新治疗策略下HIV阳性者抗病毒治疗意向和高危性行为分析
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摘要
目的分析新治疗策略下广州市尚未开始抗病毒治疗的艾滋病病毒(HIV)阳性者的治疗意向及其与高危性行为的关系。方法通过立意抽样,在广州市抽取六个区对尚未开始抗病毒治疗的HIV阳性者采用横断面调查,收集人口学特征、艾滋病相关特征、高危性行为状况及抗病毒治疗意向。采用二分类Logistic回归探究高危性行为对治疗意向的影响。结果共调查501人,完整回收问卷465份,完成率92.8%。69.5%(323/465)的HIV阳性者具有治疗意向;艾滋病相关特征中,确诊时间距今较长、通过注射毒品感染、超重/肥胖、自评健康较好是治疗意向的危险因素;校正人口学及艾滋病相关特征后,过去3个月与配偶/固定性伴发生高危性行为[比值比(OR)=2.18,95%可信区间(CI):1.04～4.56,P=0.038]的HIV阳性者治疗意向更高。结论新治疗策略下,广州市尚未具有治疗意向的HIV阳性者比例仍然较高,高危性行为发生率高,与配偶或固定性伴发生高危性行为的阳性者治疗意向高,应予以综合干预。
Objective To investigate the ART intention and its influencing factors, and high-risk sexual behaviors among HIV-positive individuals after implementation of the new strategy of ART. Methods A cross-sectional study was conducted in six districts of Guangzhou. Purposive sampling technique was employed to select respondents among HIV-positive individuals who had not started ART, to collect their demographic information, HIV-related status, high-risk sexual behaviors and ART intention. Binary logistic regression was used to analyze the association between ART intention and high-risk sexual behaviors. Results Of 465 respondents, 323(69.5%) had ART intention. Among the 299 individuals who had sexual behaviors in the past three months, 135 did not use condom every time of sex. Risk factors associated with ART intention included the duration since date of diagnosis(>12 months vs <1 month, OR=0.17, 95%CI: 0.10-0.29, P<0.001), way of HIV infection(injection drug use vs heterosexual transmission, OR=0.08, 95%CI: 0.01-0.60, P=0.014), BMI(overweight/obesity vs normal, OR=0.50, 95%CI: 0.27-0.91, P=0.024), and self-reported good health status(bad vs good, OR=3.10, 95%CI: 1.10-8.74, P=0.032). Adjusted for demographic information and HIV-related status, patients who "had high-risk sexual behaviors with their spouse/fixed partner in the past 3 months"(OR=2.18,95%CI:1.04-4.56,P=0.038) had significantly higher ART intention. Conclusion The proportion of HIV-positive individuals who had no ART intention is still high, and the prevalence of high-risk sexual behaviors is also high. HIV-positive individuals with high-risk sexual behaviors with their spouse/fixed partners have higher ART intention, thus a comprehensive and effective intervention should be conducted for those who have not started ART.
Objective To investigate the ART intention and its influencing factors, and high-risk sexual behaviors among HIV-positive individuals after implementation of the new strategy of ART. Methods A cross-sectional study was conducted in six districts of Guangzhou. Purposive sampling technique was employed to select respondents among HIV-positive individuals who had not started ART, to collect their demographic information, HIV-related status, high-risk sexual behaviors and ART intention. Binary logistic regression was used to analyze the association between ART intention and high-risk sexual behaviors. Results Of 465 respondents, 323(69.5%) had ART intention. Among the 299 individuals who had sexual behaviors in the past three months, 135 did not use condom every time of sex. Risk factors associated with ART intention included the duration since date of diagnosis(>12 months vs <1 month, OR=0.17, 95%CI: 0.10-0.29, P<0.001), way of HIV infection(injection drug use vs heterosexual transmission, OR=0.08, 95%CI: 0.01-0.60, P=0.014), BMI(overweight/obesity vs normal, OR=0.50, 95%CI: 0.27-0.91, P=0.024), and self-reported good health status(bad vs good, OR=3.10, 95%CI: 1.10-8.74, P=0.032). Adjusted for demographic information and HIV-related status, patients who "had high-risk sexual behaviors with their spouse/fixed partner in the past 3 months"(OR=2.18,95%CI:1.04-4.56,P=0.038) had significantly higher ART intention. Conclusion The proportion of HIV-positive individuals who had no ART intention is still high, and the prevalence of high-risk sexual behaviors is also high. HIV-positive individuals with high-risk sexual behaviors with their spouse/fixed partners have higher ART intention, thus a comprehensive and effective intervention should be conducted for those who have not started ART.
引文
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[9] 李健,毛宇嵘,汤后林,等. 中国艾滋病疫情重点地区HIV单阳家庭抗病毒治疗与及时性及其影响因素分析[J]. 中华预防医学杂志,2015,49(7):625-631.
[10] Ulett KB,Willig JH,Lin HY,et al. The therapeutic implications of timely linkage and early retention in HIV care[J].Aids Patient Care &Stds,2009,23(1):41.
[11] Webel AR,Sattar A,Schreiner N,et al. Social Resources,Health Promotion Behavior,and Quality of Life in Adults Living with HIV[J]. Applied Nursing Research Anr, 2015(30):204.
[12] Paz-Bailey G, Mendoza MC, Finlayson T, et al. Trends in condom use among MSM in the United States: the role of antiretroviral therapy and seroadaptive strategies[J]. AIDS, 2016, 30(12):1985-1990.
[13] 郭燕丽,周建波,郝超,等. 江苏省常州市男男性行为者婚姻状况及其对艾滋病高危行为和感染率的影响[J]. 中华流行病学杂志,2013, 34(1):19-23.
[14] 史同新,张北川,李秀芳,等. 婚姻状况对男男性行为者的艾滋病高危性行为影响研究[J]. 中国艾滋病性病, 2008,14(5):475-478.
[15] 何慧婧,陈曦,杨介者,等. 配偶对感染者早期抗病毒治疗可接受性的调查[J].实用预防医学, 2013,20(9):1060-1062.
[16] 夏彦昌,辛冰艳,李灿,等. HIV单阳家庭接受ART的影响因素及对配偶的影响[J].中国艾滋病性病,2016,22(7): 514-517.
[2] 周婧,李现红,张慈.中国HIV感染者和艾滋病患者持续参与治疗现状及多层级影响因素分析[J].中国全科医学,2017,20(1):21-28.
[3] 吴尊友. 我国实现艾滋病防治策略三个90%的进展与挑战[J]. 中华疾病控制杂志,2016,20(12):1187-1189.
[4] UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva,Switzerland: UNAIDS, 2014[EB/OL]. Available at: http://www.unaids.org/en/resources/documents/2017/90-90-90. Accessed 28 November 2017.
[5] 李耀峰,张余慧. 初期艾滋病感染者的心理困境及社会工作介入路径[J].社会工作与管理,2016,16(6): 28-35.
[6] 黄玉满,沈智勇,万孝玲,等.广西艾滋病感染者/患者抗病毒治疗及时性影响因素分析[J].中国热带医学,2017,17(11):1089-1092,1101.
[7] Zhu H, Napravnik S, Eron J, et al. Attrition among human immunodeficiency virus (HIV)-infected patients initiating antiretroviral therapy in China,2003-2010.[J]. PLoS One,2012,7(6):e39414.
[8] 胡晓松,陈芳,丁凡,等. 中国三城市HIV阳性男男性行为人群接受随访与抗病毒治疗服务状况及其影响因素分析[J].中华预防医学杂志,2015,49(11):945-949.
[9] 李健,毛宇嵘,汤后林,等. 中国艾滋病疫情重点地区HIV单阳家庭抗病毒治疗与及时性及其影响因素分析[J]. 中华预防医学杂志,2015,49(7):625-631.
[10] Ulett KB,Willig JH,Lin HY,et al. The therapeutic implications of timely linkage and early retention in HIV care[J].Aids Patient Care &Stds,2009,23(1):41.
[11] Webel AR,Sattar A,Schreiner N,et al. Social Resources,Health Promotion Behavior,and Quality of Life in Adults Living with HIV[J]. Applied Nursing Research Anr, 2015(30):204.
[12] Paz-Bailey G, Mendoza MC, Finlayson T, et al. Trends in condom use among MSM in the United States: the role of antiretroviral therapy and seroadaptive strategies[J]. AIDS, 2016, 30(12):1985-1990.
[13] 郭燕丽,周建波,郝超,等. 江苏省常州市男男性行为者婚姻状况及其对艾滋病高危行为和感染率的影响[J]. 中华流行病学杂志,2013, 34(1):19-23.
[14] 史同新,张北川,李秀芳,等. 婚姻状况对男男性行为者的艾滋病高危性行为影响研究[J]. 中国艾滋病性病, 2008,14(5):475-478.
[15] 何慧婧,陈曦,杨介者,等. 配偶对感染者早期抗病毒治疗可接受性的调查[J].实用预防医学, 2013,20(9):1060-1062.
[16] 夏彦昌,辛冰艳,李灿,等. HIV单阳家庭接受ART的影响因素及对配偶的影响[J].中国艾滋病性病,2016,22(7): 514-517.