四川省结核病患者中艾滋病病毒感染现状及流行特征研究

目的了解四川省结核病患者中HIV感染现状和流行病学特征,探讨结核病人发生HIV感染的高危因素。方法对四川省15个县（区）结核病防治机构在2009—09—01／12—31期间所有新登记的结核患者采用问卷调查与实验室检查确认相结合的方法,收集其结核病相关信息和HIV抗体检测结果,对HIV阳性者收集其艾滋病高危行为等相关信息。结果在接受HIV检测的1779例结核病患者中,共有29例HIV阳性者,HIV感染阳性检出率为1．63％。组间比较发现,15～44岁组（2．4％）,彝族（5．8％）,离异或丧偶（8．7％）和复治结核病患者（4．5％）中HIV检出率高于其他组（P〈0．05）。29例双感患者中,23例（79．3％）为男性,16例（55．2％）为涂阳结核病患者,23（79．3％）咳嗽咳痰大于等于2周,22例（75．9％）最可能的感染途径为注射毒品。结论四川省TB／HIV双重感染疫情较为严重,应将中青年男性结核病患者、复治患者以及吸毒人群结核病患者作为‘FB／HIV双重感染防治的重点人群并着重加强少数民族地区的TB／HIV双重感染防治工作。     

Multidrug-Resistant Tuberculosis Among Patients in Baja California,Mexico, and Hispanic Patients in California

Objectives. We sought to compare prevalence and determinants of multidrug-resistant tuberculosis (MDR-TB) between tuberculosis patients in Baja California, Mexico, and Hispanic patients in California.Methods. Using data from Mexico’s National TB Drug Resistance Survey (2008–2009) and California Department of Public Health TB case registry (2004–2009), we assessed differences in MDR-TB prevalence comparing (1) Mexicans in Baja California, (2) Mexico-born Hispanics in California, (3) US-born Hispanics in California, and (4) California Hispanics born elsewhere.Results. MDR-TB prevalence was 2.1% in Baja California patients, 1.6% in Mexico-born California patients, 0.4% in US-born California patients, and 2.7% in Hispanic California patients born elsewhere. In multivariate analysis, previous antituberculosis treatment was associated with MDR-TB (odds ratio [OR] = 6.57; 95% confidence interval [CI] = 3.34, 12.96); Mexico-born TB patients in California (OR = 5.08; 95% CI = 1.19, 21.75) and those born elsewhere (OR = 7.69; 95% CI = 1.71, 34.67) had greater odds of MDR-TB compared with US-born patients (reference category).Conclusions. Hispanic patients born outside the US or Mexico were more likely to have MDR-TB than were those born within these countries. Possible explanations include different levels of exposure to resistant strains and inadequate treatment.Tuberculosis (TB) is an important health concern along the 1950-mile international border shared by Mexico and the United States. The neighboring states of Baja California, Mexico, and California, United States, have TB incidence rates that far exceed those of their respective countries. In 2008, the incidence rate for TB in Baja California was 50.9 per 100 000, versus 17.1 per 100 000 nationally in Mexico.1 In California, the incidence of TB that same year was 7.4 per 100 000, compared with 4.2 cases per 100 000 persons in the United States.2Multidrug-resistant tuberculosis (MDR-TB) is TB disease associated with Mycobacterium tuberculosis strains that are resistant to isoniazid and rifampin, the 2 most effective TB medications available.3 MDR-TB is found in Mexico and California, and significantly increases treatment and societal costs of TB, with case fatality rates ranging from 12% in HIV-negative to 90% in HIV coinfected persons.3 Although TB control efforts worldwide are starting to decrease TB incidence and mortality,4,5 the emergence of MDR-TB is “threatening to destabilize global TB control,”6^(p261) and could rapidly turn TB into an untreatable disease, even in high-income countries.7California had an average of 41 MDR-TB cases per year from 1994 to 2003—the highest incidence of MDR-TB in the United States.8 More than 85% of the incident MDR-TB cases in California from 1993 to 2006 were among foreign-born individuals, 28% of whom were born in Mexico.7 In Mexico, although some studies of MDR-TB prevalence in specific populations have been conducted, 9–12 there is no routine surveillance data on MDR-TB for comparison.California and Baja California share a strong migratory dynamic. Translocation and contact between inhabitants of both sides of the border are frequent, and familial and other social relations extend across the border.13 This condition affects the binational epidemiology of TB and MDR-TB, which is heavily influenced by social networks.14 The regular contact between residents of Baja California and California involves people of all ethnicities and social groups, but it is most intense for those identified as “Hispanics,” a group that, in California, is composed mainly of persons of Mexican origin.Susceptibility testing is not routinely conducted in all TB cases in Mexico. However, from 2008 through 2009, as part of a national survey, all newly diagnosed TB cases were tested for drug resistance.15 Taking advantage of this, we studied differences in the prevalence and determinants of newly diagnosed MDR-TB cases among TB patients in Baja California as compared with Hispanics (a proxy for patients with ties to Mexico) in California, from 2004 through 2009. Although the concepts of ethnicity and race can be questioned when they imply that real genetic differences exist between different human groups,16 and the label “Hispanic” has been criticized for its lack of specificity,16,17 in the absence of other information, self-reported ethnicity can be used as an indicator of certain social and cultural characteristics.16 It can also be an index for social inequalities, including discrimination, that reflect inequalities in health.18 In the study of TB transmission between contiguous states on either side of the US–Mexico border, self-identified ethnicity can be used in this way as a proxy for people who might share social networks, related TB strains, and some social conditions.The TB control programs of Baja California and California are different in terms of resources, mainly in terms of capacity for bacterial culture and sufficiency of staff. Also, completion of treatment is mandated by law in California, which should make it less likely for recently diagnosed cases to have a history of previous treatment.19,20 The objective of this study was to compare the prevalence of risk factors for MDR-TB, including previous treatment and country of birth, among newly diagnosed TB cases (both previously treated and never treated) in Baja California, with those among Hispanics living in California. Recognizing the differences in resources between California and Baja California health systems, we hypothesized that (1) the overall prevalence of MDR-TB would be higher in Baja California than in California, (2) the proportion of TB cases with previous treatment would be higher in Baja California than in California, and (3) the prevalence of MDR-TB would be the same in Baja California and California after adjusting for previous antituberculosis treatment, one of the strongest predictors for MDR-TB globally.     

自贡市200例初治涂阳肺结核患者耐药状况分析

目的 了解自贡市初治涂阳肺结核患者结核分枝杆菌的耐药情况及其影响因素,为制定耐药结核的防治对策提供依据.方法 对初治涂阳患者痰培养阳性并经鉴定的200株结核分枝杆菌采用WHO/IUATLD耐药检测指定的比例法对4种抗结核药物(INH、SM、RFP和EMB)进行耐药性测定.结果 200株结核分枝杆菌的初始耐药率为16.00％( 32/200),耐多药率为5.5％(11/200),4种抗结核药物的耐药率顺位为INH( 10.50％,21/200)、SM (9.50％,19/200)、RFP(6.50％,13/200)、EMB(3.00％,6/200);耐1药的16例(50.00％,16/32),耐2药9例(41.00％,9/32),耐3～4药7例(21.87％,7/32).以男性患者居多,患病高峰年龄主要集中在40～ 70岁的中老年患者.结论 自贡市结核病耐药率仍然处于相对较高水平,肺结核患者耐药状况,耐药类别与频率的确定,有利于对结防工作成效的评估,也为严格实施DOTS策略,制定和采取针对性的措施.     

肺结核病患者合并HIV感染分析

目的了解肺结核病患者中合并艾滋病病毒（HIV）感染情况。方法对在广西凭祥市疾病预防控制中心结核门诊就诊的活动性肺结核病患者转介到本单位的VCT门诊,经专业的咨询员进行规范的检测前咨询后,对同意接受HIV检测者采集血样进行HIV抗体检测。结果 2006-2009年共监测767例肺结核病患者,检出HIV抗体阳性44例,阳性率为5.74%。各年间、不同年龄、不同痰检结果肺结核病患者HIV抗体阳性率差异无统计学意义（P（0.05）;男性肺结核病患者HIV抗体阳性率明显高于女性（χ^2=6.24,P（0.05）。结论对肺结核病患者中进行HIV抗体检测,有助于HIV/AIDS的早期发现和及时采取有效的控制措施。     

河北省TB/HIV双重感染监测结果分析

目的 了解结核病患者与艾滋病病毒感染者和患者中TB/HIV双重感染情况.方法 对确诊的结核病患者进行咨询及HIV抗体检测,对确诊的HIV/AIDS进行结核病筛查.结果 2007-01/09,共确诊结核病患者844例,有HIV高危行为人数51例(7.0%),未检测出HIV抗体阳性者.397例HIV/AIDS病例中确诊结核病患者8例,TB/HIV双重感染率为2.0%.结论 该研究结核病患者中HIV感染率尚处于较低水平,但有高危行为存在;TB/HIV双重感染率较低.在艾滋病疫情低流行地区,应重点监测有高危行为的结核病患者的HIV抗体情况,对所有HIV/AIDS进行结核病监测.     

HIV/AIDS与TB双重感染及其影响因素的流行病学研究

目的调查广西HIV/AIDS患者中结核病检出率,结核病患者中HIV感染检出率;了解广西HIV/AIDS患者发生结核病及结核病患者感染HIV的影响因素。方法利用艾滋病专科门诊对321例HIV/AIDS患者、结核病专科医院对580例结核病患者进行双重感染的检测,并对其影响因素进行流行病学调查。结果HIV/AIDS患者中结核病检出率为30.5%(肺结核为25.2%,肺外结核为5.3%),结核病患者中HIV感染检出率为2.8%;影响HIV/AIDS患者发生结核病的主要影响因素为CD4淋巴细胞计数水平、性别和月均收入,影响结核病患者感染HIV的主要影响因素为共用针具静脉吸毒和商业性行为。结论HIV/AIDS患者发生结核病的机率高,CD4淋巴细胞计数水平低、男性、月均收入低者易发生结核病;结核病患者中HIV感染检出率高于一般人群,共用针具静脉吸毒和商业性行为是结核病患者感染HIV的主要途径。     

上海市浦东新区2012年结核病人HIV感染检测结果分析

目的了解上海市浦东新区结核病人中艾滋病病毒(HIV)感染现状及流行病学特征,为制定TB/HIV双重感染防治对策提供依据。方法对2012年上海市浦东新区7家定点医院送检的756例结核病人,采取自愿的原则进行HIV抗体初筛检测,对HIV初筛阳性标本做免疫印迹(WB)确证实验。结果 756例结核病人进行了HIV检测,其中HIV阳性者4例,阳性率为0.53%,4例阳性者中已知HIV阳性者1例,占25.00%,新发现3例占75.00%。4例TB/HIV双感病人均为因症就诊,无固定职业,年龄以青壮年男性为主。结论对结核病人进行HIV检测是发现HIV感染者的方法之一,对控制结核病疫情均有现实意义。     

四川省结核病患者中HIV筛查结果分析

目的了解结核病(TB)病患者中人类免疫缺陷病毒(HIV)感染情况,为制定TB/HIV双重感染防治对策提供依据。方法 在四川省选择结核病和艾滋病疫情均较重的2个县,对结核病患者进行HIV检测。结果筛查结核病患者706例,确诊HIV/AIDS17例,感染率为2.4%。其中男性14例,女性3例;通过静脉吸毒血源性感染13例,性传播途径感染HIV阳性者4例。结论结核病患者中HIV感染率较高,主要集中在静脉吸毒者。     

影响TB/HIV病人临床结核病治疗效果多因素分析

目的探讨多种因素对TB/HIV病人临床治疗效果的影响状况,为制订TB/HIV双重感染防治工作规划提供依据。方法对10个工作较好的国家TB/HIV控制重点县治管的TB/HIV病人临床治疗与管理资料,采取单因素Logistic回归分析和多因素非条件Logistic回归分析。结果单因素Logistic回归分析:是否落实DOTS管理、发现延误、胸部病变X范围、CD4数量、抗结核治疗副反应、抗病毒治疗副反应、抗病毒治疗7个单因素对TB/HIV病人临床治疗效果的影响显著;多因素非条件Logistic回归分析:是否落实DOTS管理、发现延误、胸部病变X范围、抗病毒治疗副反应、抗病毒治疗5个单因素对TB/HIV病人临床治疗效果的影响显著。结论应早发现、早落实病人的抗结核和抗病毒治疗,落实DOTS下治疗与管理并及时处理抗结核和抗病毒治疗药物的副反应,以提高TB/HIV病人临床结核病治疗效果。     

流动人口肺结核病人健康促进的意义

目的探讨健康促进对流动人口结核病人在诊断和治疗过程中的意义。方法自2007年深圳市福田区实施全球基金流动人口结核病防治项目以来,通过创立＂首诊医生健康教育-确诊后主管医生和督导员共同督导并健康教育-治疗过程中三级督导员健康教育＂的模式,对辖区流动人口结核病人进行健康促进;客观系统记录＂2005-2006年＂与＂2007-2008年＂两阶段的流动人口结核病人的就诊及治疗情况,分析健康促进前后流动人口结核病人在转诊到位率、痰菌阴转率及治疗依从性等方面进行系统比较。结果通过将健康教育工作放在首位及加强督导管理,病人治疗依从性明显提高,流动人口肺结核病人的到位率及初治病人的治愈率、痰菌阴转率等有所提高并保持在较高水平,迁出率逐年下降。结论健康促进在针对流动人口肺结核病患者DOTS实施中起着积极的作用,保证了DOTS策略的有效实施,提高了结核病的治疗效果及管理效果。     

STD/STI患者艾滋病防治健康教育效果比较

目的了解极高危人群STD/STI患者对艾滋病相关知识的掌握情况,评价艾滋病宣传教育的效果,探讨艾滋病宣传教育工作所能发挥的作用,为艾滋病防控提供理论依据。方法采用横断面调查、追踪调查相结合的方式,分析STD/STI患者干预前后艾滋病相关知识知晓率及其行为和态度的改变情况。结果干预后调查对象对艾滋病的含义、传播途径及预防措施有了更加正确的认识(P均<0.01),78.9%的人对安全套的使用形成正确认识(P<0.01),62.7%的人认为对艾滋病患者或艾滋病毒感染者应持关心的态度(P<0.01)。结论正确的干预活动可提高极高危人群STD/STI患者对艾滋病防治措施的认识及自我保护意识,从而降低艾滋病的发病率。     

HIV Knowledge Among Canadian-Born and Sub-Saharan African-Born Patients Living with HIV

Research has revealed differences on scales measuring HIV knowledge between individuals from various ethnic backgrounds and cultures. Few studies have examined this knowledge with immigrant populations and persons living with HIV. This study examined HIV knowledge among persons living with HIV who were either born in Canada or in sub-Saharan Africa and, for comparison, in a sample of college students. All participants were residing in Canada. Participants completed questionnaires measuring demographic variables, sexual health behaviour, and HIV status, treatment, and knowledge. Canadian-born patients living with HIV were more likely to be older and male than the other groups. On average, patients living with HIV were diagnosed 6.4 years ago, and 80% reported having current or previous experience taking HIV medications. After adjusting for age and gender, significant differences were found between the groups on the Brief HIV Knowledge Questionnaire. Canadian-born persons living with HIV (n = 110) scored higher than sub-Saharan African-born patients (n = 23) and college students (n = 81); mean percentage correct was 86, 70, and 62%, respectively (P < .01). These results suggested that ongoing HIV education is needed for all groups, and that additional tailored and targeted educational interventions are needed to address important gaps in knowledge among persons living with HIV patients originating from Africa and among college students.     

云南省3县TB/HIV患者结核病知识知晓率及影响因素分析

目的分析云南省TB/HIV患者的流行特征和结核病知识知晓率及其影响因素,为进一步加强云南省结核病健康促进和健康教育工作提供理论依据。方法对2010年1月—2012年6月期间218名TB/HIV患者进行结核病知识知晓率的问卷调查。统计分析采用单因素分析和Logistic回归分析。结果调查对象结核病知识综合得分为（8.23±2.01）分。职业（χ2=22.515）、婚姻状况（χ2=50.110）、患者来源（χ2=6.378）、住院治疗（χ2=3.915）、管理方式（χ2=4.579）及抗病毒治疗（χ2=11.342）各组间差异均有统计学意义（P均〈0.05）。Logistic回归分析显示,影响结核病知识综合得分的因素有患者来源（Waldχ2=6.277,P=0.02）和抗病毒治疗（Waldχ2=10.678,P〈0.001）。结论云南省TB/HIV患者结核病核心信息总知晓率为82.29%,高于全国结核病防治知识80%的目标。应根据不同地区、不同人群的特点,针对性的制作各种不同的宣传材料,积极宣传结核病的防治知识。     

2008年太原市肺结核病例拒绝免费治疗情况调查

[目的]了解太原市肺结核患者拒绝免费治疗情况及原因,为进一步规范结核病管理工作提供依据。[方法]2009年2月,对太原市拒绝免费治疗的378例病人进行问卷调查。[结果]调查的378例拒绝免费治疗肺结核患者中,初中以下文化程度占44.44%;农民(农民工)占24.07%,工人占21.69%;涂阳病例占38.89%;初诊单位在综合医院的占66.67%;确诊单位在综合医院、结核病专科医院、结核病防治机构的分别占32.01%、50.27%、17.73%。有367例接受治疗,其中在结核病专科医院治疗的占65.40%,在综合医院治疗的占28.89%;医生嘱咐治疗时间不统一,不知道停药时间的占14.17%。拒绝免费治疗的原因主要是比较信任专科医院(占44.69%),听医生说免费药品不好(占29.43%)。[结论]太原市肺结核患者拒绝免费治疗者所占比例较高,主要原因是比较信任专科医院、听医生说免费药品不好。今后需加强对结核病免费治疗政策的宣传力度。     

湖南省TB/HIV双感患者治疗依从性调查及影响因素分析

目的 了解湖南省双感患者治疗依从性及影响因素,探讨提高双感患者治疗依从性方法. 方法 采用问卷调查的方法,对2011年9月-2012年12月期间全省161例双感患者进行调查,分析患者的性别、年龄、职业等因素对依从性的影响. 结果 双感患者的依从性为80.1％,单因素分析显示,依从性的影响因素为民族（P=0.047）、文化程度（P=0.034）、年龄（t=-2.543,P=0.012）、家庭人口数（t=-2.260,P=0.025）、家庭年人均收入（t=2.258,P=0.025）、居住地到抗结核治疗机构距离（t=-2.672,P=0.008）;多因素分析结果显示,年龄大（OR=1.037）、居住地到抗结核治疗机构距离远（OR=1.020）是影响依从性的危险因素. 结论 要增加双感患者治疗依从性,应重视患者的健康教育,适当为贫困患者适当提供补助.     

Institutional factors and HIV/AIDS, TB and Malaria

This paper outlines the principal institutional factors affecting the slow progress in reaching agreed targets in Africa regarding the prevention and control of HIV/AIDS, TB and Malaria. It focuses on three key factors: political analysis, strategic business approach and international inputs.Most of the analyses tend to look at the technical aspects of disease prevention and control, of political analysis there is a marked absence. Yet, we know that wider contextual or macro factors such as power and political decision making can make or break a programme.Many senior managers in public sector institutions are preoccupied with day-to-day work. Successful businesses in the private sector have some things in common with each other. Outstanding leadership, a strategic and action orientated culture, highly focused on comparative strengths on priorities and quality being some of the key ones. Adopting such successful business characteristics might make the difference to public institutions.The move to results based institutions by focussing on outputs and outcomes is for the better. However, we still need to rigorously examine the quality of inputs that the increasing availability of funds is being used on. This is especially so in relation to needing a better balance between aid for health services and that for institutional and health systems development. In addition, technical advisers from development partners need to work more across a ministry of health on institutional and management change to have a greater impact on achieving targets.     

Variations in Self-Rated Health Among Patients with HIV Infection

Purpose:To assess how patients with HIV who are enrolled in a clinical trials cohort rate their health and to compare their ratings with those of patients with HIV from 2 other cohorts: the HIV Cost and Services Utilization Study (HCSUS), and Adult AIDS Clinical Trials Group protocol 320 (ACTG 320). Methods: We analyzed baseline information for the 1649 subjects enrolled in the Adult AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT) study prior to March 2002 who had self-rated health data available. We compared those results with results from 2 other groups: HCSUS, the only nationally representative sample of people in care for HIV in the U.S., which conducted baseline interviews in 1996 and 1997, and ACTG 320, a randomized, double-blinded, placebo-controlled trial comparing a 3-drug antiretroviral regimen with a 2-drug combination, which enrolled subjects in the same general time frame as HCSUS. We used t tests, Pearson correlations, and linear regression to determine factors associated with self-rated health and z scores to compare results between cohorts. Results: The mean (SD) rating scale value on a 0–100 scale for ALLRT participants was 79.8 (16.8). Values were significantly lower for subjects who were older, had a history of injection drug use, had lower CD4 cell counts, or were beginning salvage antiretroviral therapy. Subjects in ALLRT reported significantly better self-rated health at baseline than those in HCSUS or ACTG 320 (11–12% higher rating scale values in ALLRT; p<0.05). When cohort differences were accounted for through regression and stratification, the differences in scores between subjects in ALLRT and HCSUS increased and the differences in scores between subjects in ALLRT and ACTG 320 diminished. Conclusions: Self-rated health varied significantly by age, CD4 count, injection drug use history, and salvage therapy status. Differences in self-rated health for clinical trials and non-clinical trials samples appear to be substantial and should be considered when applying trial results to clinical populations.     

江西省部分地区结核病患者吸烟状况调查

目的了解江西省部分地区结核病患者吸烟情况及戒烟意愿,为今后对结核病患者进行戒烟干预提供信息。方法对江西省部分地区2011年3月1日—8月31日间就诊并被确诊为结核病的所有患者进行问卷调查。结果 800名结核病患者中,总吸烟率为45.90%,男性、女性吸烟率分别为62.40%和0;367名结核病吸烟患者中,平均开始吸烟年龄为(19.8±6.2)岁,平均每天吸烟为(22.3±11.5)支;57.49%的吸烟患者有烟瘾;戒烟成功者占27.25%;46.05%的吸烟患者以前戒过烟;63.49%的吸烟患者表示愿意从现在开始戒烟。结论江西省部分地区肺结核病患者吸烟情况比较严重,需进一步加强对肺结核病患者进行烟草危害知识的健康教育。