Open source GIS for HIV/AIDS management

Background

A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit.

Results

The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist.

Conclusion

Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes.     

Examining the HIV/AIDS case management process

Eight themes in the HIV/AIDS case management process emerged from a 1998 study of 14 Ryan White Title I-funded case management programs in the New York City tri-county region. For individuals who were struggling with multiple environmental stressors, the diagnosis of HIV or AIDS was merely one of the many pressures that brought them to case management programs. Most came when they were in crisis. Using both chart reviews and focus groups with case managers and supervisors, this article reports that the activities that characterize this region's case management introduce alternative ways of thinking about the HIV/AIDS case management process.     

Quality-of-Care Indicators for HIV/AIDS

As care for HIV/AIDS becomes more concentrated within specific providers and organisations, it would be useful to have indicators to describe the quality of care. This paper reviews concepts related to quality of care, and practical issues including sampling and risk adjustment. Indicators can be collected using a combination of administrative, chart review and survey data to reflect clinical, patient and societal perspectives. We suggest that for adults with HIV/AIDS, indicators might include measures of health status and patient satisfaction, and essential care processes. Health status measures could include CD4+ T-lymphocyte count and HIV-RNA, progression to AIDS, symptom scores, health-related quality of life scores, patient utility and disability days. Essential care processes could include receipt of acceptable antiretroviral treatment, CD4+ and HIV-RNA monitoring, screening for opportunistic infections, prophylaxis against Pneumocystis carinii pneumonia, handling of symptoms and pneumococcal vaccination. For those at increased risk for HIV, potential indicators include screening for HIV risk behaviours and HIV testing. Data from indicators such as these could be used by individuals to select among providers, purchasers of care to select among health plans and payors to hold provider groups accountable. In addition, data could be used by groups of providers to improve the quality of care.     

督促干预对艾滋病患者肺结核感染的治疗效果分析

目的探究督促干预对艾滋病合并肺结核双重感染患者抗结核和抗病毒治疗的效果。方法选取2014年5月-2016年7月于医院治疗的82例艾滋病及肺结核双重感染患者(AIDS/TB)为研究对象,将82例患者根据随机数表法分为对照组41例和观察组41例;对两组患者均进行高效抗逆转录病毒治疗(HAART)的同时,根据病情使用抗结核组合药物治疗,观察组在对照组患者治疗基础上辅以督促干预;在治疗后使用诺丁汉健康调查问卷对两组患者生活质量进行评分,比较两组患者治疗后的病情改善情况及治疗前后肺功能指标水平。结果对照组患者诺丁汉健康调查问卷结果:精力评分7.6±2.1、疼痛评分2.7±0.8、情感评分4.5±0.8、睡眠评分9.1±3.1、社会活动2.6±0.8和身体活动3.1±0.9,总分31.9±1.8,观察组患者结果:精力评分5.3±1.7、疼痛评分2.5±0.9、情感评分3.2±0.7、睡眠评分7.4±2.8、社会活动1.3±1.0和身体活动1.4±0.9,总分21.6±0.9,两组患者评分除疼痛评分外差异均有统计学意义(P<0.05);对照组患者治疗后病情改善情况:明显改善12例,改善24例,无效5例,总有效率87.8%,观察组明显改善17例,改善22例,无效2例,总有效率95.1%,对照组和观察组患者病情改善情况比较差异有统计学意义(P<0.05);治疗前对照组患者与观察组患者肺功能指标比较差异无统计学意义,对照组患者治疗后FVC、FEV1/FVC和CD4+T细胞含量分别为76.9±4.3、75.4±4.7和258.4±141.7/ul,观察组患者治疗后分别为83.1±4.5、81.7±4.4和286.1±143.8/ul,两组患者治疗后数据比较,差异有统计学意义(P<0.05)。结论督促干预对艾滋病合并肺结核双重感染患者生活质量的提高、病情改善和肺功能恢复有着良好效果。     

对艾滋病随访管理队伍的干预效果评价

目的 评价河南省艾滋病防治人员随访管理能力的干预效果。 方法 对5个项目县从事艾滋病防治工作的人员进行基线调查,督导干预1年后进行随访调查。 结果 基线和随访调查分别纳入研究对象139人和128人,他们的能力测评得分分别为（27.77±5.49）和（29.77±4.93）分,（t = 3.121, P = 0.002),其中分析评价能力、政策执行能力、社区实践能力和专业基础知识的提升具有统计学意义（t = 4.366、P ＜0.001,t = 4.613、P ＜0.001,t = 2.626、P = 0.009,t = 2.976、P = 0.003）（P ＜0.01）。结论 随访干预可以有效提升艾滋病防治人员随访管理能力,丰富的随访管理经验、较强的沟通协调能力、对随访工作满意和年总收入的增加均有利于随访管理能力的提升。     

HIV/AIDS Reviews

Literature in Brief

HIV/AIDS Reviews     

艾滋病防治公务人员对HIV/AIDS态度分析

目的 了解艾滋病防治相关部门公务人员对待人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者的态度及其影响因素,为今后策略倡导工作提供依据。方法 对1655名艾滋病防治相关部门公务人员进行自答式匿名问卷调查。结果 83.7%的被调查者对HIV感染者/AIDS患者采取救治关怀措施并反对社会歧视的积极态度。多因素Logistic回归分析显示,文化程度、不同部门和认为只有道德败坏的人才会感染艾滋病是其影响因素。大专及以上文化程度者倾向于持积极的态度(OR为0.490,95%CI=0.350~0.686);各部门较卫生部门更多的持消极态度,尤以学校(OR为7.087,95%CI=3.878~12.95)及公安司法(OR为3.332,95%CI=1.860~5.970)2组最为突出;持只有道德败坏的人才会感染艾滋病观点是促成消极态度的因素,(OR为2.231,95%CI=1.104~4.506)。结论 应对艾滋病防治相关部门公务人员开展有针对性的宣传教育工作,尤其应加强对学校和公安司法系统的艾滋病防治策略倡导。     

全国艾滋病检测技术规范（2015年修订版）

在新疆维吾尔自治区（简称“新疆”）艾滋病防治示范区进行人类免疫缺陷病毒（HIV）抗体尿液检测的验证和推广,评估试剂的灵敏度、特异度和志愿者的检测感受,以作为是否适合地区大规模使用的依据。

在新疆某地采用分层整群抽样选取调查对象进行问卷调查及采样。运用多因素logistic回归分析对问卷结果进行统计描述,探寻HIV⁃1尿检试剂使用意愿的影响因素。以血液酶联免疫吸附试验（ELISA）抗体检测结果为参照,计算总人群和不同人群尿液HIV⁃1抗体检测的特异度、灵敏度、Kappa值等指标。

共招募2 504名参加尿液自检试剂应用研究的志愿者。总人群尿液HIV⁃1抗体检测灵敏度为94.73%（54/57）,特异度为100%（2 447/ 2 447）,阳性预测值为100%（54/54）,阴性预测值为99.88%（2 447/2 450）。不同人群比较各人群特异度均为100%。孕妇、性工作者人群、吸毒人员灵敏度均为100%,男男性行为者（MSM）人群灵敏度为50%（1/2）,Kappa值为0.796。自愿咨询者灵敏度为80%（8/10）,Kappa值为0.878。满意度调查中73.1%人群较于血液快速试剂检测更能接受尿液快速试剂检测,93.8%人群愿意推荐给他人尿液快速试剂检测,超过70%的人群均满意认可尿液快速检测试剂。多因素logistic回归分析表明年龄、文化程度、职业、婚姻状况、医疗费用支付方式和收入水平是是否接受自费购买尿液快检试剂进行自我检测的影响因素（均P<0.05）。

尿液HIV⁃1抗体检测方法具有较好的可信度和群众满意度,可以考虑在新疆地区大规模使用。

     

江西省艾滋病随访管理下沉工作现况分析与探讨

目的 了解和分析目前江西省艾滋病随访管理下沉工作现况,发现存在的问题,为江苏省艾滋病随访管理下沉策略提供参考依据。方法 采用问卷调查和个人深度访谈的形式,对92名基层艾滋病随访负责人进行现场调查,问卷调查资料用SPSS 22.0进行统计分析,定性资料逐字逐句转录成Word文档。从基层艾滋病随访负责人基本情况、随访管理内容、随访管理频次和方式、随访管理工作意愿、主要困难等方面进行研究。结果 基层艾滋病随访管理实际工作内容与服务规范有差异,年平均随访频次低于规定的4次标准,以电话随访方式为主,不愿意从事该工作者占42.4%,主要原因为"工作压力大、负荷大""待遇低""协调困难",随访面临的主要困难为"随访对象不配合""感觉自身技能不足""待遇低"。结论 江西省艾滋病随访管理下沉策略尚未凸显优势。需根据当地实际情况,针对不同特点的感染人群,选择合适的随访管理模式。     

尉氏县艾滋病单阳配偶管理状况浅析

目的通过对2005-2008年尉氏县单阳配偶感染HIV情况调查,了解艾滋病单阳配偶间的传播情况,为调整单阳配偶管理措施、减少婚内性传播提供依据。方法回顾性分析尉氏县疾病预防控制中心自2005-2008年单阳配偶感染HIV情况及随访检测记录,评价现行的预防艾滋病婚内性传播的措施及效果。结果 2005-2008年单阳配偶检测率平均为82.07%,阳转率平均为0.65%,发现配偶间性传播感染HIV者28人,4年间的HIV抗体阳转率差异无统计学意义,4年来男单配偶与女单配偶间的HIV抗体阳转率差异无统计学意义。结论目前的单阳配偶管理工作取得明显成绩,单阳配偶检测率保持在较高水平,阳转率保持在1.00%以下。以后要对经常外出者和拒绝检测者采取针对性更强的措施,对涉嫌恶意传播者司法部门有必要进一步加大干预力度。