天津市男男性行为人群随访干预的效果评价

目的 评价天津市MSM人群随访干预效果，为后续研究的开展提供参考依据。方法 2013年4月至2017年9月，在天津市通过MSM活动场所和移动互联网招募MSM，建立前瞻性开放队列，并每6个月施加随访干预，评价随访干预效果。结果 基线共招募MSM 1 822人，符合纳入标准1 007人，累积随访干预时间为2 216.96人年，HIV共阳转39例，HIV阳转密度为1.76/100人年。梅毒阴性934人，累计随访观察时间为1 959.94人年，梅毒阳转100例，梅毒阳转密度为5.10/100人年。艾滋病知识知晓率随着宣传和干预活动很快发生改善；与同性性伴、同性固定性伴、同性临时性伴发生肛交的比例在干预后增加，但肛交安全套的使用率也有所增加；随访干预超过3次后安全套使用率有所下降。广义估计方程（GEE）分析结果显示，大专及以上文化程度（aOR=0.81，95% CI：0.68～0.98），艾滋病知识知晓（aOR=0.52，95% CI：0.36～0.75），最近6个月曾接受过安全套宣传（aOR=0.60，95% CI：0.49～0.74），样本来源为移动互联网（aOR=0.85，95% CI：0.73～1.00），累计干预1次（aOR=0.55，95% CI：0.45～0.66）、2次（aOR=0.38，95% CI：0.30～0.49）、3次（aOR=0.26，95% CI：0.20～0.35）、≥4次（aOR=0.24，95% CI：0.17～0.33）是无保护肛交的保护因素；最近6个月曾被诊断为性病（aOR=1.43，95% CI：1.06～1.96），最近6个月使用过助性剂（aOR=1.22，95% CI：1.02～1.47）是无保护肛交的危险因素。结论 经过随访干预后，天津市MSM队列HIV和梅毒感染处于低水平；艾滋病知识知晓率发生改善，肛交安全套使用率有所提升；但MSM人群发生无保护肛交的影响因素很多，建议专门开展MSM人群无保护肛交的持续干预。

Evaluation on follow-up intervention program in men who have sex with men in Tianjin

Objective To evaluate the behavior intervention program on men who have sex with men (MSM) in Tianjin. Methods From April 2013 to September 2017, MSM were enrolled from MSM gathering places and through mobile internet to establish an open prospective cohort. Interventions were conducted in every follow-up meeting, while the changes of behaviors and HIV infection and syphilis incidences in the MSM before and after intervention were compared. Results A total of 1 822 MSM were interviewed at baseline survey, with 1 007 eligible MSM were enrolled in the cohort. A total of 39 new cases of HIV infection were reported, and the cumulative observation time on cohort follow-up was 2 216.96 person-year, with the HIV incidence rate as 1.76 per 100 person-years. Among them, 934 MSM were sero-negative for syphilis in baseline survey. A total of 100 new cases of syphilis were reported, and the cumulative observation time of cohort follow-up was 1 959.94 person-year, the syphilis incidence rate was 5.10 per 100 person-years. With health education and intervention conducted, the awareness rate of AIDS related knowledge for MSM increased. Though the rate of anal sex increased after intervention, the rate of condom use in anal sex increased, too. The rate of condom use decreased after receiving more than 3 interventions. Data from the multivariate GEE analysis indicated that protective factors might be as follows:education level of college and above (aOR=0.81, 95% CI:0.68-0.98), awareness of AIDS related knowledge (aOR=0.52, 95% CI:0.36-0.75), ever receiving condom promotion and distribution in the past six months (aOR=0.60, 95% CI:0.49-0.74), being recruited from mobile internet (aOR=0.85, 95% CI:0.73-1.00) and times of cumulative intervention:one time (aOR=0.55, 95% CI:0.45-0.66), two times (aOR=0.38, 95% CI:0.30-0.49), three times (aOR=0.26, 95% CI:0.20-0.35), four times and above (aOR=0.24, 95% CI:0.17-0.33). Diagnoses of STDs in the past six months (aOR=1.43, 95% CI:1.06-1.96), using rush-poppers (aOR=1.22, 95% CI:1.02-1.47) might be risk factors. Conclusions After continuous behavior intervention, the incidence of HIV infection and syphilis were at a low level in the MSM cohort in Tianjin. Their awareness rate of AIDS related knowledge and the rate of condom use increased. But there are still many risk factors influencing the unprotected anal sex in MSM. We should continuously carry out behavioral intervention programs to prevent unprotected anal sex among MSM.