昆明市HIV/梅毒共感染病例晚发现情况及其影响因素研究

目的了解昆明市艾滋病病毒(HIV)和梅毒共感染者的晚发现率及其影响因素。方法统计2005-2018年"中国疾病预防控制信息系统"中昆明市报告的HIV/梅毒共感染者晚发现比例,运用χ²检验分析晚发现率的变化趋势,采用Logistic回归对其影响因素进行相关分析。结果862例研究对象平均年龄(36.77±0.474)岁,男性占79.4%;高中或中专及以上文化程度的占52.6%;无业占34.3%;异性性传播(56.1%)为主。2005-2007年昆明市共感染者的晚发现率为69.4%,2016-2018年为39.7%,呈下降趋势,有统计学意义(χ_趋势²=21.025,P<0.001)。晚发现的病例中,检测咨询发现的逐年下降(χ_趋势²=26.938,P<0.001),医疗机构发现的逐年上升(χ_趋势²=30.291,P<0.001)。多因素Logistic回归分析结果显示,HIV/梅毒共感染病例中,常住人口的晚发现率高于流动人口调整比值比(aOR)=1.863,95%可信区间(CI):1.179~2.943]、异性性传播的晚发现率高于同性性传播(aOR=1.506,95%CI:1.050~2.159)。结论昆明市2005-2018年HIV/梅毒共感染病例的晚发现率维持在较高水平,应继续推进医疗机构全面推动医务人员主动提供艾滋病检测咨询服务。有针对性地对异性性行为人群开展早发现、早治疗益处的宣传教育,提高有过高危行为者的主动检测意识。

Epidemiological characteristics and correlations of delayed diagnosis of HIV/syphilis co-infection in Kunming

Objective To analyze the percentages and correlation of delayed diagnosis of HIV/syphilis co-infection among the reported cases in Kunming.Methods Percentages of delayed diagnosis of HIV/syphilis co-infection during 2005 to 2018 were calculated by using data of Kunming from China disease prevention and control information system.Chi-square test was used to analyze the changes of delayed diagnosis percentages,and multivariate logistic regression was conducted to test all correlations.Results Of the 862 cases,the average age was(36.77±0.474)years old,with 79.4%male,52.6%who had received high school or higher education,34.3%unemployed,and 56.1%infected through heterosexual contact.The percentages of delayed diagnosis of HIV/syphilis co-infection decreased from 69.4%to 39.7%from 2005-2007 to 2016-2018(χ²=26.938,P<0.001).Delayed diagnosed cases were reported decreasingly from voluntary counseling and testing clinics(χ²=30.501,P<0.001),increasingly from hospital screening(χ²=30.291,P<0.001).Multiple logistic regression analysis indicated higher percentages of delayed diagnosis among cases with local residency(aOR=1.863,95%CI:1.179-2.943)and heterosexual transmission(aOR=1.506,95%CI:1.050-2.159).Conclusion The delayed diagnosis rate of HIV/syphilis co-infection remains at a high level in Kunming from 2005 to 2018,and medical institutions should continue to promote provider initiated HIV testing and counseling(PITC).And early detection and early treatment strategy should be strengthened and targeted intervention be taken for the groups with risk behaviors.