| Research background and purposesAIDS spread has the characteristics of fast speed,hidden transmission chain,complex transmission population,and no cure.It poses a huge threat to human health,and also seriously affects social stability and economic development.AIDS has been prevalent for nearly 40 years.Its spread and prevalence are affected by environmental factors,including the natural ecological environment,geographical environment,and social environment,which can significantly affect the HIV epidemic and prevention and control effect.The social environment affects the occurrence of HIV transmission behavior and the management of transmission routes.The HIV/AIDS prevention and control policy environment can significantly affect the detection rate and treatment rate of HIV/AIDS,thus affecting the speed of HIV/AIDS transmission.Therefore,the policy environment and the accompanying detection level and monitoring capacity are also one of the research contents of environment and health.The prevention and control policies of my country and Hubei Province have undergone great changes with the changes in the epidemic situation.The prevention and control practice has also been adjusted from the strategy of attaching importance to border inspection and strengthening monitoring to a comprehensive prevention and control strategy centered on detecting the source of infection and antiviral treatment.There are no studies that comprehensively evaluate HIV prevention and control policies,prevention and control systems,testing,and antiretroviral treatment strategies in Hubei Province.Therefore,the purpose of this study is as follows:(1)To systematically analyze the AIDS prevention and control policies in Hubei Province and to construct an AIDS prevention and control system in Hubei Province;(2)To analyze the current situation,characteristics and trends of AIDS epidemic in Hubei Province using the data of AIDS prevention and control practices in Hubei Province;(3)To clarify the HIV testing strategy in Hubei Province and evaluate the testing effect;(4)To clarify the HIV antiretroviral treatment strategy in Hubei Province and evaluate the therapeutic effect.Provide a scientific basis for proactively and proactively responding to the spread of AIDS,improving the capacity building of the prevention and control system,and improving and optimizing prevention and control strategies.MethodsAccording to the research purpose,this research is mainly divided into four parts,namely: Hubei Province AIDS prevention and control policy and system,Hubei Province AIDS epidemic characteristics,detection strategy and effect evaluation,and treatment strategy and effect evaluation.The following research methods were adopted respectively:(1)Using the literature research method to analyze the AIDS prevention and control policies in Hubei Province,summarizing its policy characteristics,and constructing the AIDS prevention and control system in Hubei Province based on the actual work of AIDS prevention and control,and analyzing its functions;(2)Using descriptive analysis methods The spatial and temporal distribution of newly discovered and existing HIV/AIDS cases in Hubei Province was analyzed with spatial analysis method,and the age-period-cohort model was used to analyze the infection routes of newly discovered HIV/AIDS cases in Hubei Province over the years from 1995 to 2020.The change trajectory of the cohort,the time series method was used to predict the change trend of the number of newly discovered infected persons,and the molecular epidemiological method was used to analyze the distribution and influencing factors of HIV subtypes in the drug-resistant population in Hubei Province from 2014 to 2020;(3)The descriptive type was used.Analytical methods and spatial analysis methods were used to analyze the temporal and spatial distribution of HIV testing ability and testing effect in Hubei Province,and the Specturm/EPP model method was used to estimate the detection ratio of infected persons;(4)To describe the coverage rate of antiretroviral treatment in Hubei Province,logistic regression was used to analyze antiviral.The success rate and influencing factors of treatment were analyzed by survival analysis method.ResultsPolicy section.The trend of changes in the number of major AIDS prevention and control policies in Hubei Province is more consistent with the changes in the number and content of major policies at the national level.In 2004,the most policy documents were issued,accounting for 50% of the total.The main body of policy issuance was the government and health administrative departments.Among the policy topics,comprehensive documents accounted for the highest proportion.The main AIDS prevention and control policies are characterized by timeliness,diversified and networked governance subjects,professional governance methods,and complex governance tools.Based on the characteristics of AIDS prevention and control practices and policies in Hubei Province,an AIDS prevention and control system covering the entire population was summarized and constructed,with Hubei Province Disease Control as the core and leading department,and consisting of designated medical institutions and sentinel monitoring points for screening.In conclusion,the system has two basic functions of detection and treatment,and is the basic network for HIV prevention and control in Hubei Province.Epidemicsection.(1)By the end of 2020,Hubei Province had reported a total of31,693 HIV/AIDS cases,and 23,893 HIV/AIDS cases were alive.The ratio of males to females was 3.64:1.The main route is sexual transmission(94.37%),and Huangshi City has the highest distribution density,reaching 6.78 people/10,000 people(about 4people/10,000 people in the province).The male-to-female ratio of newly discovered HIV/AIDS cases has increased year by year,from 1.34:1 in 2008 to 4.59:1 in 2015,and fluctuated around 4.50:1 from 2016 to 2020.The male-to-female sex ratio has risen most significantly in the younger age group.The 15-19,20-24,and 25-29 age groups have risen from 0.50:1,0.72:1,and 1.16:1 in 2005 to 29.67:1,23.23:1 and 14.26:1.in 2020,respectively.Since 2006,sexual transmission has become the primary route of infection for newly discovered HIV/AIDS every year.From 2013 to 2020,the sexual transmission route fluctuated between 98.5% and 99.7%.From 2011 to 2020,the HIV-positive rate of men who have sex with men has always fluctuated within a high range(2.68%-4.48%),while other sentinel surveillance populations were below 0.7%.(2)From 1995 to 2020,the proportion of newly discovered HIV/AIDS cases in menstrual blood infection decreased with age,the period effect showed a trend of increasing first and then decreasing(it reached a high point in 2005),and the cohort effect showed a decreasing trend;The proportion of infections increased with age;the period effect first decreased and then increased(the lowest in 2000),and the cohort effect showed an “inverted U-shaped”trend of first increase and then decrease,and a significant decrease around the 2000 cohort.(3)From 2014 to 2020,a total of 9 HIV-1 subtypes were monitored,namely subtypes A,B,C and other 6 recombinant viruses CRF01＿AE,CRF07＿BC,CRF08＿BC,BC recombinant,B+CRF01＿AE,CRF55＿01B,Age,ethnicity,educational level,occupation,route of transmission,first CD4 count,and year of detection were significantly associated with the distribution of HIV subtypes.Testing section:(1)In 1995,Hubei Province established the first AIDS confirmation laboratory.In 2020,there will be 1,689 AIDS testing laboratories at all levels and types.The detection method developed from enzyme-linked immunosorbent assay to a comprehensive detection system integrating antibody detection,CD4 cell count,viral load quantification,and genotype drug resistance.The number of antibody tests increased from7.59 thousand in 2007 to 7.743 million in 2020;the HIV detection rate in the whole population increased from 2.59% in 2008 to 13.41% in 2020.From 2011 to 2020,the total amount of HIV antibody testing in medical institutions fluctuated around 71% of the total population,and the number of HIV/AIDS cases found accounted for 58.25%(15312/26288).(2)From 2008 to 2020 in Hubei Province,among the special populations in Hubei Province,314,002 people who have sex with men(MSM)were tested for HIV antibodies,and 5,052 people were reported to be positive,with a positive detection rate of1.61.%;the HIV antibody detection rate of pregnant and lying-in women has increased from 84.51% in 2006 to 99.97% in 2020.(3)Spectrum/EPP model estimates show that from 2010 to 2020,the number of surviving infected persons in Hubei Province increased year by year,from 19,600 to 32,900,and the estimated rate of HIV/AIDS diagnosis and detection increased from 23.34%(4574/19600)in 2010 to 72.62%(23893/32900)in2020.Treatment section.By the end of 2021,the total number of HIV/AIDS cases receiving ART is 26,120.The proportion of antiretroviral therapy increased from 52.54%in 2011 to 92.70% in 2020.By the end of 2021,the success rates of antiviral therapy were96.95%,96.75% and 96.41% for patients who started treatment at three different time periods,2003-2010,2011-2015 and 2016-2020,respectively.Multivariate Logistic regression showed that patients with sexually transmitted infections,baseline CD4 cell counts greater than 500 cells/microliter,and the difference between the last CD4 cell count after antiviral therapy and baseline levels of more than 300 cells/microliter,had a higher chance of successful treatment.big.By the end of 2021,a total of 3,535 HIV/AIDS deaths(13.53% death rate)and 3,204 HIV/AIDS-related deaths(12.27% death rate)in the province receiving antiretroviral treatment.At 5,10,15,and 19 years,the patient survival rates were 95.12%,88.43%,81.61%,73.77%,and 66.39%,respectively.From 2003 to2010,2011 to 2015 and 2016 to 2020,the first-year survival rates of patients who started antiviral therapy were 91.36%,94.24%,and 96.29%,respectively;the 5-year survival rates were were 82.25%,87.86% and 90.12%.The results of multivariate Cox analysis showed that the mortality risk of the age group over 65 years old was 3.52 times(95% CI:3.12-3.98)of the age group less than 35 years old;the mortality risk of unmarried/unmarried patients was 1.12 times that of married/cohabiting patients(95% CI:1.04-1.21);patients with drug use infections had a 1.62-fold higher risk of death than those with sexual infections(95% CI: 1.21-2.16);patients with baseline CD4 counts greater than 500 cells/microliter had a lower risk of death than 0.08 times of 200/μl(95%CI: 0.06-0.10).By the end of 2021,among 4288 HIV/AIDS cases with viral load greater than 1000 copies/ml during treatment,698 cases(16.28%)died due to HIV/AIDS-related diseases.The cumulative survival rates were 99.74%,90.17%,78.94% and 69.34%,respectively,at the 1st,5th,10 th,and 15 th years after the start of treatment.ConclusionAccording to the epidemic characteristics of AIDS in different periods,the country and Hubei Province have formulated and implemented a large number of AIDS prevention and control policies.At present,government-led,multi-departmental cooperation and multi-party prevention and control network has been initially formed,which plays two basic functions of detection and treatment,and has achieved remarkable results.The AIDS epidemic in Hubei Province is at a low level as a whole,and the transmission of AIDS through blood,mother-to-child a,nd intravenous drug use has been effectively controlled.In recent years,the newly discovered HIV/AIDS is mainly sexually transmitted,and the age distribution of newly discovered cases shows a polarization between the elderly and the young,and the infection rate of men who have sex with men is relatively high.From 2007 to 2020,the detection technology and capacity of the HIV/AIDS prevention and control system in Hubei Province were gradually improved.The number of AIDS testing laboratories in the province has increased significantly.In addition,the detection rate of surviving HIV/AIDS cases is gradually increasing,from 23.3% in 2010 to 72.62% in 2020,but there is still a gap between the detection rate of HIV/AIDS and the target of 90%.From 2003 to 2020,the work of antiviral therapy in Hubei Province has achieved remarkable results.Among them,the proportion of antiviral therapy and the success rate of treatment have increased year by year,reaching a high level,and the measures of antiviral therapy have been well implemented.On the other hand,the survival rate of HIV/AIDS cases has been improved,and the survival time has been extended to a certain extent,but there is a problem of poor drug resistance treatment effect,which may be related to the low efficiency of drug resistance detection in the AIDS prevention and treatment system.The detection capacity and level are one of the main shortcomings of AIDS prevention and control,including the empowerment and settings of the testing agency,the level of detection and the setting of the detection channel.The results of HIV prevention and control in Hubei Province,especially the recent results,are closely related to it.The improvement of HIV testing capacity in Hubei Province also needs to pay attention to the problems of narrow coverage and poor accessibility of key technologies in testing technology,so as to effectively play the role of molecular biology technology in HIV tracing and transmission chain analysis.With the development of molecular epidemiology,AIDS tracing investigation and precision treatment will have broad development space.In the future,there will be more new laboratory testing technologies and methods,so as to help further shorten the window period of HIV,discover new cases and transmission chain,and improve clinical diagnosis and treatment services. |
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