南京市2011-2015年新报告艾滋病病毒感染者/艾滋病病人的晚发现率及其影响因素分析

目的 分析南京市2011-2015年新报告的艾滋病病毒（human immunodeficiency virus，HIV）感染者/艾滋病（acquired immune deficiency syndrome，AIDS）病人晚发现率及其影响因素。方法 从艾滋病综合防治信息系统中选取南京市2011-2015年新报告的HIV/AIDS，采用趋势χ2检验分析晚发现率变化趋势，采用Logistic回归模型进行晚发现影响因素分析。结果 南京市2011-2015年新报告HIV/AIDS的晚发现率依次为32.0%、30.5%、32.5%、29.6%和30.9%，未呈现明显的下降趋势（χ_趋势2=0.255，P=0.614）。检测咨询发现的病例晚发现率由2011年的14.0%上升至2015年的21.4%，医疗机构发现的病例晚发现率由2011年的53.4%下降至2015年的47.4%，经趋势χ2检验差异均有统计学意义（均有P<0.05）。多因素Logistic回归分析结果显示，>64岁年龄组（aOR=4.563，95%CI=2.502~8.320）、已婚有配偶（aOR=1.628，95%CI=1.306~2.028）、非本市现住址（aOR=2.041，95%CI=1.683~2.475）、经异性传播（aOR=1.279，95%CI=1.040~1.572）和医疗机构来源（aOR=2.791，95%CI=2.280~3.416）的病例晚发现率较高。结论 南京市2011-2015年新报告HIV/AIDS的晚发现率维持在较高水平，应继续推进各级医疗机构全面开展医务人员主动提供艾滋病检测咨询服务（provider initiated HIV testing and counseling，PITC），同时扩大对重点人群宣传教育和检测动员，促进HIV感染者的早期发现。

Analysis on the influencing factors of late diagnosis of newly identified HIV/AIDS cases in Nanjing from 2011 to 2015

Objective To analyze the late diagnosis (LD) status and its influencing factors of newly reported HIV/AIDS cases in Nanjing from 2011 to 2015. Methods Newly identified HIV/AIDS in Nanjing from 2011 to 2015 were selected from the National HIV/AIDS comprehensive information system. Chi-square test was used for trend analysis on LD rate and multivariate Logistic regression was conducted to test the factors associated with LD. Results From 2011 to 2015, the prevalence of LD were 32.0%, 30.5%, 32.5%, 29.6% and 30.9%, without a decreasing trend(χ2=0.255, P=0.614). The LD rate among cases found by voluntary counseling and testing increased significantly from 14.0% in 2011 to 21.4% in 2015 and the LD rate among cases found from medical institution decreased significantly from 53.4% to 47.4% in the same period. Multiple Logistic regression analysis indicated that those who were married (aOR=1.628,95% CI:1.306-2.028), aged over 64 (aOR=4.563,95% CI:2.502-8.320), didn't live in Nanjing(aOR=2.041,95% CI:1.683-2.475), infected via heterosexual transmission(aOR=1.279,95% CI:1.040-1.572), found from medical institutions (aOR=2.791,95% CI:2.280-3.416) were more likely to be diagnosed lately. Conclusions Given a high prevalence of LD among newly reported HIV/AIDS in Nanjing from 2011 to 2015, more efforts are urgently needed to promote medical institutions to carry out PITC, as well as expand HIV counseling and testing targeted key populations, so as to promote the early detection of HIV.