新疆库车县HIV感染者阴性配偶队列研究

目的观察新疆库车县HIV感染者阴性配偶中HIV新发感染率,为指导HIV感染者阴性配偶的干预工作提供科学依据。方法在HIV感染者阴性配偶中建立前瞻性队列,每3个月进行一次定位随访,每6个月完成一次问卷调查和HIV、梅毒、丙型肝炎的检测,队列随访周期为一年。结果纳入阴性配偶队列共113人,随访观察101人,一年随访期间HIV新发感染率0.93/100人年(1/108人年),梅毒新发感染率10.00/100人年(10/100人年),丙型肝炎新发感染率0.95/100人年(1/105人年);最近6个月内与主要性伴性行为的不同频次之间、最近一个月性行为每次安全套使用率差异有统计学意义(χ2=15.81,P<0.005)。结论库车县HIV感染者阴性配偶中HIV新发感染率较低,提示库车县艾滋病综合防治工作及HIV感染者阴性配偶干预工作取得了一定成效,今后应进一步加大干预力度和频度,特别针对文化程度偏低的"单阳"家庭,运用各种形式普及HIV/STD相关知识,采取他们容易接受的方式开展干预,使其真正意识到相关的危险行为,树立安全的性行为观念,增强其自我保护意识,预防HIV在"单阳"家庭中的二代传播。     

中山市213例HIV/AIDS病人配偶HIV抗体检测及随访情况分析

目的了解广东省中山市艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)的配偶HIV抗体检测及随访HIV抗体阳转情况。方法从国家艾滋病综合防治信息系统中下载病例报告信息和随访信息,采用SPSS分析2010-2012年中山市新发现的已婚HIV/AIDS病人的配偶检测及随访情况,随访信息截止时间为2013年12月31日。结果 213例已婚HIV/AIDS病人被纳入分析,175例(82.2%)的配偶接受过HIV检测,其中41.1%(72/175)的配偶首次检出HIV抗体阳性。女性病例配偶的HIV抗体阳性率是男性病例配偶抗体阳性率的2.31倍[相对危险度(RR)=2.31,95%可信区间(CI):1.62~3.3]。文化程度越高,配偶HIV抗体阳性率越低(趋势χ2=5.73,P=0.02)。配偶接受HIV抗体检测的HIV/AIDS病人中,100例在确诊后2个月内进行了CD+4T淋巴细胞(简称CD4细胞)计数检测,其中47例200个/μL,26例200~349个/μL;CD4细胞350个/μL的配偶HIV抗体检测阳性率是CD4细胞≥350个/μL病例配偶的2.28倍(RR=2.28,95%CI:1.09~4.79)。配偶首次检测HIV抗体阴性的103例HIV/AIDS病人中,68例(66.0%)的配偶完成随访≥1次,合计随访81.8人年,其中1例出现阳转,阳转率为1.22/100人年(95%CI:0~3.6/100人年)。结论中山市发现已婚HIV/AIDS病人,配偶首次检测HIV阳性率高。今后工作应促进病例早发现,提高配偶HIV检测率和随访率。     

晚发现HIV/AIDS病例和配偶/固定性伴传播关系的研究

目的了解晚发现和非晚发现艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的配偶/固定性伴(简称配偶),在随访期1年内发生血清阳转的情况。方法对2010年1月1日到12月31日期间登记的HIV/AIDS病人的配偶建立观察队列,按是否是晚发现分组,统计基线调查后12个月内HIV/AIDS病人配偶的HIV血清阳转频率,并比较各分层因素HIV血清阳转优势比,计算晚发现和非晚发现两组随访1年内患者配偶血清阳转密度,明确晚发现和HIV血清阳转的关系。结果 1 649例HIV/AIDS病人中,晚发现HIV/AIDS病人占66.28%(1 093/1 649),非晚发现HIV/AIDS病人33.72%(556/1 649)。282例(17.10%)HIV/AIDS病人的配偶发生HIV血清阳转,晚发现病人配偶的血清阳转占总阳转患者比例为73.40%(207/282),非晚发现病人配偶的阳转比例为26.60%(75/282),两组比较差异有统计学意义(P=0.003);随访12个月时HIV/AIDS病人配偶的HIV血清阳转密度为30.97/100人年,其中晚发现病人的配偶为36.76/100(207/563.17)人年,非晚发现病人的配偶为21.58/100人年(75/347.47)。和非晚发现病人的配偶相比,晚发现病人配偶的HIV血清阳转在年龄、性别、职业、教育程度、感染途径等分层因素差异有统计学意义(P0.05);晚发现HIV/AIDS病人配偶的血清转化密度最高是55~64岁组,30~40岁组是另一血清转化高峰。结论观察期1年内,广西HIV/AIDS病人配偶的HIV血清转化率较高,以55~64岁组为血清转化高峰,主要由晚发现患者导致。应提高HIV/AIDS病人早发现能力,和家庭计划生育干预、抗病毒治疗等干预措施相结合,减少HIV家庭内传播。     

阜阳市三级网络管理对HIV/AIDS病例的随访管理效果

目的评估阜阳市实施三级网络化管理的随访模式,对艾滋病病毒(HIV)感染者/艾滋病(AIDS)病例(简称HIV/AIDS病例)的随访管理效果。方法以2007年阜阳市随访管理工作指标值为基础,与2008-2014年历年相应的指标值比较,了解三级网络化管理模式对提高随访管理工作指标的效果。结果自2008年对HIV/AIDS病例实施三级网络管理后,阜阳市HIV/AIDS病例随访干预率、CD+4T淋巴细胞检测率和配偶/固定性伴HIV检测率,分别由2007年的89.6%、65.8%和80%增长为2014年的近100.0%、97.3%和99.3%,逐年增长趋势χ2检验有统计学意义(χ2随=988.85,P随0.05;χ2CD4=404.46,PCD40.05;χ2配偶=439.02,P配偶0.05)。结论阜阳市实施的三级网络管理模式,有效提高了HIV/AIDS病例的随访管理工作效果。     

经血传播HIV/AIDS病人夫妻间传播的影响因素研究

目的了解经血传播艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人),夫妻间传播的危险因素,以指导河北省预防HIV传播工作的开展。方法对河北省1995年前后发生的单采血浆感染和输血感染的已婚HIV/AIDS病人的配偶进行观察,采集血标本检测HIV感染情况,调查相关危险因素,用Logistic回归方法对危险因素进行分析。结果来自全省的输血和有偿供血感染的HIV/AIDS病人共268例,夫妻累积传播概率为19.0%(51人),传播频率为1.7/100人年。丈夫比妻子更容易将HIV传给对方(χ2=4.025,P=0.0045)。输血感染者比单采血浆感染者更容易将HIV传给配偶(χ2=4.382,P=0.0036),1990-2007年结婚者比早些时候结婚者更容易传播(χ2=4.337,P=0.037)。单因素分析中发现,配偶不知道对方感染HIV的时间越长,越容易感染HIV(χ2=4.091,P=0.043)。结论性别、感染方式、结婚时机和知情状况影响夫妻HIV传播效率,应采取相应干预措施控制夫妻间HIV传播。     

对HIV/AIDS患者及配偶(性伴)健康教育和行为干预的效果研究

目的探索对HIV/AIDS患者及配偶进行艾滋病相关知识的健康教育和行为干预的有效方法及效果.方法选择在北京佑安医院就诊的一方为HIV/AIDS 42对配偶(性伴)为对象,分别进行不同形式的艾滋病健康教育及行为干预,时间为半年,并在干预前后各进行1次问卷调查和HIV抗体检测.结果42对(84人)夫妇(性伴)在半年时间内接受不少于3次的健康教育及行为干预,其中夫妻(性伴)双方感染者2对(4.76%),一方感染者40对(95.24%).同性恋5对(11.9%),异性婚配37对(88.1%).半年后艾滋病知识的掌握程度明显提高,其配偶HIV抗体检测均阴性.结论应经常性地加强对HIV/AIDS患者夫妇(性伴)的健康教育及行为干预,阻断HIV在配偶(性伴)间传播,保护HIV感染者的配偶(性伴)免遭HIV感染.     

TOPSIS法在HIV感染者随访管理工作质量评价中的应用

目的应用TOPSIS法,对福州市等9个市艾滋病病毒(HIV)感染者随访管理指标进行综合评价,确定不同市之间HIV感染者随访管理工作质量。方法运用TOPSIS法从HIV感染者/病人的随访干预比例、CD4检测率和配偶/固定性伴HIV抗体检测率,对HIV感染者的随访管理工作质量进行综合评价。结果泉州市的HIV感染者随访管理工作指标相对接近度(Cij)值为0.876 403,高于全省其他8个市,提示泉州市HIV感染者随访管理工作质量要比其他市好。TOPSIS法综合评价结果与泉州市实际工作开展情况基本一致。结论 TOPSIS法可简单、有效地对HIV感染者随访管理工作质量有关的多项指标进行综合评价,并为制定措施提供参考依据。     

主动与被动发现的HIV/AIDS病人防控指标的比较

目的比较主动与被动发现的艾滋病病毒(Human immunodeficiency virus,HIV)感染者/艾滋病(Acquired immunodeficiency syndrome,AIDS)病人(HIV/AIDS病人)的防控指标。方法采用回顾性队列研究方法,抽取扬州市1997-2010年主动发现和被动发现的HIV/AIDS病人,收集首次随访情况、病程阶段及配偶HIV抗体结果等数据作比较。结果两种方式各调查90例,主动发现和被动发现的HIV/AIDS病人首次随访完成率分别为97.78%(88/90)和87.78%(79/90),HIV感染者比例分别为67.78%(61/90)和45.56%(41/90),配偶HIV抗体阳性比例分别为1.47%(1/68)和9.52%(6/63),发现-发病间隔期分别为(602.62±538.31)天和(245.12±447.91)天,发现-死亡间隔期分别为(978.40±530.74)天和(772.69±734.94)天,死亡率分别为17.78%和41.11%,治疗12个月CD4+T淋巴细胞数分别升高(165.81±166.47)个/μL和(92.97±95.33)个/μL,与被动发现相比,主动发现首次随访完成率高(χ2=6.72,P<0.01),HIV感染者比例高(χ2=4.19,P<0.05),配偶HIV抗体阳性比例低(χ2=9.05,P<0.01),发现-发病间隔时间长(t=3.15,P<0.01),发现-死亡间隔时间长(t=2.14,P<0.05),死亡率低(χ2=11.79,P<0.01),治疗12个月CD4+T淋巴细胞数上升值高(t=2.16,P<0.05)。结论主动发现方式能够早期发现HIV/AIDS病人,降低二代传播,提高病例的生存质量,值得在今后工作中推广。     

南昌市部分社区老年人阿尔茨海默病发病率

目的了解南昌市部分城市社区老年人阿尔茨海默病(AD)的发病率。方法对南昌市洪都街道所辖的10个社区9 733例60岁以上老年人进行AD筛查随访,采用与国际接轨的两阶段调查法确定病例,并利用SPSS20.0进行统计分析。结果社区老年人AD发病率为13.13/1 000人年,其中女性发病率为15.25/1 000人年,男性为10.94/1 000人年,女性高于男性(χ2=10.19,P0.05);AD的发病率随年龄增长而增加(χ2趋势=15.13,P0.01)。结论南昌市社区老年人AD发病率较高,严重影响了老年人的生活质量,应引起有关部门的高度重视,积极采取预防干预措施。     

HCV对HIV/HCV共感染患者病情进展的影响

目的探讨HCV对HIV/HCV共感染病情进展的影响。方法研究对象为2012年8月到北京佑安医院随访的HIV/HCV共感染者29例及HIV单独感染者20例。两组患者年龄、性别及HIV感染时间及感染方式、感染的HIV病毒亚型均具有可比性。外周血生化指标检测并采用瞬时弹性扫描仪FibroScan评估肝脏功能及纤维化程度,运用流式细胞技术检测外周血CD4+T、CD8+T细胞绝对计数。两组计量资料比较采用t检验,计数资料比较采用χ2检验。结果 HIV/HCV共感染组ALT、AST及TBil水平分别为(76.16±81.25)U/L、(87.66±71.32)U/L、(14.21±9.56)μmol/L,明显高于HIV单独感染组[(27.74±20.63)U/L、(45.65±16.95)U/L、(10.26±3.22)μmol/L],差异具有统计学意义(P值分别为0.004、0.005及0.046)。与HIV单独感染组相比,HIV/HCV共感染组Stiffness指数有升高的趋势,但差异无统计学意义(t=1.889,P=0.080)。HIV/HCV共感染组HIV病毒载量(拷贝/ml)的对数值为3.66±0.97明显高于HIV单独感染组的3.02±0.90(t=2.251,P=0.030)。HIV/HCV共感染组、HIV单独感染组CD4+T淋巴细胞计数及CD4+T/CD8+T细胞比例分别为(374.25±185.48)/μl及(0.33±0.17)、(496.45±230.98)/μl及(0.46±0.27),HIV/HCV共感染组CD4+T淋巴细胞计数及CD4+T/CD8+T细胞比例低于HIV单独感染组,差异具有统计学意义,P值分别为0.048、0.043。共感染组艾滋病发病率(27.59%)呈现出较HIV单独感染组(5%)高的趋势(P=0.063)。结论HCV促进HIV/HCV共感染者肝脏损伤,增强HIV复制,加剧机体免疫功能损伤,HCV可能加速HIV/HCV共感染者的病情进展。     

Healthcare providers’ understanding of HIV serodiscordance in South Africa and Uganda: implications for HIV prevention in sub-Saharan Africa

HIV transmission within stable heterosexual HIV serodiscordant couples accounts for almost half the new incident infections in South Africa and Uganda. Advances in HIV prevention provide opportunities to reduce transmission risk within serodiscordant partnerships (e.g., antiretroviral treatment (ART), pre-exposure prophylaxis (PrEP), medical male circumcision, and couples-based HIV counselling and testing). These interventions require a clinical encounter with a provider who recognises prevention opportunities within these partnerships. We explored healthcare provider understanding of HIV serodiscordance in a reproductive counselling study with providers in eThekwini district, South Africa, and Mbarara district, Uganda. In eThekwini, in-depth interviews (29) and focus group discussions (2) were conducted with 42 providers (counsellors, nurses and doctors) from public sector clinics. In Mbarara, in-depth interviews were conducted with 38 providers (medical officers, clinical officers, nurses, peer counsellors and village health workers). Thematic analysis was conducted using NVivo software. In eThekwini, many providers assumed HIV seroconcordance among client partners and had difficulty articulating how serodiscordance occurs. Mbarara providers had a better understanding of HIV serodiscordance. In the two countries, providers who understood HIV serodiscordance were better able to describe useful HIV-prevention strategies. Healthcare providers require training and support to better understand the prevalence and mechanisms of HIV serodiscordance to implement HIV-prevention strategies for HIV serodiscordant couples.     

A qualitative study of barriers to consistent condom use among HIV-1 serodiscordant couples in Kenya

This study explored barriers to consistent condom use among heterosexual HIV-1 serodiscordant couples who were aware of the HIV-1 serodiscordant status and had been informed about condom use as a risk reduction strategy. We conducted 28 in-depth interviews and 9 focus group discussions among purposively selected heterosexual HIV-1 serodiscordant couples from Thika and Nairobi districts in Kenya. We analyzed the transcribed data with a grounded theory approach. The most common barriers to consistent condom use included male partners' reluctance to use condoms regardless of HIV-1 status coupled with female partners' inability to negotiate condom use, misconceptions about HIV-1 serodiscordance, and desire for children. Specific areas of focus should include development of skills for women to effectively negotiate condom use, ongoing information on HIV-1 serodiscordance and education on safer conception practices that minimize risk of HIV-1 transmission.     

A group-based intervention to increase condom use among HIV serodiscordant couples in India, Thailand, and Uganda

This study assessed the feasibility of a group-based couples intervention to increase condom use in HIV serodiscordant couples in three countries (India, Thailand and Uganda). The intervention focused on communication, problem solving, and negotiation skills. Forty-three couples enrolled in the intervention (15 in India, 14 in Thailand, and 14 in Uganda) and 40 couples completed all study activities. Participants were interviewed at baseline and at one and three months post- intervention. The intervention consisted of two same sex sessions and two couples sessions with 'homework' to practice skills between sessions. The same intervention modules were used at each site, tailored for local appropriateness. Participants at each site were enthusiastic about the intervention, citing information about HIV serodiscordancy and the opportunity to meet couples 'like us' as important features. Participants reported increased comfort discussing sex and condoms with their partner, although some participants remain concerned about situations when condoms might not be used (e.g. when drunk). At three-month follow up 90% of the participants reported having been able to use the skills from the intervention with their partner. Our results highlight the feasibility of this couples group-based intervention and the need for ongoing support for discordant couples.     

Survey of HIV care providers on management of HIV serodiscordant couples – assessment of attitudes,knowledge, and practices

Human immunodeficiency virus (HIV) serodiscordant couples are at risk of sexual transmission of HIV between the infected and uninfected partner. We assessed New York area care providers for people living with HIV regarding attitudes, knowledge, and practice patterns toward fertility and conception in serodiscordant couples. Data were collected via a survey distributed in October 2013. Seventeen percent of respondents reported prescribing antiretroviral preexposure prophylaxis (PrEP) for a woman in a serodiscordant couple, and 38% percent of respondents reported having counseled serodiscordant couples on timed, unprotected intercourse without PrEP. Respondents who reported being “very” familiar with the data on HIV transmission in serodiscordant couples were more likely to report counseling their patients in timed, unprotected intercourse compared with those who reported less familiarity with the data (41% vs. 8%, p = 0.001). Although only 20% reported being “very” or “somewhat” familiar with the data on the safety of sperm washing with intrauterine insemination, those who did were more likely to have reported referring a patient for assisted reproductive technology (61% vs. 32%, p = 0.006). Effective patient counseling and referral for appropriate reproductive options were associated with knowledge of the literature pertaining to these options. This emphasizes the need for further provider education on reproductive options and appropriate counseling for serodiscordant couples.     

Male Migration/Mobility and HIV Among Married Couples: Cross-Sectional Analysis of Nationally Representative Data from India

This paper examines the associations between male migration and mobility with HIV among married couples in India. Cross-sectional analyses of a nationally representative household survey conducted across all 29 states of India from 2005 to 2006 via the National Family Health Survey-3 (NFHS-3) included a subsample of 27,771 married couples who were tested for HIV as a part of their participation. Both bi-variate and multi-variate analyses were conducted. About 0.5% of the total married couples in the current study included an HIV-infected partner; 0.11% were HIV concordant and 0.38% were HIV serodiscordant couples. Adjusted logistic regression analyses demonstrated that HIV infection in couples (seroconcordant or serodiscordant) was significantly more likely among those couples where the man was migrant but not mobile and those couples where the man was migrant as well as mobile, relative to those couples where the man was neither migrant nor mobile. Male migration increases the risk for HIV among married couples in India, largely in the form of serodiscordance in which men are HIV infected. These findings document the need for not only primary prevention efforts to reduce HIV acquisition among migrant male workers, particularly more mobile migrants, but also efforts are needed to reduce subsequent transmission to their wives.     

Predictors and correlates of reduced frequency or cessation of injection drug use during a randomized HIV prevention intervention trial

Aims This study conducted a secondary analysis to examine injection cessation and decreasing frequency of injection during a multi‐site randomized controlled HIV prevention intervention trial that sought to reduce sexual and injection risk behavior among young injection drug users. Design and Setting A six‐session, cognitive–behavioral skills‐building intervention in which participants were taught peer education skills [peer education intervention (PEI)] was compared with a time‐equivalent attention control. Follow‐up interviews were conducted at 3 and 6 months post‐baseline. Participants Trial participants were HIV and hepatitis C virus (HCV) antibody‐negative injection drug users aged 15–30 years. Participants who had at least one follow‐up interview and reported injecting drugs in the previous 3 months at baseline were eligible for the present analysis (n = 690). Measurements At each interview, data were collected on the number of times participants injected drugs over the previous 3 months. Findings Twenty‐seven per cent of participants reported at least one 3‐month period of injection cessation. In a multivariate, zero‐inflated negative binomial regression adjusting for prior injection frequency, time of follow‐up and psychosocial variables, PEI trial arm and smaller session size were associated significantly with injection cessation. Trial arm had no effect on the frequency of injection among those who continued to inject. Conclusions HIV prevention interventions that encourage injection drug users to take on the role of peer educator may have the additional benefit of increasing the likelihood of injection cessation. Intervention group size is also an important consideration, with smaller groups having higher rates of cessation.     

长途客车司机的性健康同伴骨干教育

目的探索长途客车司机性健康同伴骨干教育方式，为长途客车司机的行为干预提供参考。方法采用个别访谈、小组讨论、建立同伴骨干工作小组、同伴骨干管理培训网络等方式，开展长途客车司机性健康同伴骨干教育。结果建立了以客运公司为主进行组织管理、多方参与培训骨干、多种方式给予激励、干预工作突出文化特征和交流方式等为特点的同伴骨干教育干预网络，其工作效果已开始显现。结论同伴骨干教育干预网络的建立，提供了一种可持续开展长途客车司机社区干预活动的思路和方法。     

沈阳市西塔地区娱乐场所服务员预防AIDS/STI行为干预研究

目的 使目标人群预防艾滋病／性传播感染(AIDS／STI)相关知识水平提高30％以上，增强自我保护意识，进而改变高危行为，推广使用安全套，降低和减少AIDS／STI的危害。方法 按教育对象的年龄、教育程度、来源，随机分为教育组和对照组，教育组的干预方法采取同伴教育形式。干预前后通过问卷形式对各组进行干预效果评估。结果 教育组预防AIDS／STI知识知晓率提高36．5％，而对照组无明显提高，安全套使用在干预前后未见差异。结论 同伴教育可以提高高危人群预防AIDS／STI知识的知晓率，但行为干预工作应在不同人群、从不同层面开展，以保证行为干预成果的持续性。     

Parental HIV serodiscordance: implications for the care of the HIV seropositive child in a resource-poor setting

This prospective study compared the care and support provided for symptomatic HIV seropositive children of HIV serodiscordant parents (only the mother of the child is HIV infected) with children of seroconcordant parents (both parents are HIV infected) during admission and after discharge from a tertiary health institution in southwestern Nigeria. Information was collected from parents of eligible children by semi-structured questionnaires and observation of the children and their parents while on admission and at home. Of the 51 couples who met the study criteria, there were 27 seroconcordant couples and 24 serodiscordant couples. The children from serodiscordant couples were more frequently discharged against medical advice, abandoned, lost to follow-up, cared for by their mothers alone and were not up-to-date with their immunization schedule when compared with children from seroconcordant parents. These were statistically significant (p < 0.05). There was a higher mortality among these children and their mothers (p < 0.05). Paternal reasons for not providing adequate care for the children from serodiscordant parents included fear of being infected, doubt of child's paternity and waste of family resources on a 'child who is dying'. None of the children from both groups received support from governmental and non-governmental agencies. It is concluded that the care of sick HIV seropositive children of serodiscordant parents poses special challenges for clinicians working in Nigeria where there is no social support system.     

Maximizing the impact of HIV prevention efforts: Interventions for couples

Despite efforts to increase access to HIV testing and counseling services, population coverage remains low. As a result, many people in sub-Saharan Africa do not know their own HIV status or the status of their sex partner(s). Recent evidence, however, indicates that as many as half of HIV-positive individuals in ongoing sexual relationships have an HIV-negative partner and that a significant proportion of new HIV infections in generalized epidemics occur within serodiscordant couples. Integrating couples HIV testing and counseling (CHTC) into routine clinic- and community-based services can significantly increase the number of couples where the status of both partners is known. Offering couples a set of evidence-based interventions once their HIV status has been determined can significantly reduce HIV incidence within couples and if implemented with sufficient scale and coverage, potentially reduce population-level HIV incidence as well. This article describes these interventions and their potential benefits.