Implementation Of A "County-Township-Village'' Allied HIV Prevention And Control Intervention In Some One County

Object The objective of this study is to report the results of this“county-township-village”allied intervention and provides a good reference for further research.Method Data of female sex workers(FSWs)and drug users(DUs)were obtained from the national HIV epidemiology and treatment databases of local Centers for Disease Control and Prevention(CDC),including their information about HIV/AIDS-related knowledge,attitudes,and behaviors,the data were collected from 2009 to 2014.The questionnaire was designed by China CDC.SPSS16.0,when appropriate,was used to assess whether the demographicvariables,HIV/AIDS knowledge,and risk behaviors were different orsignificantly changed before and after the“county-township-village”allied intervention implemented in the county.Data of HIV/AIDS incidence in the county were obtained from the national HIV epidemiology and treatmentdatabases of local CDCs,the data were collected from 2003 to 2014.The Grey GM(1,1)Forecast Model was established through SAS version 9.3,fitted by2003~2011 annual HIV/AIDS incidence data.Data of the project funding were collected to analyze the cost-benefit of the“county-township-village”allied intervention.Results 1.Demographic characteristics of FSWs and DUs.In this study,we totally enrolled 1652 FSW and 1519 DU subjects.The average age of FSWswho accepted traditional or innovative intervention was 35.7±7.1 or 38.1±7.6years,respectively.In both FSW groups,the number of Han ethnic group was higher than the total number of other ethnic groups.Most of FSWs only hadeducation level of junior middle school or lower.Almost all FSWs traded in street-based places.More than 80%of FSWs had a regular sexual partner(s).The average age of DUs who accepted the traditional intervention or theinnovative intervention was 30.0±7.3 or 32.8±7.7 years,respectively.In both DU groups,most of DUs were male.More than 90%of DUs belonged toZhuang ethnic nationality.Most of DUs only had the educational level of junior middle school or lower.More than 60%of DUs had no regular sexual partner(s).2.FSWs and DUs got high level of HIV/AIDS basic knowledge.During the period of traditional or innovative intervention,both FSW and DU populations had a high level of knowledge of HIV/AIDS.The correct rates of eight questions of the questionnaire were all higher than 92%.There is no significant difference(p>0.05)in knowledge level between the two intervention groups,either in FSW or in DU population.3.The“county-township-village”allied intervention achieves a better result in decreasing risky behaviors compared to traditional intervention.For FSWs,condoms use rates in the last commercial sex and in the last month increased from 96.88%to 99.49%(?~2=15.20;p<0.01)and from 72.06%to 96.82%(?~2=186.20;p<0.01)respectively.For DUs,injection use of drug in the last month fall from 92.99%to 64.29%(?~2=158.27;p<0.01),a downward trend was observed in proportion of DUs who injected drugs,and having commercial sex in the last year dropped from 17.20%to 5.94%(?~2=47.52;p<0.01),among them,76.09%used condom all the time(?~2=61.46;p<0.01).4.“county-township-village”allied intervention effectively suppressed the rising trend of HIV incidence.The gray GM(1,1)model shows that the predicted numbers of HIV/AIDS new cases were 233 for 2012,272 for 2013, and 317 for 2014,respectively.However,the actual new HIV cases in the county during 2012~2014 were significantly lower than predicted ones.In addition,the gray GM(1,1)model shows that the predicted the HIV incidence was 8.959/10,000 for 2012,10.606/10,000 for 2013 and12.555/10,000 for 2014,respectively.However,a downward trend was observed in the actual HIVincidence in the county during 2012~2014.The risk ratio of HIV acquisition in the innovative intervention group compared with the traditional intervention group was 0.631(95%confidence interval 0.549–0.726).5.Cost-effectiveness analysis indicates that innovative intervention avoids each infected case costing an average of 17179.48 yuan and restores each disability-adjusted life year(DALY)costing an average of 827.53 yuan.Compared with traditional mode,this village-level model does not cost much.Conclusion 1.The“county-township-village”allied intervention effectively decreased Guangxi rural FSW and DU populations' HIV/AIDS-related risky behaviors.2.The“county-township-village”allied intervention effectively decreased Guangxi rural HIV/AIDS incidence.3.The“county-township-village”allied intervention does not cost much,compared with traditional mode.4.This type of village-based intervention for HIV/AIDS prevention and control can serve as a model for other rural areas in China to curb the local HIV epidemic and provides a good reference for further research.