康效应及代表性指标列表,采用德尔菲法对指标开展咨询论证。结果WHO及国外健康影响因素和健康效应的框架范围基本相同,但各国的具体指标不同。依据国外框架,上海城市健康影响因素包括环境,社会、文化,经济与产业,生活方式4大类共210项代表性指标;健康效应包括人群整体健康水平、死亡和肿瘤、慢性病和精神健康、职业病和地方病、其他伤害或疾病、生殖健康、妇女儿童健康7大类共69项代表性指标。专家咨询积极系数为95%,指标重要性、可操作性、一致性较好,专家协调系数为0.204和0.214(P<0.05)。结论研究建立的指标有助于推进上海城市健康影响评估工作,但需依据评估对象特点增补和筛选代表性指标,并对代表性指标进行权重配比或重要性评判。

面向城市规划方案的定量健康影响评估研究

Health impact assessment (HIA) is an approach to identification of potential health benefits or hazards in urban planning schemes.Quantitative HIA provides uniform and comparable health outcomes (e.g.,the morbidity of a specific disease),which could effectively assist planning decisions.However,there are currently few quantitative HIA methods specifically for urban planning applications.Based on a review of existing HIA methods,this paper has developed a quantitative HIA system for urban planning schemes in China,and specifically evaluates health risks,health behaviors,and health outcomes.Taking the Territorial and Spatial Master Plan of the Gucun Township of Shanghai as an example,we have illustrated how to evaluate the reduced health risks and increased health behaviors,as well as how to calculate changes in potential health outcomes in order to provide a reference for relevant HIA practices.