Epidemiology Study For Acquired Immune Deficiency Syndrome In Hubei Province

Objective1.To understand the status of HIV-infected individuals'finding, epidemiological investigation, tracing and management, and analyze existing problems in the working mode, put forward relevant suggestions, finally provide some scientific evidences for further constituting plans and strategy to prevent and control AIDS.2.To analyze AIDS prevalent characteristics and trend completely in the past years in Hubei province, and then provide scientific evidences to perfect strategy of prevention and control.3.To study the post-treatment clinical effect by highly active anti-retroviral therapy (HAART) in AIDS patients and provide scientific basis for improving the curative effect and prognosis.4.To analyze the pathogenetic condition, survival and related factors of AIDS patients among paid blood donors in Suizhou city of Hubei province, evaluate the effect of strategy and measure for prevention and control.5.To study the life quality of HIV/AIDS patients and its related factors, and provide scientific evidence to perfect strategy of prevention and control.6.To have an investigation to the problem that people were infected by HIV via blood transfusion or using blood goods, and provide some evidences to investigation scheme for instituting salvation policy to AIDS patients who were infected by blood transfusion or using blood goods. Method1.To assess present measures that were adopted in allusion to the finding, epidemiological investigation, tracing and management of patients with AIDS by using qualitative analysis of sociological method, focusing grouping discussion, expert consultation, and so on.2.By adopting cross-sectional study, to have a systematic analysis to point surveillance materials from 1995 to 2005 which were collected by network direct report system in all cities and counties of Hubei province, and comprehensive surveillance materials in 2004 and 2005.3.An epidemiological method was used to describe the post-treatment clinical symptoms of 181 AIDS patients in Suizhou from five aspects, and to evaluate the change of virus load and immune function of 79 AIDS patients. Data was doubly recorded in Epidata and database was set up by using SPSS13.0 to analyze.4.A retrospective cohort study was carried out to determine the pathogenetic condition, survival time and related factors of 141 AIDS patients who were infected through paid blood donation. Kaplan-meier method was used to describe the survival distribution and Cox proportional hazard model was used to analyze the factors associated with the survival.5. A cross-sectional study was carried out to166 HIV/AIDS people in Hubei province. Life quality was measured by WHOQOL-HIV-BREF,the Sociodemographic variables was examined by the self-made questionnaire. Compared life quality scores of HIV/AIDS patients with normal model nationwide, and multiple linear regression was used to examine the influencing factors of life quality.6.To explore work model of AIDS prevention and control by using journalism means and hygiene administration method.Result1.From the process that the first AIDS patient in each place of Hubei province was found and identified, to understand the main problems and difficulties in AIDS patients'finding, epidemiological investigation, tracing and management, and propose measures and strategy to solve the problems.2.At present, the HIV-infected situation is very serious in Hubei province. In particularly, the infected individuals have increased obviously. The main transmission routes of AIDS are paid selling blood(44.17%), sex contact(9.91%), blood transfusion(9.47%). The age of infect patients mainly concentrated between 16 and 45 years (74.11%). The infected rates of AIDS risk population is still in a high level. Although infect rate of prostitutes decreased, it is increasing persistently in injection drug users.3. The effective rate of irregular fever, cough, diarrhea, lymphadenectasis, weight loss, tetter, mycotic infection is 81.39%, 85%, 84.62%, 81.89%, 82.86%,66.07%and 45.45%, respectively. CD4+ T lymphocyte count obviously rose after treatment, its mean was 276×106cells/ml (65~824×106cells/ml ) and added 129×106 cells/ml in three months. The mean was 294×106cells/ml (102~750×106cells/ml ) in six months. The count change of CD4+ T lymphocyte between 3 months and 6 months had no obvious difference. The death cases in patients who discontinued therapy were 14, case fatality rate was 29.79%; and the death in patients who insisted therapy persistently was 3, case fatality ratewas2.24%.4.Serious infection, organ failure and AIDS cerebropathia were the main cause of death. Of the 141 AIDS cases, the total mortality was 78.04/1000 p-m and AIDS related mortality was 71.43/1000 p-m. The median survival time was 6.00 months(95% Confidence Interval: 5.54～6.46 months). The median survival time was related to the clinical stage when they saw the doctor or they were detected HIV positive and the period when they felt ill and received HAART.5.Except for Spirituality/Personal beliefs domain, the scores of the other five domains and overall life quality and general health perceptions were significantly lower than normal model nationwide. Multiplicity showed that sex, career, culture, CD4+ T cell count, symptom count and HAART had a significant difference to the influence of PLWHA life quality. Each field of WHOQOL-HIV-BREF and total Cronbach's Alpha exceed 0.6. The Pearson coefficient of criterion related validity was 0.735(p<0.01).6.Although most current problems of HIV-infected persons and patients are solved at the moment by some measures in various places, there aren't uniform helping standard in our country. With the increase of new infected persons and patients, the workload of dealing with dissensions is very heavy. It causes huge pressure in energy and outlay, and influences the work of AIDS prevention and control severely in each place.Conclusion1. While testing and finding out HIV, performing the epidemiological investigation, tracing and management, we should manage and educate the masses according to the law, mobilize the masses to participate actively, protect the population from infecting and stick up for the legal rights of the infected individuals and the patients, educate the patients with HIV to change their bad behavior and not do harm to others. For the susceptible population, we also need to reinforce publicity and education to make them get certain prevention easily.2. Although there was never a large-scale epidemic of AIDS in Hubei province, but the existing problems should not be ignored. So the positive and effective AIDS prevention and treatment are imperative.3. This research shows that HAART can improve the AIDS patients'clinical symptom obviously, and decline virus load, and improving the clinical compliance can reduce the case fatality rate.4. The AIDS patients were seriously ill in Suizhou city, they had a poor life quality, and the survival time was short. HAART is an effective approach to prolong survival of AIDS patients. We should enhance the interventions according to the local epidemic characteristics.5 The life quality of HIV/AIDS patients is significantly low. It is necessary to guide patients to treat regularly in extending HAART. The comprehensive care model should have been established more for the poorest population and peasants. The WHOQOL-HIV -BREF was demonstrated with good reliability and validity, and it is concise and can save time. However, the items which are unfit to our country's background need modifying.6. To solve the problem that the population was infected HIV by using the blood or blood products in Hubei province, 10 policy proposals according to our national conditions were suggested.Main innovations1. This research put forward a reasonable work mode according to the detection and find of HIV, epidemiological investigation, trace and management for the first time in Hubei province.2. It has a comprehensive assessment of clinical remedial effect of AIDS patients after HAART for the first time, prove the remedial effect under the strategy guide, and provide scientific basis for improving the remedial effect and prognosis of the AIDS patients.3. This research put forward a helping policy firstly for the ones who infected HIV via the blood transmission, provides scientific basis for the salvation of this population, and also suggestion to other provinces on solving familiar problems.