开远市暗娼人群HIV/STIs发病率的前瞻性队列研究
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摘要
[背景]FSWs是我国艾滋病防治的重要高危人群,但我国至今仍缺乏FSWs人群的HIV/STIs发病率水平,HIV/STIs感染率的变化趋势,及其高危行为变化趋势的信息。
[目的](1)了解FSWs中的HIV感染率的变化趋势及HIV感染的关联因素;(2)了解FSWs人群中各种艾滋病相关高危行为的变化趋势;(3)了解FSWs人群中的HIV发病率,HIV新发感染者的特征;(4)评估BED-CEIA应用于FSWs人群中HIV发病率估计的效果。
[方法](1)2006年3月-2007年4月,在开远市的FSWs中开展了三阶段系列横断面调查;(2)重复参加过系列横断面调查的FSWs构成了开放式队列。(3)连续参加过三次横断面调查的FSWs构成了封闭式FSWs队列。(4)通过队列研究的结果评估BED-CEIA应用于FSWs人群HIV发病率估计的效果。
[结果](1)系列横断面调查中开远FSWs人群中的HIV感染率依次为10.3%(76/737),11.9%(89/747)和13.0%(92/705),但升高趋势无统计学显著性(p＞0.1)。注射吸毒行为是FSWs人群HIV感染的主要危险因素(aOR=9.8):(2)连续参加过三次横断面调查的封闭式FSWs队列中,自报吸毒行为及高危性行为随调查时间均出现了降低的趋势,另外其性病感染率及尿吗啡阳性率的降低也印证了其自报高危行为特征的下降;(3)开放式FSWs队列中的HIV发病密度为1.4(95%CI0.5～3.3)/100人年,HIV新发感染FSWs与嫖客之间的高危性行为十分突出,以非吸毒FSWs为主(4/5):(4)BED-CEIA阳性标本中的假阳性率为42.1%(16/38),但在排除误检的既往HIV感染标本后,BED-CEIA及开放式队列研究估计的HIV发病密度十分接近(2.1/100人年vs.2.0/100人年:0.4/100人年vs.0.6/100人年)。
[结论]开远FSWs人群中HIV感染途径呈现由吸毒为主向异性传播为主的转别,当前应重点加强对其商业性行为中无保护性行为的干预;开远FSWs中各种高危行为的下降与本研究提供的HIV/STIs检测后咨询,及调查问卷本身提供的信息存在一定的关联性;在详细收集检测对象既往HIV检测状况等相关信息的基础上,BED-CEIA可较好地应用于我国FSWs人群HIV发病率的评估。
Background Female sex workers(FSWs) are one of the HIV/AIDS-related high risk populations in China;however,there is still lack of information about HIV/STIs incidence,HIV/STIs prevalence trends,and the changes in high-risk behaviors among FSWs.
Objective(1) to estimate HIV prevalence trends and the correlates of HIV infection among China FSWs;(2) to estimate the longitudinal change in HIV/AIDS related high-risk behaviors among FSWs;(3) to measure HIV incidence and the characteristics of recently HIV-infected FSWs;(4) to evaluate the effect of HIV-1-specific IgG capture ELISA(BED-CEIA) on HIV incidence estimation among China FSWs by cohort survey.
Method(1) Three-stage serial cross-sectional surveys were carried out among FSWs in Kaiyuan City,China between March 2006 and April 2007;(2) FSW participants who repeatedly attended serial cross-sectional surveys comprised an open-cohort.(3) FSWs participants who attended all the three cross-sectional surveys composed an close-cohort.(4) The effect of BED-CEIA estimated HIV incidence was evaluated by open-cohort survey among the same FSWs population.
Result(1) The prevalence of HIV were 10.3%(76/737),11.9%(89/747) and 13.0%(92/705) among Kaiyuan FSWs who attended the serial cross-sectional surveys, but its increasing trend was not statistically significant(p＞0.1).Injection drug use history was the main risk factor among FSWs(adjusted OR=9.8);(2) The self reported illicit drug-using behaviors and high risk sexual behaviors among close-cohort of FSWs who attended all the three cross-sectional surveys decreased accompanied with the survey time.The decrease of STIs prevalence and urine positive rate among them confirmed their decreased high risk behaviors;(3)The incidence of HIV was 1.4(95%CI 0.5～3.3)/100 Person Year(PY) in the open-cohort.FSWs who were recently HIV-infected had obvious high risk sexual behaviors with clients and 4/5 of them were not illicit-drug using FSWs;(4) 42.1%(16/38) of BED-CEIA positive specimens were false positives(＞155 days),but after eliminating the misclassified long-term HIV infected specimens,the BED-CEIA estimated HIV incidence were similar with that of the cohort survey among the same FSWs(2.1/100PY vs.2.0/100PY;0.4/100PY vs. 0.6/100PY).
Conclusion The main transmission route for HIV among Kaiyuan FSWs is changing from drug injecting behaviors to unprotected heterosexual behaviors. Strengthened efforts should be made to curb their unprotected commercial sex;the decrease in various high risk behaviors among Kaiyuan FSWs may be related to the HIV/STIs post-counseling and information provided by our questionnaire.With careful collection of information on previous HIV testing conditions and so on,BED-CEIA is appropriate for the estimation of HIV incidence among China FSWs.
[目的](1)了解FSWs中的HIV感染率的变化趋势及HIV感染的关联因素;(2)了解FSWs人群中各种艾滋病相关高危行为的变化趋势;(3)了解FSWs人群中的HIV发病率,HIV新发感染者的特征;(4)评估BED-CEIA应用于FSWs人群中HIV发病率估计的效果。
[方法](1)2006年3月-2007年4月,在开远市的FSWs中开展了三阶段系列横断面调查;(2)重复参加过系列横断面调查的FSWs构成了开放式队列。(3)连续参加过三次横断面调查的FSWs构成了封闭式FSWs队列。(4)通过队列研究的结果评估BED-CEIA应用于FSWs人群HIV发病率估计的效果。
[结果](1)系列横断面调查中开远FSWs人群中的HIV感染率依次为10.3%(76/737),11.9%(89/747)和13.0%(92/705),但升高趋势无统计学显著性(p＞0.1)。注射吸毒行为是FSWs人群HIV感染的主要危险因素(aOR=9.8):(2)连续参加过三次横断面调查的封闭式FSWs队列中,自报吸毒行为及高危性行为随调查时间均出现了降低的趋势,另外其性病感染率及尿吗啡阳性率的降低也印证了其自报高危行为特征的下降;(3)开放式FSWs队列中的HIV发病密度为1.4(95%CI0.5～3.3)/100人年,HIV新发感染FSWs与嫖客之间的高危性行为十分突出,以非吸毒FSWs为主(4/5):(4)BED-CEIA阳性标本中的假阳性率为42.1%(16/38),但在排除误检的既往HIV感染标本后,BED-CEIA及开放式队列研究估计的HIV发病密度十分接近(2.1/100人年vs.2.0/100人年:0.4/100人年vs.0.6/100人年)。
[结论]开远FSWs人群中HIV感染途径呈现由吸毒为主向异性传播为主的转别,当前应重点加强对其商业性行为中无保护性行为的干预;开远FSWs中各种高危行为的下降与本研究提供的HIV/STIs检测后咨询,及调查问卷本身提供的信息存在一定的关联性;在详细收集检测对象既往HIV检测状况等相关信息的基础上,BED-CEIA可较好地应用于我国FSWs人群HIV发病率的评估。
Background Female sex workers(FSWs) are one of the HIV/AIDS-related high risk populations in China;however,there is still lack of information about HIV/STIs incidence,HIV/STIs prevalence trends,and the changes in high-risk behaviors among FSWs.
Objective(1) to estimate HIV prevalence trends and the correlates of HIV infection among China FSWs;(2) to estimate the longitudinal change in HIV/AIDS related high-risk behaviors among FSWs;(3) to measure HIV incidence and the characteristics of recently HIV-infected FSWs;(4) to evaluate the effect of HIV-1-specific IgG capture ELISA(BED-CEIA) on HIV incidence estimation among China FSWs by cohort survey.
Method(1) Three-stage serial cross-sectional surveys were carried out among FSWs in Kaiyuan City,China between March 2006 and April 2007;(2) FSW participants who repeatedly attended serial cross-sectional surveys comprised an open-cohort.(3) FSWs participants who attended all the three cross-sectional surveys composed an close-cohort.(4) The effect of BED-CEIA estimated HIV incidence was evaluated by open-cohort survey among the same FSWs population.
Result(1) The prevalence of HIV were 10.3%(76/737),11.9%(89/747) and 13.0%(92/705) among Kaiyuan FSWs who attended the serial cross-sectional surveys, but its increasing trend was not statistically significant(p＞0.1).Injection drug use history was the main risk factor among FSWs(adjusted OR=9.8);(2) The self reported illicit drug-using behaviors and high risk sexual behaviors among close-cohort of FSWs who attended all the three cross-sectional surveys decreased accompanied with the survey time.The decrease of STIs prevalence and urine positive rate among them confirmed their decreased high risk behaviors;(3)The incidence of HIV was 1.4(95%CI 0.5～3.3)/100 Person Year(PY) in the open-cohort.FSWs who were recently HIV-infected had obvious high risk sexual behaviors with clients and 4/5 of them were not illicit-drug using FSWs;(4) 42.1%(16/38) of BED-CEIA positive specimens were false positives(＞155 days),but after eliminating the misclassified long-term HIV infected specimens,the BED-CEIA estimated HIV incidence were similar with that of the cohort survey among the same FSWs(2.1/100PY vs.2.0/100PY;0.4/100PY vs. 0.6/100PY).
Conclusion The main transmission route for HIV among Kaiyuan FSWs is changing from drug injecting behaviors to unprotected heterosexual behaviors. Strengthened efforts should be made to curb their unprotected commercial sex;the decrease in various high risk behaviors among Kaiyuan FSWs may be related to the HIV/STIs post-counseling and information provided by our questionnaire.With careful collection of information on previous HIV testing conditions and so on,BED-CEIA is appropriate for the estimation of HIV incidence among China FSWs.
引文
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