| SECTION ONE STUDY ON THE HIV/AIDS EPIDEMIOLOGICAL OF LARGE-SCALE HIV SCREENING IN AN AIDS PREVENTION DEMONSTRATION COUNTYObjective: To understand local HIV infection rate and disease risk factors by large-scale HIV screening among permanent residents in an AIDS prevention demonstration county(hereinafter referred as County A),and to explore the crowd infection risk,thus provide scientific basis for HIV/AIDS epidemic trend and prevention and control measures for Western China,even for the whole country.Method: To collect related physical examination data through taking two rounds of screening(including HIV testing)to permanent residents of ≥18months of age,and the floating population living more than three months living more than three months in County A and ≥18 months of age by the method of the census.The descriptive statistical method was used to analyze the related rates.Single factor and multiple factors logistic regression models were used to analyze relevant factors.Results: 1.General situation and coverage of HIV screening in County A The number of respondents in the first round of HIV screening was 215197,and the number of respondents in the second round of HIV screening was271663.The number of people tested two round of HIV screening was179133,which coverage rate was52.73%(179133/339700).The total number of people having HIV screening was 307727,which coverage rate was 90.59%(307727/339700).2.The HIV infection rates in the two rounds of HIV screening The HIV infection rates in the two rounds of HIV screening was 0.57%and 0.51%,respectively.Among them,the HIV infection rate among 41-70 years old male is relatively high,the HIV infection rates in the two rounds of HIV screening were more than 1%.3.The rates of new HIV infection in County A The rate of new HIV infections among male was 3.21 person/ten thousand person.year,which was more than female’s(1.37 person/ten thousand person.year).The rate of new HIV infection among the aged more than 50 old was relatively higher comparing with young and mid-aged people.The highest rate of new infections among 51-60 aged male and female was 7.85 person/ten thousand person.year and 4.17person/ten thousand person.year.4.To explore the risk factors for HIV infection and AIDS high-risk groups in County A Through single factor and multiple factors logistics regression analysis,the results showed that the marital status,age,nationality were the influence factors of HIV infection(P<0.05);Unmarried,widowed,divorced,aging were the risk factors for HIV infection,Zhuang was the protection factor for HIV infection;the middle and old aged,widowed and divorced people were at high risk for HIV infection in County A.Conclusion: 1.Two rounds of HIV antibody screening cover most of the local resident population,which can find the HIV positive cases hidden in the crowd effectively and concentratedly.It helps to understand and grasp HIV basic characteristics in County A.2.41-70 years old people have higher HIV infection rate comparing with other groups in two rounds of HIV antibody screening.It should put more attention to this group of people in the future of AIDS prevention and control work.3.The rate of new HIV infection among male was higher than female’s.The rate of new HIV infection among the 51-60 years old was relatively higher comparing with other age groups.4.The middle and old aged,widowed and divorced people are at high risk for HIV infection in County A.It should put more attention to this group of people in the future of AIDS prevention and control work.SECTION TWO STUDY ON THE BEHAVIORAL TRANSMISSION PATHS AMONG THE HIV POSITIVE CASES IN AN AIDS PREVENTION DEMONSTRATION AREAObjective: To collect related information of 361 HIV positive cases in an AIDS prevention demonstration area(including County A,County B,and County C),and to understand their high risk behaviors forms of social relations through the analysis of the epidemic features of HIV positive cases and the related risk behaviors factors,in order to explore the HIV transmission paths.Combining with the HIV virus genetic system evolution analysis of middle and old aged HIV positive clients,to explore the HIV transmission paths effectively through the epidemic theory and the molecular evolution analysis method.To locate the efficient paths and key nodes of HIV spread,in order to provide the scientific evidence for the development of AIDS prevention and control strategies.Method: Analyze the information of 361 HIV positive cases from the three counties by using the method of social behavior epidemiological analysis theory.Analyze the HIV virus of middle-and-old aged HIV-positive clients by using the method of molecular evolution analysis.Results: 1.In 361 HIV-positive cases,HIV positive transferred cases was102(sex ratio was 3.43:1,female=1),new reported but not HIV positive transferred cases was 128(sex ratio was 2.66:1,female=1),past HIV-positive cases was 131(sex ratio 3.25:1,female=1).The main of new reported HIV positive cases were male(74.78%,172/230),rural residents(94.35%,217/230),farmers(61.74%,142/230),the more than 50 aged(63.48%,146/230).The marital status of marriage/cohabitation accounted for 40.43%(93/230).The main of past HIV positive cases were male(76.34%,100/131),rural residents(96.95%,127/131),farmers(48.09%,63/131),the more than 50 aged(60.31%,79/131).The marital status of marriage/cohabitation accounted for 62.60%(82/131).2.The HIV transmission paths of HIV-positive cases In new reported HIV-positive cases,the male ones were mainly infected with the commercial heterosexual transmission.The percentage of commercial heterosexual transmission among <50 years old group was 73.33%(44/60),and the percentage of≥50 years old group was 90.18%(101/112).The female ones were mainly infected with fixed sexual transmission /marital sexual transmission,which was 56.90%(33/58).In past HIV-positive cases,the male ones were mainly infected with the commercial heterosexual transmission.The percentage of commercial heterosexual transmission among < 50 years old group was 90.00%(54/60),and the percentage of ≥50 years old group was100.00%(40/40).The female ones were mainly infected with sexual transmission fixed/marital sexual transmission,which was 90.32%(28/31).3.Commercial sexual behavior characteristics of male HIV-positive cases In the survey,194 people(53.74%,194/361)had commercial sexual behavior recently.Among them,122 new reported HIV-positive cases(53.04%,122/230)had commercial sexual behavior,72 past HIV positive cases(54.96%,72/131)had commercial sexual behavior.270 male patients who had commercial sexual behavior were had multiple response analysis.The mainly commercial sex sites of new reported cases were a small hotel(60),the massage and feet wash house(27),and the rental house(21),following by the residence(11),a small roadside hotel(10),etc.The mainly commercial sex sites of past cases were the massage and feet wash house(32),a small hotel(17).In newly reported cases,the proportion of more than 1-time commercial behavior(including 1 to 2 times,3-4 times and 5 times or higher)a year was57.38%(70/122)before HIV positive detection,the proportion was 9.02%(11/122)after HIV positive detection.The frequency of commercial behavior after HIV positive detection was lower than before(P < 0.05).In past cases,the proportion of more than 1-time commercial behavior(including 1 to 2 times,3-4 times and 5 times or higher)a year was 12.50%(9/72)before HIV positive detection,the proportion was 30.56%(22/72)after HIV positive detection.The frequency of commercial behavior after HIV positive detection was higher than before(P < 0.05).The proportion of using aphrodisiac among new reported HIV-positive cases was(12.30%,15/122)less than that among the past HIV positive cases(22.22%,16/72).The frequency of using condom among the new reported and the past cases after finding HIV-positive were 86.05%(37/43)and 64.29%(18/28)(P < 0.05).4.Temporary sexual behavior characteristics of the HIV-positive cases In the objects of having temporary sexual behavior,male were 46(71.88%,46/64),female were 18(28.12%,18/64).The high proportion of role among new reported HIV cases were local acquaintances(49.35%,38/77),strangers(16.88%,13/77),neighbors(11.69%,9/77),and internet users(11.69%,9/77).The high proportion of role among the past HIV cases were strangers(40.63%,13/32)and local acquaintances(25.00%,8/32).The frequency of using condoms during temporary behavior among HIV-positive cases was higher after the HIV positive(P < 0.001).5.Fixed sexual behavior characteristics of the HIV-positive cases84.35%(194/230)of new reported HIV cases had fixed sexual partners.The mainly fixed sexual partners among the HIV cases were their spouses.The proportion of more than 1-time commercial behavior a month among the new reported male was lower(40.63%,52/128)than that among the past ones(59.09%,52/88)(P=0.009).The frequency of using condoms during fixed sexual behavior among HIV positive cases was higher(74.13%,192/259)after the HIV-positive than before(14.07%,28/199)(P<0.001).6.Analyze the HIV virus of middle-and-old aged HIV-positive clients by using the method of molecular evolution analysis68 samples were sequencing amplified in the 83 middle-and-old aged HIV-positive clients samples,accounting for 81.93%.HIV gene subtype analysis results showed that the CRF01_AE accounted for 89.71%(61),CRF08_BC accounted for 8.82%(6),CRF07_BC accounted for 1.47%(1).After analyzing 61 CRF01_AE samples,it found that 54 samples were Cluster1(88.52%).Cluster1 was contained five clusters,which was composed of one cluster with 7 samples,one cluster with 4 samples,three clusters with 2 samples,accounting for 31.48% of the Cluster 1.7 samples were Cluster 2,accounting for 11.48%,which was found no spread of cluster.Conclusion: 1.≥50 aged men in the rural area is the main groups of HIV infection.The marital status of HIV positive cases are mainly marriage/cohabitation.2.The new reported HIV-positive male were mainly infected with the commercial heterosexual transmission,the female ones were mainly infected with fixed sexual transmission /marital sexual transmission.3.Commercial sexual behavior characteristics of male HIV positive cases The percentage of having commercial sexual behavior among HIV positive cases is high.The mainly commercial sex sites are the small hotel,the massage and feet wash house.The frequency of commercial behavior among new reported HIV positive cases after HIV positive detection is lower than that before,the frequency of commercial behavior among past HIV positive cases after HIV positive detection is higher than that before.HIV positive cases use aphrodisiac during the commercial behaviors.After HIV-positive detection,the frequency of using condom among the new reported and the past cases is86.05% and 64.29%.Middle-and-old aged HIV-positive clients are the key to the efficient spread of HIV/AIDS group,which is the key group bring the risk of HIV infection to other clients and FSW.It should pay more attention to promote the harm of using aphrodisiac and the advantage of using condoms,and to actively educate the prevention knowledge of sexually transmitted diseases and HIV/AIDS,in order to prevent cross-infection through the commercial sexual way.4.The proportion of temporary sexual behavior among male is higher comparing with the female.The roles of high proportion among new reported HIV cases are local acquaintances,strangers,neighbors,and net friends.The roles of high proportion among the past HIV cases are strangers and local acquaintances.The frequency of using condoms during temporary behavior among HIV-positive cases is higher after finding the HIV positive.5.The mainly fixed sexual partners among the HIV cases are their spouses.After finding the HIV positive,they sometimes do not want to use condoms.The spouses are the high-risk group to HIV transmission through the fixed sexual behavers.6.The molecular evolution analysis of the HIV virus among the middle-and-old aged HIV-positive clients shows that they are multiple sources of strains.The mainly HIV virus subtype is CRF01_AE with multiple spread clusters.SECTION THREE STUDY ON THE COMPREHENSIVE EVALUATION OF LARGE-SCALE HIV SCREENING EFFICIENCYObjective: To evaluate comprehensively large-scale HIV screening efficiency,and to build a comprehensive evaluation system from the aspects of health economics,the effects of HIV antiviral treatment,mortality,the changes of HIV positive reports,the population characteristics of HIV positive cases from large-scale HIV screening and the regular report.Using the method of health economics and epidemiologically related indexes,to the provide the reference for the departments when making strategic plans,in order to effectively make good use of configuration and health resources,thus to achieve the optimal goal of using health resources.Method: Collect related data through two rounds of large-scale HIV screening.Markov model was used to analyze health economics efficiency.The descriptive statistical method was used to analyze morbidity rate.Single factor and multiple factors logistic regression models were used to analyze relevant factors.Results: 1.The analysis of direct economic benefit and cost benefit by using large-scale HIV screening30.628 million yuan was invested in three counties.The average cost of HIV/AIDS detection in three counties was 17720 yuan/cases respectively,21020 yuan/cases and 17200 yuan/cases.Markov model analysis showed the overall cost in the demonstration area was 1590 yuan/QALY.The cost was1400yuan/QALY,1820 yuan/QALY,and 1610 yuan/QALY in three counties,respectively.The cost effect index of County A was better than those of County B and County C.2.Evaluate the antiviral treatment effect by using Markov model By Markov model,it found that HIV positive cases from large-scale HIV screening having antiviral therapy could help to reduce the fatality rate,thus improve their survival time.3.The changes of HIV positive reports from 2012 to 2015 in the three counties The changes of HIV positive reports from 2012 to 2015 in the three counties showed that HIV positive report number soared after the start of the first round of HIV screening,and then began to decline.After the start of the second round of HIV screening,the number of positive reports was rise again,formed a peak,but the peak value was lower than the first round of screening.4.The population characteristics of HIV positive cases from the large-scale HIV screening and the regular report In the HIV positive cases from the large-scale HIV screening,the characteristics of not-Han(χ2=4.96,P=0.026),farmers(χ2=39.33,P<0.001),HIV positive cases(χ2=5.04,P=0.025),heterosexual transmission(χ2=44.56,P<0.001)and the first CD4+≥200 per/μL(χ2=4.58,P=0.032)had the high proportion.And there were statistical differences in the age composition(χ2=82.30,P<0.001),the marital status(χ2=10.39,P=0.006),and the educational status(χ2=51.43,P<0.001).With the logistic regression model analysis,the result showed that the characteristics of the 30-44 years old(OR=4.45,95%CI:2.51-7.92),the 45-59 years old(OR=5.40,95%CI:2.97-9.82),≥60 years old(OR=7.76,95%CI:4.06-14.83),the educational status of primary school(OR=2.49,95%CI:1.36-4.59),the educational status of the junior middle school(OR=3.34,95%CI:1.84-6.06)and the first CD4+≥200 per/μL(OR=1.52,95%CI:1.15-2.01)were at the high risk of discovering with the HIV screening.The characteristics of the not-farm(OR=0.59,95% CI: 0.40-0.88),and other transmission(OR=0.17,95%CI: 0.07-0.38)were at the low risk.Conclusion: 1.The average cost of HIV/AIDS detection in three counties is 17720 yuan/cases,21020 yuan/cases,and 17200 yuan/cases,respectively.The average cost of HIV/AIDS detection is related to the factors such as the whole project investment,HIV positive detection rate,etc.Through the cost-effectiveness analysis with the Markov model,the large-scale HIV screening in each demonstration county has high cost-effectiveness.The cost effect index of County A is better than that of County B and County C.2.Having the large-scale HIV screening can help to enhance the antiviral treatment effect,and reduce the fatality rate,thus to increase the cost-effectiveness of the overall research.3.During the screening,the number of HIV positive cases reported is increased.It shows that having the large-scale HIV screening can help to find the hidden HIV-positive cases in the crowd.4.Most of the HIV positive cases found by the large-scale HIV screening have the characteristics of the middle-and-old aged,the Han nationality,farmers,married,the educational status of the elementary school and junior high school,living in the countryside,HIV-positive,heterosexual transmission and the first CD4+≥200 per/μL.Comparing with the conventional detection,the people of≥30 years old,the educational status of elementary school and junior high school have a higher risk of finding in the large-scale HIV screening,which means that the large-scale HIV screening coveres more people,thus to help to find hidden HIV-positive cases. |
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