基于Lasso-Logistic回归构建美沙酮维持治疗门诊患者继续使用毒品风险预测模型

  目的  探讨美沙酮维持治疗(methadone maintenance treatment, MMT)门诊患者入组治疗后继续使用毒品的影响因素,构建并验证继续使用毒品风险预测模型。  方法  以2013―2017年入组云南省MMT门诊的患者为研究对象,利用Lasso回归筛选出与患者继续使用毒品相关的变量,用于构建多因素Logistic回归分析模型;采用Bootstrap法进行模型内部验证并用列线图实现模型的可视化。  结果  本研究纳入的7 899名研究对象在接受治疗的6个月内,共有4 125(52.22%)人发生了继续使用毒品行为。Lasso回归筛选出9个与继续使用毒品相关的变量,分别是男性、独居、目前无工作、家庭关系一般、家庭关系较差、吸毒时长、过去1个月有注射行为、过去3个月曾被公安抓捕和过去3个月因吸毒而违法犯罪。预测模型的曲线下面积(area under curve, AUC)为0.70(95% CI: 0.69~0.72)。  结论  本研究构建的风险预测模型具有较好的预测能力,可用于指导MMT门诊工作人员提早识别出治疗期间继续使用毒品的高风险人群。     

Effects of home-based Voluntary Counselling and Testing on HIV-related stigma: Findings from a cluster-randomized trial in Zambia

HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n = 1500) and a follow-up survey (n = 1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (β = −0.22, p = 0.423). Being tested for HIV was associated with a reduction in stigma (β = −0.57, p = 0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (β = −0.78, p = 0.080 vs. β = −0.37, p = 0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma.     

The Development and Evaluation of an Internet-Based Intervention to Increase Awareness About Food Portion Sizes: A Randomized,Controlled Trial

ObjectiveTo develop a Web-based tool (PortionSize@warenessTool) and to evaluate its effectiveness in increasing awareness of reference serving sizes and factors that may contribute to overeating in response to large portion sizes.MethodsA randomized, controlled trial (intervention, n = 167; control, n = 143) was conducted. The authors measured awareness of reference serving size and overeating triggers from larger portions by an online questionnaire, assessed at baseline and 1 week later. Exposure dose reflected online activity (eg, number of Web pages viewed). Process evaluation data were collected within the intervention group.ResultsThe intervention group demonstrated significantly higher awareness of reference serving sizes (η² = .062; P < .001) and overeating triggers from larger portions (η² = .061; P < .001) at posttest. Also, the authors observed a dose-dependent effect that led to improved awareness.Conclusions and ImplicationsThe PortionSize@warenessTool constitutes a promising tool to improve portion size awareness.     

Molecular epidemiology of HIV-1 infection in Europe: An overview

Human Immunodeficiency Virus type 1 (HIV-1) is characterised by vast genetic diversity. Globally circulating HIV-1 viruses are classified into distinct phylogenetic strains (subtypes, sub-subtypes) and several recombinant forms. Here we describe the characteristics and evolution of European HIV-1 epidemic over time through a review of published literature and updated queries of existing HIV-1 sequence databases. HIV-1 in Western and Central Europe was introduced in the early-1980s in the form of subtype B, which is still the predominant clade. However, in Eastern Europe (Former Soviet Union (FSU) countries and Russia) the predominant strain, introduced into Ukraine in the mid-1990s, is subtype A (A_FSU) with transmission mostly occurring in People Who Inject Drugs (PWID). In recent years, the epidemic is evolving towards a complex tapestry with an increase in the prevalence of non-B subtypes and recombinants in Western and Central Europe. Non-B epidemics are mainly associated with immigrants, heterosexuals and females but more recently, non-B clades have also spread amongst groups where non-B strains were previously absent - non-immigrant European populations and amongst men having sex with men (MSM). In some countries, non-B clades have spread amongst the native population, for example subtype G in Portugal and subtype A in Greece, Albania and Cyprus. Romania provides a unique case where sub-subtype F1 has predominated throughout the epidemic. In contrast, HIV-1 epidemic in FSU countries remains more homogeneous with A_FSU clade predominating in all countries. The differences between the evolution of the Western epidemic and the Eastern epidemic may be attributable to differences in transmission risk behaviours, lifestyle and the patterns of human mobility. The study of HIV-1 epidemic diversity provides a useful tool by which we can understand the history of the pandemic in addition to allowing us to monitor the spread and growth of the epidemic over time.     

Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia

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Lessons on causality assessment and communications from the 2019 South-East Asia Regional (SEAR) workshop on inter-country expert review of selected Adverse Events Following Immunization (AEFI) cases

BackgroundSurveillance of AEFI is fundamental for improving safety and maintaining public support for vaccination. In SEAR, billions of doses of vaccine are given annually. The objective of the 2019 SEAR AEFI training workshop was to further strengthen in-country vaccine safety, assess capacity compared to 2014 and to better integrate communication into the AEFI causality assessment program.MethodsA 3 ½ day workshop with AEFI experts from all 11 SEAR countries. Participants outlined each county’s AEFI data, critiqued their AEFI program, reviewed and critiqued causality assessment of 23 anonymized serious AEFI cases and proposed communication plans for each.ResultsBetween 2016 and 2018, over 2.9 billion doses of vaccine were given in SEAR. Compared to 2014, AEFI detection and causality assessment skills had improved. AEFI experts’ communication planning skills markedly improved during the workshop. Good concordance was found between country causality assessment findings and the workshop critiques. A list of targeted recommendations (country, regional and global levels) arose from the workshop.ConclusionsSEAR countries have much improved their AEFI detection and causality assessment expertise since 2014. Given the high volume of doses administered and the AEFI technical expertise, SEAR countries can well monitor safety of regionally produced vaccines. Integration of AEFI communication into AEFI causality assessment can help mitigate potential negative impacts of serious AEFIs.     

HIV-1 DNA的检测及临床应用

HIV-1储存库的持续存在是治愈HIV的主要障碍,在临床研究中,需要可靠的生物标志物对其进行标记。HIV-1 DNA在HIV-1储存库中可被持续检测到,在HIV-1感染诊断、预测病毒反弹和监测治疗效果等方面具有重要应用价值。PCR的检测技术是临床上常用的HIV-1 DNA检测方法,随着技术的不断创新与进步,可更准确地通过定性或定量检测感染细胞中总的、整合的和未整合的HIV-1 DNA。感染细胞中不同形式的HIV-1 DNA作为生物标志物在HIV感染监测和艾滋病治疗相关研究中报道日益增多。本文对感染细胞中HIV-1 DNA的检测方法及其作为生物标志物的临床应用进展进行综述。     

昆明市15岁以上男性发生男男性行为的比例及相关因素分析

目的 调查昆明市>15岁男性发生男男性行为的比例及其相关因素,为MSM规模估计提供参考依据。方法 采用横断面调查设计、多阶段抽样方法和街头拦截调查方法,2019年10-12月对昆明市>15岁男性进行调查,估计样本量为9 908人。结果 在昆明市5个县区的30个招募点,共招募了>15岁男性10 707人,调查10 283人,应答率96.0%。调查对象16~40岁占75.3%（7 748人）,高中及以上文化程度占71.1%（7 312人）,未婚占49.8%（5 121人）。调查对象与年龄标准化后的最近半年发生男男性行为的比例分别为1.06%（95%CI：0.86%~1.26%）与0.97%（95%CI：0.78%~1.16%）,多因素logistic回归分析结果显示,其相关因素包括调查区域在主城区是远郊县（区）的2.217倍（95%CI：1.004~4.895）、其他城市户籍地是昆明市户籍的0.421倍（95%CI：0.260~0.682）、在昆明市居住时间≤ 6个月是>6个月的2.282倍（95%CI：1.262~4.126）、高中及以上文化程度是初中及以下的0.336倍（95%CI：0.228~0.495）、已婚者是未婚者的0.462倍（95%CI：0.303~0.705）。结论 昆明市>15岁男性最近半年发生男男性行为比例接近1.00%,主要相关因素包括来自昆明市主城区、昆明市户籍、昆明市居住时间较短、初中及以下文化程度者和未婚者。本研究结果为云南省开展MSM规模估计提供了参考依据。     

北京市男男性行为人群对HIV非职业暴露后预防用药的使用意愿及相关因素分析

目的 分析MSM对HIV非职业暴露后预防(nPEP)用药的使用意愿及相关因素。方法 采用同伴推动抽样法招募MSM进行面对面问卷调查,估算样本量为600人。收集研究对象的社会人口学、行为学、nPEP知晓和使用意愿情况,采用复杂抽样的logistic回归模型分析MSM的nPEP用药相关因素。结果 共招募14轮,招募研究对象MSM 608人,年龄(41.6±11.0)岁,MSM的nPEP知晓率为55.4%(95%CI:49.4%~59.4%),nPEP用药既往使用率为4.5%(95%CI:2.9%~6.2%),有使用意愿的占35.9%(95%CI:31.1%~40.7%)。在无使用意愿的原因中,不知晓nPEP的占68.9%(244/354),认为不会感染的侥幸心理占24.6%(87/354)。logistic多因素分析结果显示,MSM的nPEP用药使用意愿的相关因素包括25~39岁年龄组(aOR=1.80,95%CI:1.01~3.20)、艾滋病知识知晓者(aOR=2.43,95%CI:1.52~3.90)、最近半年每次肛交使用安全套(aOR=1.76,95%CI:1.11~2.79)。结论 北京市MSM中nPEP用药既往使用率较低,使用意愿也有待提高,应加强对MSM社会组织的培训,提高同伴教育在nPEP用药推广方面的作用。