2016-2020年湖南省新报告成年HIV/AIDS病例抗病毒治疗及时性及影响因素分析

目的 分析2016-2020年湖南省新报告的成年HIV/AIDS病例及时入组抗病毒治疗的情况,了解湖南省实现“发现即治疗”工作实施情况,探索影响工作开展的相关因素。方法 对2016-2021年1月中国疾病预防控制中心艾滋病防治基本信息系统的湖南省随访管理数据和抗病毒治疗管理数据进行分析,了解不同年份间抗病毒治疗及时情况及可能的影响因素。结果 31 635例新报告成年HIV/AIDS病例中,男女比例3.54∶1;中位年龄48(33,60)岁,未婚/离异占54.17%,农民占55.11%,异性性传播占77.31%。2016-2020年总体及时入组抗病毒治疗率为61.85%,入组治疗中位时间20 d,及时治疗率从2016年的51.65%上升到2020年67.91%(χ^(2)_(趋势)=550.060,P<0.001)。女性(OR=1.228,95%CI:1.150~1.311)、检测咨询来源病例(OR=1.169,95%CI:1.104~1.237)更易及时治疗;婚姻状况未婚(OR=0.792,95%CI:0.749~0.837)、职业为工人(OR=0.765,95%CI:0.680~0.860)、商业服务(OR=0.828,95%CI:0.749~0.916)、外省户籍(OR=0.604,95%CI:0.528~0.691)、注射毒品(OR=0.487,95%CI:0.357~0.664)、羁押人员检测(OR=0.165,95%CI:0.127~0.214)及其他来源(OR=0.732,95%CI:0.647~0.829)、CD4^(+)T淋巴细胞检测不及时(OR=0.201,95%CI:0.190~0.212)、首次CD4细胞计数越高者(OR_(≥500)=0.613,95%CI:0.566~0.663)更不易及时治疗。结论 湖南省抗病毒治疗工作有进步,但治疗及时性仍需提高。应加强对男性、单身、流动人员、吸毒人员及羁押人员落实管理,开展有针对性的治疗动员及转介;做好检测前后宣传咨询,及时开展随访工作,避免失访,优化随访与治疗转介模式,提高抗病毒治疗及时性。

Timeliness of antiretroviral therapy initiation and its influencing factors among newly reported HIV/AIDS adult cases in Hunan Province, 2016-2020

Objective To analyze the timeliness of antiretroviral therapy initiation among newly reported HIV/AIDS adult cases in Hunan Province from 2016 to 2020, to investigate the status of implementation of Treat All Policies in Hunan Province, and to explore the relevant factors affecting the work. Methods We analyzed the follow-up management data and antiviral treatment management data of Hunan Province from 2016 to January 2021 from the Basic Information System for HIV/AIDS Prevention and Control of Chinese Center for Disease Control and Prevention. The timely initiation of antiretroviral therapy in different years and the possible influencing factors were surveyed. Results Among 31,635 newly reported HIV/AIDS adult cases, the sex ratio was 3.54:1, and the median age 48 (33, 60) years old. The unmarried/divorced, farmers and heterosexual transmission accounted for 54.17%, 55.11% and 77.31%, respectively. The overall rate of timely initiation of antiretroviral therapy in 2016-2020 was 61.85%, and the median enrollment time 20 days. The timely treatment rate increased from 51.65% in 2016 to 67.91% in 2020 (χ²_trend=550.060, P<0.001). Female (OR=1.228, 95%CI:1.150-1.311) and detection and consultation cases (OR=1.169, 95%CI:1.104-1.237) were easier to initiate antiretroviral therapy in time. The unmarried (OR=0.792, 95%CI:0.749-0.837), workers (OR=0.765, 95%CI:0.680-0.860), commercial service persons (OR=0.828, 95%CI:0.749-0.916),residents with a household registration in other provinces (OR=0.604, 95%CI:0.528-0.691), injecting drug users (OR=0.487, 95%CI:0.357-0.664), cases from detection in detainees (OR=0.165, 95%CI:0.127-0.214) or other sources (OR=0.732, 95%CI:0.647-0.829), cases withuntimely detection of CD4⁺T lymphocytes (OR=0.201, 95%CI:0.190-0.212) and cases with a higher level of first CD4 cell count (OR_≥500=0.613, 95%CI:0.566-0.663) were difficult to initiate antiretroviral therapy in time. Conclusion Hunan Province has progressed in implementing Treat All Policies, but the timely initiation of antiretroviral therapy still needs to be improved. It is necessary to strengthen the management, mobilization and referral of targeted treatment for males, the unmarried, floating people, drug addicts and detainees. Publicity and consultation should be done before and after the testing, and follow-up survey should be carried out in time to avoid loss of follow-up. Follow-up and treatment referral mode should be optimized to improve the timely initiation of antiretroviral therapy.