2011—2016年德宏州美沙酮维持治疗者HIV新发感染率及其影响因素
|
摘要
目的了解云南省德宏傣族景颇族自治州(简称德宏州)美沙酮维持治疗(MMT)者在2011—2016年间艾滋病病毒(HIV)新发感染率及其影响因素。方法将德宏州2011—2016年所有入组MMT且HIV检测阴性的海洛因成瘾者纳入队列观察其HIV阳转情况,计算HIV新发感染率并运用COX比例风险回归模型分析其影响因素。结果共有5 048名海洛因成瘾者符合队列纳入标准,截至2016年12月,共有827名(16.4%)入组MMT后从未接受过HIV随访检测,属于"失访",另有4 221人(83.6%)接受过至少一次HIV随访检测,累积随访观察人年11 484.96人年,期间15人发生HIV抗体阳转,HIV新发感染率为1.3/1 000人年。运用COX比例风险模型多因素分析显示,在控制混杂因素的影响后,入组时年龄≥35岁MMT者HIV感染风险显著低于≤24岁年龄组者[调整比值比(aHR)=0.05, 95%可信区间(CI):0.01～0.59],初中及以上文化程度者HIV感染风险显著低于小学及以下者(aHR=0.29, 95%CI:0.09～0.88),入组MMT前有注射吸毒史者HIV感染风险显著高于无注射吸毒史者(aHR=11.07, 95%CI:2.19～55.98)。结论德宏州MMT门诊在减少HIV经吸毒途径传播中成效显著,要继续加强随访和HIV的检测力度,尤其要重点关注年轻、教育程度较低以及入组前有注射毒品行为者。
Objective To determine the incidence and determinants of HIV infection among heroin addicts receiving methadone maintenance treatment(MMT) between 2011 and 2016 in Dehong prefecture of Yunnan province. Methods All heroin addicts who were HIV negative at initiation of MMT in Dehong between 2011 and 2016 were included in the analysis. HIV incidence rate was calculated. Cox proportional hazard regression model was used to explore the factors associated with risks of HIV incidence. Results A total of 5 048 MMT clients were included. 827(16.4%) clients enrolled in MMT who had never received HIV testing at follow-up visits were considered as "dropout from follow-up". The other 4 221(83.6%) clients had received at least one HIV testing at follow-up visits and were observed for a total of 11 484.96 person-years. 15 clients were detected as HIV seroconversion, resulting in an overall HIV incidence of 1.3/1000 person-years. Multivariate analysis showed that age ≥35 years(vs age ≤24)(adjusted hazard ratio[aHR]=0.05, 95% confidence interval[CI]: 0.01-0.59), and at least junior middle education(vs illiterate or primary education)(aHR=0.29, 95%CI: 0.09-0.88) were associated with decreased risks of HIV seroconversion while history of injection drug use(IDU) prior to MMT was associated with increased risks of HIV seroconversion(aHR=11.07, 95%CI: 2.19-55.98). Conclusion MMT program in Dehong prefecture is effective in reducing HIV transmission through drug use. HIV testing program should be strengthened among MMT clients, particularly young MMT clients, those with lower educational level and a history of IDU.
Objective To determine the incidence and determinants of HIV infection among heroin addicts receiving methadone maintenance treatment(MMT) between 2011 and 2016 in Dehong prefecture of Yunnan province. Methods All heroin addicts who were HIV negative at initiation of MMT in Dehong between 2011 and 2016 were included in the analysis. HIV incidence rate was calculated. Cox proportional hazard regression model was used to explore the factors associated with risks of HIV incidence. Results A total of 5 048 MMT clients were included. 827(16.4%) clients enrolled in MMT who had never received HIV testing at follow-up visits were considered as "dropout from follow-up". The other 4 221(83.6%) clients had received at least one HIV testing at follow-up visits and were observed for a total of 11 484.96 person-years. 15 clients were detected as HIV seroconversion, resulting in an overall HIV incidence of 1.3/1000 person-years. Multivariate analysis showed that age ≥35 years(vs age ≤24)(adjusted hazard ratio[aHR]=0.05, 95% confidence interval[CI]: 0.01-0.59), and at least junior middle education(vs illiterate or primary education)(aHR=0.29, 95%CI: 0.09-0.88) were associated with decreased risks of HIV seroconversion while history of injection drug use(IDU) prior to MMT was associated with increased risks of HIV seroconversion(aHR=11.07, 95%CI: 2.19-55.98). Conclusion MMT program in Dehong prefecture is effective in reducing HIV transmission through drug use. HIV testing program should be strengthened among MMT clients, particularly young MMT clients, those with lower educational level and a history of IDU.
引文
[1] 韦莉,张渝婧.柳州市吸毒人群HIV、HCV和梅毒感染状况及影响因素分析[J].中华疾病控制杂志,2015,19(12):1248-1251,1264.
[2] 王常合,庞琳,柔克明,等.我国社区美沙酮维持治疗吸毒人员HIV新发感染研究[J].中国艾滋病性病,2012,18(6):392-395.
[3] 曹晓斌,吴尊友.美沙酮维持治疗预防HIV研究进展[J].中国艾滋病性病,2011,17(2):196-199.
[4] 徐超.美沙酮维持治疗受治者HIV阳转情况及影响因素分析[D].北京:中国疾病预防控制中心,2009.
[5] 段松,杨跃诚,韩晶,等.云南省德宏州美沙酮维持治疗者HIV新发感染率研究[J].中华流行病学杂志,2011,32(12):1227-1231.
[6] 普丽芳,苏迎盈,王桂香,等.云南省开远市美沙酮门诊在治者HIV、HCV感染现状分析[J].中华流行病学杂志,2015,36(8):829-831.
[7] 朵林,刘济,薛皓铭,等.云南省美沙酮门诊受治者接受不同服务对偷吸的影响[J].卫生软科学,2012,26(11):978-980.
[8] 戴继舫,李丽娜,杨玉兰,等.吸毒人员HCV感染危险因素的Logistic回归分析[J].中国社会医学杂志,2013,30(4):244-247.
[9] 刘茵,邹霞,徐勇,等.社区美沙酮维持治疗新入组者HCV感染率变化趋势及危险因素[J].中华疾病控制杂志,2017,21(1):35-39.
[2] 王常合,庞琳,柔克明,等.我国社区美沙酮维持治疗吸毒人员HIV新发感染研究[J].中国艾滋病性病,2012,18(6):392-395.
[3] 曹晓斌,吴尊友.美沙酮维持治疗预防HIV研究进展[J].中国艾滋病性病,2011,17(2):196-199.
[4] 徐超.美沙酮维持治疗受治者HIV阳转情况及影响因素分析[D].北京:中国疾病预防控制中心,2009.
[5] 段松,杨跃诚,韩晶,等.云南省德宏州美沙酮维持治疗者HIV新发感染率研究[J].中华流行病学杂志,2011,32(12):1227-1231.
[6] 普丽芳,苏迎盈,王桂香,等.云南省开远市美沙酮门诊在治者HIV、HCV感染现状分析[J].中华流行病学杂志,2015,36(8):829-831.
[7] 朵林,刘济,薛皓铭,等.云南省美沙酮门诊受治者接受不同服务对偷吸的影响[J].卫生软科学,2012,26(11):978-980.
[8] 戴继舫,李丽娜,杨玉兰,等.吸毒人员HCV感染危险因素的Logistic回归分析[J].中国社会医学杂志,2013,30(4):244-247.
[9] 刘茵,邹霞,徐勇,等.社区美沙酮维持治疗新入组者HCV感染率变化趋势及危险因素[J].中华疾病控制杂志,2017,21(1):35-39.