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Stephen W. Pan Yuhua Ruan Patricia M. Spittal Margo E. Pearce Han-zhu Qian Dongliang Li 《AIDS care》2014,26(6):742-749
Few studies have examined coercive sex and HIV vulnerabilities among men who have sex with men (MSM) in China. The present study seeks to compare individual characteristics between MSM who did and did not experience coercive sex at their MSM sexual debut and to identify HIV risk factors correlated with coercive sex at MSM sexual debut. In 2007, we recruited 167 MSM in Beijing, China by peer-referred social network sampling. Each participant then completed self-administered questionnaires regarding their sexual experiences and practices. Results show that 14% of participants reported coercive sex at MSM sexual debut, of whom 48% reported recent unprotected anal intercourse (UAI). Coercive sex at MSM sexual debut was significantly associated with UAI [adjusted odds ratio (AOR): 5.38, 95% confidence interval: 1.95–14.87] and lifetime number of male sex partners (AOR: 7.25, 95% CI: 2.39–22.01). Coercive sex is harming MSM in China and should be immediately addressed by researchers, public health officials, and MSM community stakeholders. 相似文献
33.
Ram K. Shrestha Stephanie L. Sansom Benjamin T. Laffoon Paul G. Farnham R. Luke Shouse Karen MacMaster H. Irene Hall 《Public health reports (Washington, D.C. : 1974)》2014,129(6):496-504
Objectives
HIV case surveillance is a primary source of information for monitoring HIV burden in the United States and guiding the allocation of prevention and treatment funds. While the number of people living with HIV and the need for surveillance data have increased, little is known about the cost of surveillance. We estimated the economic cost to health departments of conducting high-quality HIV case surveillance.Methods
We collected primary data on the unit cost and quantity of resources used to operate the HIV case surveillance program in Michigan, where HIV burden (i.e., the number of HIV cases) is moderate to high (n=14,864 cases). Based on Michigan''s data, we projected the expected annual HIV surveillance cost for U.S., state, local, and territorial health departments. We based our cost projection on the variation in the number of new and established cases, area-specific wages, and potential economies of scale.Results
We estimated the annual total HIV surveillance cost to the Michigan health department to be $1,286,524 ($87/case), the annual total cost of new cases to be $108,657 ($133/case), and the annual total cost of established cases to be $1,177,867 ($84/case). Our projected median annual HIV surveillance cost per health department ranged from $210,600 in low-HIV burden sites to $1,835,000 in high-HIV burden sites.Conclusions
Our analysis shows that a systematic approach to costing HIV surveillance at the health department level is feasible. For HIV surveillance, a substantial portion of total surveillance costs is attributable to maintaining established cases.An estimated 1.2 million people aged 13 years and older are living with human immunodeficiency virus (HIV) in the United States, and about 47,500 people are infected with the virus each year.1,2 A recent HIV surveillance report shows that the number of people living with HIV increased by 8% from 2006 through 2009.3 The U.S. Centers for Disease Control and Prevention (CDC) has developed an HIV surveillance system for collecting, analyzing, and disseminating accurate information on the number of people with new HIV diagnoses (new cases) and those living with HIV infection (established cases).4,5 Access to timely and high-quality surveillance data is essential to detect trends in the HIV burden and develop appropriate prevention and control measures.4,6,7 The U.S. Department of Health and Human Services has closely aligned the $16 billion it spent in 2010 on HIV care, treatment, and prevention with the number of reported HIV cases in each state.8 HIV case surveillance additionally guides the implementation of test-and-treat prevention strategies that require data on timing of diagnosis, entry into and retention in care, and viral load (VL) suppression.8–10 The Institute of Medicine recently identified HIV case surveillance as one of the data collection systems that could be used to monitor progress in achieving National HIV/AIDS Strategy goals.11,12The purpose of this analysis was to estimate the economic cost to health departments to conduct high-quality HIV case surveillance, where high quality is defined as meeting or exceeding CDC data quality standards regarding the completeness and timeliness of reporting diagnosed HIV cases and ascertaining duplicate cases and deaths.6,7 We examined potential variation in costs across health departments based on differences in the number of new vs. established HIV cases, area-specific wages, and potential economies of scale. Results from the analysis could help inform surveillance funding allocation across health departments and enable health departments to more accurately assess their own costs attributable to new and established HIV cases. 相似文献34.
《Academic pediatrics》2014,14(5):517-525
BackgroundEducation in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience.MethodsWe conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey.ResultsStudy participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing “QI Basics.”ConclusionsOnline educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study. 相似文献
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目的了解艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(HIV/AIDS病人)告知随访管理,对相关服务可及性的影响,为艾滋病防治策略提供依据。方法选择4个县,每县将50例自2008年进入管理并一直随访的〉15岁的HIV/AIDS病人作为管理组,以50例2011年检测发现并至少接受过一次随访的〉15岁HIV/AIDS病人作为对照组。通过"艾滋病综合防治信息系统"网路直报数据,对2006-2010年云南省接受相关服务的HIV/AIDS病人的数据进行分析,以P〈0.05为差异有统计学意义。结果共调查403人,其中对照组203人,管理组200人。对照组过去6个月获得AIDS咨询70.0%(142人)、免费安全套42.4%(86人)、民政救助5.4%(11人)、结核病筛查50.7%(103人)、抗病毒治疗12.8%(26人)、美沙酮维持治疗0.5%(1人)。与对照组相比,管理组过去6个月获得AIDS咨询100%(200人)(P〈0.05)、免费安全套69.5%(139人)[比值比(OR)=3.1,95%可信区间(CI):2.0527~4.671,P〈0.05]、民政救助65.0%(130人)(OR=32.416,95%CI:16.529~63.573,P〈0.05)、结核病筛查81.5%(163人)(OR=4.277,95%CI:2.725~6.712,P〈0.05)、抗病毒治疗60.0%(120人)(OR=10.212,95%CI:6.197~16.827,P〈0.05)、美沙酮维持治疗44.0%(88人)(OR=158.714,95%CI:21.814~1154.766,P〈0.05),均高于对照组,差异有统计学意义。2006-2010年,云南省获得CD4T淋巴细胞计数检测、配偶HIV抗体检测、抗病毒治疗和转介、母婴阻断转介和治疗、美沙酮维持治疗服务的HIV/AIDS病人均呈逐年大幅上升。结论综合管理工作促进HIV/AIDS病人获得相关服务,符合HIV/AIDS病人需求,对艾滋病防控起了重要作用 相似文献
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BackgroundIn China, western blot (WB) is the recommended procedure for the diagnosis of HIV infection. However, this technique is time consuming and labor intensive, and its complexity restricts wide application in resource-limited regions.ObjectiveThe aim of this study was to evaluate the efficacy of a dry blood spots (DBS)–urine paired enzyme-linked immunosorbent assay (ELISA) test, instead of WB, for HIV antibody detection.Study designPlasma, DBS, and urine samples were collected from 1213 subjects from different populations. Two diagnostic testing strategies were conducted in parallel. The equivalence of the paired ELISA and WB strategies was assessed.ResultsA diagnosis of HIV was determined in 250 subjects according to the paired ELISA test, and in 249 according to the WB strategy. The discordant case was judged HIV-positive during follow-up. In total, 18 subjects were diagnosed with possible HIV using the paired ELISA test, among whom, 11 subjects tested negative with WB, and one was confirmed to be HIV-positive during follow-up. For the remaining 945 subjects, both strategies indicated a negative result. The kappa test indicated good conformity (kappa = 0.954) between the two diagnostic strategies.ConclusionThe DBS–urine paired ELISA could be applied as an alternative to WB in HIV diagnosis, which would be valuable in resource-limited regions owing to the associated affordability and ease of use. 相似文献
39.
Deborah Cragun Rheanna N. Ata Rita D. DeBate J. Kevin Thompson 《Journal of nutrition education and behavior》2013,45(5):450-454
ObjectiveTo examine gender differences in unhealthy weight-control behaviors (UWCB) and identify key psychosocial and demographic correlates of UWCB among sixth-graders.MethodsA cross-sectional survey was completed by 146 boys and 153 girls at a middle school. Secondary data analyses included bivariate tests and multivariable logistic regression.ResultsForty-seven percent of participants reported 1 or more UWCB, with no differences by gender (P = .75). Factors common to boys and girls included: lower global self-esteem; lower body-esteem; and greater negative parental modeling among participants who engaged in UWCB compared to those who did not. However, multivariable models revealed gender differences. Among boys, body mass index, negative parental modeling, and global self-esteem retained statistically significant associations with UWCB after controlling for other variables in the model, whereas race and weight-related body-esteem remained significant for girls.Conclusions and ImplicationsThis research highlights the need for gender-specific UWCB prevention programs implemented in late childhood and early adolescence. 相似文献
40.