艾滋病高危人群基数估计方法比较研究
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摘要
背景
艾滋病高危人群被称为隐蔽人群或难以接近的人群，通常是因为①艾滋病高危人群害怕受到歧视，不愿承认其高危行为；②在对艾滋病高危人群进行抽样调查研究的时候，通常难以获得抽样框。这些人群特征使得各国政府无法准确掌握艾滋病高危人群基数，以至于干预工作只能覆盖艾滋病高危人群中的部分个体。鉴于此种情形，联合国艾滋病规划署和世界卫生组织在2003年联合发布了《艾滋病高危人群基数估计方法指南》（所涉及的研究方法有枚举法、捕获再捕获法、提名法和乘数法），并于2010年对该指南进行了更新，在传统方法基础上增加了一种新方法——网络扩大法。该方法由美国人类学家Bernard、Killworth、Johnsen和Robinson等人于1991年提出，之后陆续被美国、乌克兰、摩尔多瓦、哈萨克斯坦、卢旺达、日本、泰国和伊朗用于艾滋病高危人群基数的估计。2011年，Salganik等人校正了网络扩大法中的两个偏倚，此举得到了学术界以及联合国艾滋病规划署和世界卫生组织的肯定，从而将方法升级为广义网络扩大法。同年，Salganik、Mello和Abdo等人首次将该方法与传统方法进行了比较，在巴西估计重度吸毒人群基数时，发现广义网络扩大法与乘数法估计结果相差5倍。尽管，之前就有来自英国和俄罗斯的研究结果表明乘数法存在低估现象。但是，由于缺乏重度吸毒人群基数的金标准，该现象仍有可能是乘数法产生了低估，或广义网络扩大法产生了高估。所以Salganik、Mello和Abdo等人建议进一步对两种方法进行比较研究，因为作为联合国艾滋病规划署和世界卫生组织推荐的两种高危人群基数估计方法，无论是乘数法低估还是广义网络扩大法高估都会影响到两种方法的应用前景，对上述情况进行验证以及对成因进行分析就变得迫在眉睫。本次研究目的在于通过评价和对比乘数法和广义网络扩大法在艾滋病高危人群基数估计中的应用，为两法适用人群的选择、是否满足应用条件的判断以及实际应用提供建设性建议。
方法
以MOOSE指南为准则，对2003年6月1日至2013年6月1日之间在国内利用乘数法估计男男同性恋人群基数的文献进行Meta分析。对PubMed、万方(Wanfang Data)、CNKI (China National Knowledge Infrastructure)、维普(VIPDatabase for Chinese Technical Periodicals)和CBM (Chinese BioMedical LiteratureDatabase)五个数据库进行中英文检索。中文检索词为：“男男同性恋”或“同性恋”、“基数估计”或“人群基数”、“乘数法”和“中国”。英文检索词为：‘men who have sex with men’ OR ‘homosexual’ OR ‘MSM’ AND ‘prevalence’OR ‘size estimation’ OR ‘population size’ AND ‘multiplier method’ AND ‘China’。
以MOOSE指南为准则对2003年6月1日至2013年6月1日之间在国内利用乘数法估计女性性工作者人群基数的文献进行Meta分析。对PubMed、万方、CNKI、维普和CBM五个数据库进行中英文检索。中文检索词为：“女性性工作者”或“暗娼”、“基数估计”或“人群基数”、“乘数法”和“中国”。英文检索词为：‘female sex workers’ OR ‘prostitutes’ OR ‘prostitution’ AND‘prevalence’ OR ‘size estimation’ OR ‘population size’ AND ‘multiplier method’AND ‘China’。
利用广义网络扩大法对太原市区男男同性恋以及女性性工作者人群基数进行估计。以太原市区常住345.49万人口为调查总体，采用二阶段按比例分层整群抽样方案，在20个行业中按比例随机抽取174个一级单位、405个二级单位以及8031个三级单位进行调查。此外，对294名静脉注射吸毒人员、319名男男同性恋以及301名女性性工作者人群进行同伴驱动抽样调查。在本次研究中，随机应答技术将首次与广义网络扩大法相结合以消除应答偏倚。
结果
在国内利用乘数法估计男男同性恋人群基数文献的Meta分析中，剔除5项研究之后（3项重复发表、2项未得到结果），剩下的13项研究（1项英文发表、12项中文发表）来自11个省的13个城市。13项研究乘数法估计的男男同性恋人群基数占其本地15至49岁男性人口比例的中位数(0.486%)低于国家疾病预防控制中心、联合国艾滋病规划署和世界卫生组织联合提出中国平均水平(2%-4%)的4到8倍。
在国内利用乘数法估计女性性工作者人群基数文献的Meta分析中，剔除3项重复发表研究之后，剩下的7项研究（2项英文发表、5项中文发表）来自7个城市。7项研究乘数法估计的女性性工作者人群基数占其本地15至49岁女性人口比例的中位数(2.485%)处于国家平均水平(0.2%-2.6%)区间范围内。
在利用广义网络扩大法对太原市区男男同性恋以及女性性工作者人群基数估计中，总共有8031名一般人群受访者接受了广义网络扩大法的现场调查，应答率96.4%。294名静脉注射吸毒人员、319名男男同性恋以及301名女性性工作者人群接受了同伴驱动抽样调查。太原市男男同性恋人群基数估计的结果为26870人(95%CI:23556,30184)，占太原市15至49岁男性人口的2.927%(95%CI:2.566%,3.288%)，处于国家平均水平(2%-4%)区间范围内。太原市女性性工作者人群基数估计的结果为11787人(95%CI:10767,12808)，占太原市15-49岁女性人口的1.284%(95%CI:1.172%,1.400%)，处于国家平均水平(0.2%-2.6%)区间范围内。
结论
乘数法估计艾滋病高危人群基数的Meta分析以及乘数法的实证研究结果表明，在女性性工作者人群基数估计中，乘数法获得了有效估计，然而，在男男同性恋人群基数估计中，由于难以获取高质量历史数据，乘数法频频出现低估现象，所以该方法并不适合用于男男同性恋人群基数的估计。
广义网络扩大法的实证研究结果表明，在男男同性恋和女性性工作者人群基数估计中，广义网络扩大法均获得了有效估计。由于在男男同性恋人群基数估计中，乘数法频频出现低估现象，所以当具备了高质量的已知人群信息时，应优先选择广义网络扩大法。此外，我们建议应将随机应答技术与广义网络扩大法结合应用。
Objectives
Behavioral interventions are effective strategies for HIV/AIDS prevention and control.However, implementation of such strategies relies heavily on the accurate estimationof the high-risk population size. Populations at high risk for humanimmunodeficiency virus mainly include female sex workers, men who have sex withmen, and injection drug users). These groups are considered as hidden orhard-to-reach populations with two characteristics that create difficulties forestimating population size:1) They tend to hide their true identities from the publicbecause of the stigma; and2) There is no sampling frame used for surveys. However,without reliable estimates of the size of these at-risk populations, the ability ofgovernments to carry out intervention planning, resource allocation, estimate thenumber of people infected with HIV, project disease burden, measure coverage, andevaluate interventions is limited. With these issues in mind, the Joint United NationsProgramme on HIV/AIDS and the World Health Organization released guidelines in2003, which were updated in2010, for estimating the size of populations at high riskfor HIV. The guideline encompasses enumeration methods, capture-recapture method,nomination methods, multiplier method, population surveys and generalized networkscale-up methods. The most important advantage of the multiplier method is that it ismuch more straightforward to use. However, studies of the multiplier method used toestimate the population prevalence of men who have sex with men in China publishedbetween July1,2003and July1,2013were reviewed. The median of studies usingthe multiplier method to estimate the population prevalence of men who have sexwith men in China was4-8times lower than the national level estimate.
The network scale-up method was first proposed by Bernard, Killworth, Johnsen,and Robinson in1991and uses information collected in general population surveys toestimate the size of populations that have a high risk of HIV. The generalized network scale-up method proposed by Salganik et al. based on the network scale-upmethod lies in adjusting information transmission bias with the popularity ratio andinformation transmission rate. The multiplier method and generalized networkscale-up method were used to estimate the number of heavy-drug users in Curitiba,Brazil in2011. However, Salganik et al. found that the estimate yielded by thegeneralized network scale-up method was5times higher than that of the multipliermethod. It is possible that the generalized network scale-up method producedoverestimates or the multiplier method produced underestimates in the absence of agold standard for the number of heavy-drug users. Thus, Salganik et al. recommendedthat additional studies be undertaken to assess these two methods. This study aims toassess and compare the two methods for estimating the size of populations at highrisk for HIV, and to provide practical guidelines and suggestions for implementingthe two methods.
Methods
Studies of the multiplier method used to estimate the population prevalence of menwho have sex with men and female sex workers in China published between July1,2003and July1,2013were reviewed. The MOOSE recommendations were used toconduct the reviews. Five electronic databases were searched in Chinese and English:PubMed, Wanfang Data, China National Knowledge Infrastructure, VIP Database forChinese Technical Periodicals, and Chinese BioMedical Literature Database.
A survey of the general population using stratified two-stage cluster samplingwas conducted in the urban district of Taiyuan. For the first stage,174primary units(institutions/organizations/companies/governments) from all20industries wereselected from the sampling frame, with the probability of selection being proportionalto industry size. For the second stage,405second-stage units (departments) weredrawn from those chosen in the first stage wherein8,031third-stage units(respondents) aged18and above were interviewed and randomized responsetechnique was applied to eliminate response bias. A national-level estimate proposedby the National Center for AIDS and Sexually Transmitted Disease Control andPrevention in collaboration with UNAIDS/WHO in2007was selected as a reference to assess these two results.
Results
After the removal of5studies (3duplicate publications and2studies did not obtainappropriate data),13studies (1in English and12in Chinese) were from13cities.The estimated MSM population prevalence of the adult male population of the13cities were0.066%,0.249%,0.486%,1.220%, and6.884%for the minimum,25thpercentile, median,75th percentile, and maximum, respectively. The median (0.486%)of the13cities was4-8times lower than the national-level estimate (2.0-4.0%).
After the removal of3duplicate studies,7studies remained (2in English and5in Chinese) that originated from7cities. The estimated FSW prevalence of the adultfemale population (aged15-49) of the7cities was0.777%,1.766%,2.485%,3.600%and4.365%for the minimum,25th percentile, median,75th percentile, and maximum,respectively. The median (2.485%) of the7cities fell within the range ofnational-level estimate (0.2-2.6%).
The generalized network scale-up method allowed us to estimate the number ofMSM in Taiyuan as being26,870(95%CI:23,556,30,184), which corresponds to2.927%(95%CI:2.566%,3.288%) of the adult male population (aged15-49). Theestimates of generalized network scale-up method fall within the range ofnational-level estimate. The generalized network scale-up method allowed us toestimate the number of FSW in the urban district of Taiyuan as being11,787(95%CI:10,767,12,808), corresponding to1.284%(95%CI:1.172%,1.400%) of the femalepopulation aged15-49.
Conclusions
When high-quality existing data are not readily available, the multiplier methodfrequently yields underestimated results. We thus suggest that the generalizednetwork scale-up method is preferred when sampling frames for the generalpopulation and accurate demographic information are available.
艾滋病高危人群被称为隐蔽人群或难以接近的人群，通常是因为①艾滋病高危人群害怕受到歧视，不愿承认其高危行为；②在对艾滋病高危人群进行抽样调查研究的时候，通常难以获得抽样框。这些人群特征使得各国政府无法准确掌握艾滋病高危人群基数，以至于干预工作只能覆盖艾滋病高危人群中的部分个体。鉴于此种情形，联合国艾滋病规划署和世界卫生组织在2003年联合发布了《艾滋病高危人群基数估计方法指南》（所涉及的研究方法有枚举法、捕获再捕获法、提名法和乘数法），并于2010年对该指南进行了更新，在传统方法基础上增加了一种新方法——网络扩大法。该方法由美国人类学家Bernard、Killworth、Johnsen和Robinson等人于1991年提出，之后陆续被美国、乌克兰、摩尔多瓦、哈萨克斯坦、卢旺达、日本、泰国和伊朗用于艾滋病高危人群基数的估计。2011年，Salganik等人校正了网络扩大法中的两个偏倚，此举得到了学术界以及联合国艾滋病规划署和世界卫生组织的肯定，从而将方法升级为广义网络扩大法。同年，Salganik、Mello和Abdo等人首次将该方法与传统方法进行了比较，在巴西估计重度吸毒人群基数时，发现广义网络扩大法与乘数法估计结果相差5倍。尽管，之前就有来自英国和俄罗斯的研究结果表明乘数法存在低估现象。但是，由于缺乏重度吸毒人群基数的金标准，该现象仍有可能是乘数法产生了低估，或广义网络扩大法产生了高估。所以Salganik、Mello和Abdo等人建议进一步对两种方法进行比较研究，因为作为联合国艾滋病规划署和世界卫生组织推荐的两种高危人群基数估计方法，无论是乘数法低估还是广义网络扩大法高估都会影响到两种方法的应用前景，对上述情况进行验证以及对成因进行分析就变得迫在眉睫。本次研究目的在于通过评价和对比乘数法和广义网络扩大法在艾滋病高危人群基数估计中的应用，为两法适用人群的选择、是否满足应用条件的判断以及实际应用提供建设性建议。
方法
以MOOSE指南为准则，对2003年6月1日至2013年6月1日之间在国内利用乘数法估计男男同性恋人群基数的文献进行Meta分析。对PubMed、万方(Wanfang Data)、CNKI (China National Knowledge Infrastructure)、维普(VIPDatabase for Chinese Technical Periodicals)和CBM (Chinese BioMedical LiteratureDatabase)五个数据库进行中英文检索。中文检索词为：“男男同性恋”或“同性恋”、“基数估计”或“人群基数”、“乘数法”和“中国”。英文检索词为：‘men who have sex with men’ OR ‘homosexual’ OR ‘MSM’ AND ‘prevalence’OR ‘size estimation’ OR ‘population size’ AND ‘multiplier method’ AND ‘China’。
以MOOSE指南为准则对2003年6月1日至2013年6月1日之间在国内利用乘数法估计女性性工作者人群基数的文献进行Meta分析。对PubMed、万方、CNKI、维普和CBM五个数据库进行中英文检索。中文检索词为：“女性性工作者”或“暗娼”、“基数估计”或“人群基数”、“乘数法”和“中国”。英文检索词为：‘female sex workers’ OR ‘prostitutes’ OR ‘prostitution’ AND‘prevalence’ OR ‘size estimation’ OR ‘population size’ AND ‘multiplier method’AND ‘China’。
利用广义网络扩大法对太原市区男男同性恋以及女性性工作者人群基数进行估计。以太原市区常住345.49万人口为调查总体，采用二阶段按比例分层整群抽样方案，在20个行业中按比例随机抽取174个一级单位、405个二级单位以及8031个三级单位进行调查。此外，对294名静脉注射吸毒人员、319名男男同性恋以及301名女性性工作者人群进行同伴驱动抽样调查。在本次研究中，随机应答技术将首次与广义网络扩大法相结合以消除应答偏倚。
结果
在国内利用乘数法估计男男同性恋人群基数文献的Meta分析中，剔除5项研究之后（3项重复发表、2项未得到结果），剩下的13项研究（1项英文发表、12项中文发表）来自11个省的13个城市。13项研究乘数法估计的男男同性恋人群基数占其本地15至49岁男性人口比例的中位数(0.486%)低于国家疾病预防控制中心、联合国艾滋病规划署和世界卫生组织联合提出中国平均水平(2%-4%)的4到8倍。
在国内利用乘数法估计女性性工作者人群基数文献的Meta分析中，剔除3项重复发表研究之后，剩下的7项研究（2项英文发表、5项中文发表）来自7个城市。7项研究乘数法估计的女性性工作者人群基数占其本地15至49岁女性人口比例的中位数(2.485%)处于国家平均水平(0.2%-2.6%)区间范围内。
在利用广义网络扩大法对太原市区男男同性恋以及女性性工作者人群基数估计中，总共有8031名一般人群受访者接受了广义网络扩大法的现场调查，应答率96.4%。294名静脉注射吸毒人员、319名男男同性恋以及301名女性性工作者人群接受了同伴驱动抽样调查。太原市男男同性恋人群基数估计的结果为26870人(95%CI:23556,30184)，占太原市15至49岁男性人口的2.927%(95%CI:2.566%,3.288%)，处于国家平均水平(2%-4%)区间范围内。太原市女性性工作者人群基数估计的结果为11787人(95%CI:10767,12808)，占太原市15-49岁女性人口的1.284%(95%CI:1.172%,1.400%)，处于国家平均水平(0.2%-2.6%)区间范围内。
结论
乘数法估计艾滋病高危人群基数的Meta分析以及乘数法的实证研究结果表明，在女性性工作者人群基数估计中，乘数法获得了有效估计，然而，在男男同性恋人群基数估计中，由于难以获取高质量历史数据，乘数法频频出现低估现象，所以该方法并不适合用于男男同性恋人群基数的估计。
广义网络扩大法的实证研究结果表明，在男男同性恋和女性性工作者人群基数估计中，广义网络扩大法均获得了有效估计。由于在男男同性恋人群基数估计中，乘数法频频出现低估现象，所以当具备了高质量的已知人群信息时，应优先选择广义网络扩大法。此外，我们建议应将随机应答技术与广义网络扩大法结合应用。
Objectives
Behavioral interventions are effective strategies for HIV/AIDS prevention and control.However, implementation of such strategies relies heavily on the accurate estimationof the high-risk population size. Populations at high risk for humanimmunodeficiency virus mainly include female sex workers, men who have sex withmen, and injection drug users). These groups are considered as hidden orhard-to-reach populations with two characteristics that create difficulties forestimating population size:1) They tend to hide their true identities from the publicbecause of the stigma; and2) There is no sampling frame used for surveys. However,without reliable estimates of the size of these at-risk populations, the ability ofgovernments to carry out intervention planning, resource allocation, estimate thenumber of people infected with HIV, project disease burden, measure coverage, andevaluate interventions is limited. With these issues in mind, the Joint United NationsProgramme on HIV/AIDS and the World Health Organization released guidelines in2003, which were updated in2010, for estimating the size of populations at high riskfor HIV. The guideline encompasses enumeration methods, capture-recapture method,nomination methods, multiplier method, population surveys and generalized networkscale-up methods. The most important advantage of the multiplier method is that it ismuch more straightforward to use. However, studies of the multiplier method used toestimate the population prevalence of men who have sex with men in China publishedbetween July1,2003and July1,2013were reviewed. The median of studies usingthe multiplier method to estimate the population prevalence of men who have sexwith men in China was4-8times lower than the national level estimate.
The network scale-up method was first proposed by Bernard, Killworth, Johnsen,and Robinson in1991and uses information collected in general population surveys toestimate the size of populations that have a high risk of HIV. The generalized network scale-up method proposed by Salganik et al. based on the network scale-upmethod lies in adjusting information transmission bias with the popularity ratio andinformation transmission rate. The multiplier method and generalized networkscale-up method were used to estimate the number of heavy-drug users in Curitiba,Brazil in2011. However, Salganik et al. found that the estimate yielded by thegeneralized network scale-up method was5times higher than that of the multipliermethod. It is possible that the generalized network scale-up method producedoverestimates or the multiplier method produced underestimates in the absence of agold standard for the number of heavy-drug users. Thus, Salganik et al. recommendedthat additional studies be undertaken to assess these two methods. This study aims toassess and compare the two methods for estimating the size of populations at highrisk for HIV, and to provide practical guidelines and suggestions for implementingthe two methods.
Methods
Studies of the multiplier method used to estimate the population prevalence of menwho have sex with men and female sex workers in China published between July1,2003and July1,2013were reviewed. The MOOSE recommendations were used toconduct the reviews. Five electronic databases were searched in Chinese and English:PubMed, Wanfang Data, China National Knowledge Infrastructure, VIP Database forChinese Technical Periodicals, and Chinese BioMedical Literature Database.
A survey of the general population using stratified two-stage cluster samplingwas conducted in the urban district of Taiyuan. For the first stage,174primary units(institutions/organizations/companies/governments) from all20industries wereselected from the sampling frame, with the probability of selection being proportionalto industry size. For the second stage,405second-stage units (departments) weredrawn from those chosen in the first stage wherein8,031third-stage units(respondents) aged18and above were interviewed and randomized responsetechnique was applied to eliminate response bias. A national-level estimate proposedby the National Center for AIDS and Sexually Transmitted Disease Control andPrevention in collaboration with UNAIDS/WHO in2007was selected as a reference to assess these two results.
Results
After the removal of5studies (3duplicate publications and2studies did not obtainappropriate data),13studies (1in English and12in Chinese) were from13cities.The estimated MSM population prevalence of the adult male population of the13cities were0.066%,0.249%,0.486%,1.220%, and6.884%for the minimum,25thpercentile, median,75th percentile, and maximum, respectively. The median (0.486%)of the13cities was4-8times lower than the national-level estimate (2.0-4.0%).
After the removal of3duplicate studies,7studies remained (2in English and5in Chinese) that originated from7cities. The estimated FSW prevalence of the adultfemale population (aged15-49) of the7cities was0.777%,1.766%,2.485%,3.600%and4.365%for the minimum,25th percentile, median,75th percentile, and maximum,respectively. The median (2.485%) of the7cities fell within the range ofnational-level estimate (0.2-2.6%).
The generalized network scale-up method allowed us to estimate the number ofMSM in Taiyuan as being26,870(95%CI:23,556,30,184), which corresponds to2.927%(95%CI:2.566%,3.288%) of the adult male population (aged15-49). Theestimates of generalized network scale-up method fall within the range ofnational-level estimate. The generalized network scale-up method allowed us toestimate the number of FSW in the urban district of Taiyuan as being11,787(95%CI:10,767,12,808), corresponding to1.284%(95%CI:1.172%,1.400%) of the femalepopulation aged15-49.
Conclusions
When high-quality existing data are not readily available, the multiplier methodfrequently yields underestimated results. We thus suggest that the generalizednetwork scale-up method is preferred when sampling frames for the generalpopulation and accurate demographic information are available.
引文
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[1] Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS report onthe global AIDS epidemic2013. Geneva: UNAIDS.2013
[2] Joint United Nations Programme on HIV/AIDS (UNAIDS), World HealthOrganization. Guidelines on Estimating the Size of Populations most at Risk to HIV.Geneva: UNAIDS, WHO.2010
[3] Family Health International, UNAIDS, WHO. Working Group on GlobalHIV/AIDS Surveillance: Estimating the Size of Populations at Risk for HIV: Issuesand Methods. ARlington: Family Health International (FHI).2003
[4] Heckathorn DD. Respondent-Driven Sampling: A New Approach to the Study ofHidden Populations. Social Problems44:174-199.1997
[5] Hickman M, Hope V, Platt L, et al. Estimating prevalence of injecting drug use: acomparison of multiplier and capture-recapture methods in cities in England andRussia. Drug Alcohol Rev,2006,25(2):131-40
[6] Modified from Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis ofobservational studies in epidemiology: a proposal for reporting. Meta-analysis OfObservational Studies in Epidemiology (MOOSE) group. JAMA,2000,283:2008-12
[7] Luan RS, Zeng G, Zhang DP, et al. A study on methods of estimating thepopulation size of men who have sex with men in Southwest China. European Journalof Epidemiology,2005,20:581-585
[8]王丽艳,夏冬艳,吴玉华,等.乘数法估计北京、哈尔滨两市男性同性恋人群规模的研究.华南预防医学,2006,32(3):9-11
[9]杨介者,潘晓红,杨清,等.艾滋病高危人群基数估计方法在男性同性恋人群规模估计中的应用.中国艾滋病性病,2006,12(6):525-526
[10]宁镇,潘启超,郑晓虹,等.乘数法估计上海市男男性接触者人群规模.中华流行病学杂志,2007,28(9):848-850
[11]徐娟,李翠,张佳慧,等.男男同性恋人群间接规模估计方法的比较研究.医学与社会,2007,20(11):14-15
[12]王成,凌莉,何群,等.应用乘数法估计广州市男性同性恋人群规模.中国艾滋病性病,2009,15(6):592-593
[13]查干花,苗志峰,王丽艳,等.同伴推动抽样法在西部某城市男男性接触者基数估计中的应用.华南预防医学,2009,35(6):20-23
[14]闫红静,唐卫明,张敏,等.乘数法与定性访谈相结合估计江苏省某市MSM人群规模的研究.中国艾滋病性病,2010,16(1):29-32
[15]薛芳辉,孙智霞,林素芳,等.应用乘数法估计某地男性同性恋人群基数的研究.中国初级卫生保健,2010,24(10):67-69
[16]崔巍,张炎,袁海燕.邯郸市男性同性恋人群规模调查估计.实用预防医学,2011,18(12):2418-2419
[17]杨芳,王备,姚璇,等.基于艾滋病高危人群基数估计方法的湖北省荆州市男男性行为人群的比较分析.医学与社会,2012,25(4):4-6
[18] Wang L, Wang N, Wang LY, et al. The2007estimates for people at risk for andliving with HIV in China: progress and challenges. J Acquir Immune Defic Syndr,2009,50:414-418
[19]杨春霞,栾荣生,毛宇嵘,等.乘数法对绵阳市暗娼基数的研究.中国艾滋病性病,2004,10(1):45-47
[20]马烨,吕繁,卢培能,等.应用乘数法估计暗娼规模的方法学研究.疾病控制杂志,2005,9(3):205-08
[21]余爱玲,王丽艳,屠爱霞,等.运用普查法和乘数法对嘉峪关市暗娼人群基数进行估计.中国艾滋病性病,2006,12(6):522-24
[22] Zhang DP, Lv F, Wang LY, et al. Estimating the population of female sexworkers in two Chinese cities on the basis of the HIV/AIDS behavioural surveillanceapproach combined with a multiplier method. Sex Transm Infect,2007,83:228-31
[23]陈琳,冯铁建,谭京广,等.应用乘数法估计深圳市性工作者和吸毒人群规模.中国艾滋病性病,2008,14(1):31-32
[24]胡祥标.应用乘数法估计淮北市暗婚规模.中华疾病控制杂志,2010,14(8):796-97
[25] J Vandepitte, R Lyerla, G Dallabetta, et al. Estimates of the number of femalesex workers in different regions of the world. Sex Transm Infect,2006,82(SupplIII):iii18–iii25
[26]Zhang D, Wang L, Lv F. Advantages and challenges of using census andmultiplier methods to estimate the number of female sex workers in a Chinese city.AIDS Care,2007,19:17-19
[27] Vadivoo S, Gupte M, Adhikary R, et al. Appropriateness and executionchallenges of three formal size estimation methods for high-risk populations in India.AIDS,2008,22(suppl5):S137–S148
[28] Johnston L, Prybylski D, Raymond H, et al. Incorporating the Service MultiplierMethod in Respondent-Driven Sampling Surveys to Estimate the Size of Hidden andHard-to-Reach Populations: Case Studies From Around the World. SexuallyTransmitted Diseases,2013,40:304-310
[29]吕繁，李平，刘刚.乘数法估计四川乐山市中区吸毒人群基数研究.中国药物依赖性杂志,2007,16:41-47
[30]栾荣生，曾亚莉，王斌.应用乘数法估计艾滋病男性高危人群基数.中国公共卫生,2004,20:806-807
[31] Johnston LG, Prybylski D, Raymond HF, et al. Incorporating the ServiceMultiplier Method in Respondent-Driven Sampling Surveys to Estimate the Size ofHidden and Hard-to-Reach Populations: Case Studies From Around the World.Sexually Transmitted Diseases,2013,40:304-310
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[60]包水莲，吴国辉，张维，等.利用网络规模迭加法估计重庆市男男性行为人群规模的研究.中华流行病学杂志，2012,33(10):1036-1040
[61]还锡萍，包水莲，羊海涛，等.利用网络规模迭加法估计泰州市暗娼和嫖客人群规模.中华预防医学杂志，2013,47(3):233-237
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[14]闫红静,唐卫明,张敏,等.乘数法与定性访谈相结合估计江苏省某市MSM人群规模的研究.中国艾滋病性病,2010,16(1):29-32
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[22]吕繁，李平，刘刚.乘数法估计四川乐山市中区吸毒人群基数研究.中国药物依赖性杂志,2007,16:41-47
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[42]包水莲，吴国辉，张维，等.利用网络规模迭加法估计重庆市男男性行为人群规模的研究.中华流行病学杂志，2012,33(10):1036-1040
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[1] Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS report onthe global AIDS epidemic2013. Geneva: UNAIDS.2013
[2] Joint United Nations Programme on HIV/AIDS (UNAIDS), World HealthOrganization. Guidelines on Estimating the Size of Populations most at Risk to HIV.Geneva: UNAIDS, WHO.2010
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[6] Modified from Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis ofobservational studies in epidemiology: a proposal for reporting. Meta-analysis OfObservational Studies in Epidemiology (MOOSE) group. JAMA,2000,283:2008-12
[7] Luan RS, Zeng G, Zhang DP, et al. A study on methods of estimating thepopulation size of men who have sex with men in Southwest China. European Journalof Epidemiology,2005,20:581-585
[8]王丽艳,夏冬艳,吴玉华,等.乘数法估计北京、哈尔滨两市男性同性恋人群规模的研究.华南预防医学,2006,32(3):9-11
[9]杨介者,潘晓红,杨清,等.艾滋病高危人群基数估计方法在男性同性恋人群规模估计中的应用.中国艾滋病性病,2006,12(6):525-526
[10]宁镇,潘启超,郑晓虹,等.乘数法估计上海市男男性接触者人群规模.中华流行病学杂志,2007,28(9):848-850
[11]徐娟,李翠,张佳慧,等.男男同性恋人群间接规模估计方法的比较研究.医学与社会,2007,20(11):14-15
[12]王成,凌莉,何群,等.应用乘数法估计广州市男性同性恋人群规模.中国艾滋病性病,2009,15(6):592-593
[13]查干花,苗志峰,王丽艳,等.同伴推动抽样法在西部某城市男男性接触者基数估计中的应用.华南预防医学,2009,35(6):20-23
[14]闫红静,唐卫明,张敏,等.乘数法与定性访谈相结合估计江苏省某市MSM人群规模的研究.中国艾滋病性病,2010,16(1):29-32
[15]薛芳辉,孙智霞,林素芳,等.应用乘数法估计某地男性同性恋人群基数的研究.中国初级卫生保健,2010,24(10):67-69
[16]崔巍,张炎,袁海燕.邯郸市男性同性恋人群规模调查估计.实用预防医学,2011,18(12):2418-2419
[17]杨芳,王备,姚璇,等.基于艾滋病高危人群基数估计方法的湖北省荆州市男男性行为人群的比较分析.医学与社会,2012,25(4):4-6
[18] Wang L, Wang N, Wang LY, et al. The2007estimates for people at risk for andliving with HIV in China: progress and challenges. J Acquir Immune Defic Syndr,2009,50:414-418
[19]杨春霞,栾荣生,毛宇嵘,等.乘数法对绵阳市暗娼基数的研究.中国艾滋病性病,2004,10(1):45-47
[20]马烨,吕繁,卢培能,等.应用乘数法估计暗娼规模的方法学研究.疾病控制杂志,2005,9(3):205-08
[21]余爱玲,王丽艳,屠爱霞,等.运用普查法和乘数法对嘉峪关市暗娼人群基数进行估计.中国艾滋病性病,2006,12(6):522-24
[22] Zhang DP, Lv F, Wang LY, et al. Estimating the population of female sexworkers in two Chinese cities on the basis of the HIV/AIDS behavioural surveillanceapproach combined with a multiplier method. Sex Transm Infect,2007,83:228-31
[23]陈琳,冯铁建,谭京广,等.应用乘数法估计深圳市性工作者和吸毒人群规模.中国艾滋病性病,2008,14(1):31-32
[24]胡祥标.应用乘数法估计淮北市暗婚规模.中华疾病控制杂志,2010,14(8):796-97
[25] J Vandepitte, R Lyerla, G Dallabetta, et al. Estimates of the number of femalesex workers in different regions of the world. Sex Transm Infect,2006,82(SupplIII):iii18–iii25
[26]Zhang D, Wang L, Lv F. Advantages and challenges of using census andmultiplier methods to estimate the number of female sex workers in a Chinese city.AIDS Care,2007,19:17-19
[27] Vadivoo S, Gupte M, Adhikary R, et al. Appropriateness and executionchallenges of three formal size estimation methods for high-risk populations in India.AIDS,2008,22(suppl5):S137–S148
[28] Johnston L, Prybylski D, Raymond H, et al. Incorporating the Service MultiplierMethod in Respondent-Driven Sampling Surveys to Estimate the Size of Hidden andHard-to-Reach Populations: Case Studies From Around the World. SexuallyTransmitted Diseases,2013,40:304-310
[29]吕繁，李平，刘刚.乘数法估计四川乐山市中区吸毒人群基数研究.中国药物依赖性杂志,2007,16:41-47
[30]栾荣生，曾亚莉，王斌.应用乘数法估计艾滋病男性高危人群基数.中国公共卫生,2004,20:806-807
[31] Johnston LG, Prybylski D, Raymond HF, et al. Incorporating the ServiceMultiplier Method in Respondent-Driven Sampling Surveys to Estimate the Size ofHidden and Hard-to-Reach Populations: Case Studies From Around the World.Sexually Transmitted Diseases,2013,40:304-310
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