男男同性恋HIV感染者自我管理效果评价研究

张鹏; 高静; 张勇; 尹华卿

doi:10.16462/j.cnki.zhjbkz.2019.05.018

男男同性恋HIV感染者自我管理效果评价研究

doi: 10.16462/j.cnki.zhjbkz.2019.05.018

张鹏¹,
高静¹,
张勇²,
尹华卿^3, ,

1.
201318 上海, 上海健康医学院
2.
200125 上海, 上海市浦东新区疾病预防控制中心
3.
200124 上海, 上海市浦东新区三林康德社区卫生服务中心

基金项目:

上海市浦东新区卫计委面上项目 PW2016A-7

上海健康医学院种子基金 SFP-18-21-01-002

详细信息

通讯作者:
尹华卿, E-mail: yin1094664817@163.com

中图分类号: R512.91
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- 文章访问数: 329
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- PDF下载量: 34
- 被引次数: 0
出版历程
- 收稿日期: 2018-10-09
- 修回日期: 2019-01-22
- 刊出日期: 2019-05-10

Evaluation of self-management model among HIV-infected men who have sex with men

1.
Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
2.
Shanghai Pudong New Area Center for Disease control and Prevention, Shanghai 200125, China
3.
Shanghai Pudong New Area SanLin-Kangde Community Healthcare Center, Shanghai 200124, China

Funds:

>Pudong New Area Health and Family Planning Commission of Shanghai, China PW2016A-7

the Seed Fund Program of Shanghai University of Medicine & Health Sciences SFP-18-21-01-002

More Information

Corresponding author: Yin Hua-qing, E-mail: yin1094664817@163.com

摘要

摘要: 目的评估自我管理模式在感染艾滋病病毒(human immunodeficiency virus，HIV)的男男同性恋人群中的实践效果，为制定该人群HIV/艾滋病(acquired immune deficiency syndrome，AIDS)综合管理策略提供依据。方法依托男男同性恋非政府组织(non-governmental organizations，NGOs)采用同伴推动抽样方法(respondent-driven sampling，RDS)招募研究对象，并随机分为干预组和对照组。干预组实行自我管理模式，建立自我管理小组，在慢性病自我管理(chronic disease self-management，CDSM)的理论基础上以小组为单位开展健康教育课程和同伴教育；对照组实行常规随访管理模式，即以疾控中心为主体开展的医学随访等相关活动；1年后开展效果评估。结果自我管理小组在健康感受、角色功能、生活质量、健康转换、心理健康5个指标的得分上有不同程度的提高。自我管理小组有焦虑症状的比例从38.6%下降到22.6%，经常使用安全套的比例从43.3%提高到47.3%，坚持服药的比例从68.2%提升到78.8%。结论自我管理模式可有效突破目前男男同性恋人群艾滋病管理的瓶颈，可以改善该人群的生存质量。
- 艾滋病病毒 /
- 男男性行为者 /
- 自我管理模式
Abstract: Objective To evaluate practical effects of self-management model among HIV-infected men who have sex with men (MSM), and to provide evidence for the development of HIV/AIDS comprehensive management strategies for this population. Methods Respondent-driven sampling (RDS) sampling was used to recruit subjects with the help of the non-governmental organization. Selected MSM were randomly divided into intervention group and control group. The intervention group implemented a self-management model and established a self-management group to conduct health education courses and peer-education based on chronic disease self-management (CDSM) theory. The control group was organized by the center for diseases control and prevention (CDC) to carry out medical follow-up and other related activities. After one year, the evaluation survey was carried out, and the data was statistically analyzed using SPSS software. Results The CDSM team had different degrees of improvement in the scores of general health, role function, quality life, health transition and mental health sumonary scores. The proportion of self-management groups with anxiety symptoms decreased from 38.6% to 22.6%, the proportion of condom use increased from 43.3% to 47.3%, and the proportion of adherence to medication increased from 68.2% to 78.8%. Conclusion The self-management model can effectively break through the bottleneck of HIV/AIDS management for MSM and can improve quality of life of them.
- HIV /
- MSM /
- Self-management model

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表 1 生存质量各维度评分(x±s)

Table 1. Dimension scores of QOL(x±s)

条目	评分	干预组	对照组	P值
GH	60.35±16.90	60.48±16.18	60.21±17.62	0.874
PF	81.49±22.82	82.34±21.66	80.63±23.94	0.442
RF	89.76±26.80	92.14±24.89	87.38±28.44	0.069
SF	82.09±22.01	83.71±20.41	80.47±23.43	0.132
CF	77.75±18.98	79.85±16.78	75.64±20.78	0.023
PN	88.07±14.37	88.20±14.13	87.93±14.63	0.851
MH	65.28±16.86	66.95±16.18	63.60±17.06	0.042
VT	62.08±17.01	63.28±17.74	60.88±17.62	0.164
HD	75.02±20.50	77.00±19.16	73.04±21.61	0.048
QL	68.21±15.11	70.36±14.85	66.07±15.09	0.004
HT	68.57±24.00	69.40±23.74	67.74±24.29	0.477
PHSS	53.70±8.52	54.46±8.04	52.94±8.93	0.067
MHSS	49.94±8.79	51.06±8.17	48.82±9.26	0.009

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表 2 干预组和对照组人口学特征[n(%)]

Table 2. Demographic characteristics of intervention and control group [n(%)]

人口学特征	n(%)	干预组(n=210)	对照组(n=210)	P值
年龄(岁)				0.213
15~	36(8.6)	15(7.1)	21(10.0)
25~	203(48.4)	97(46.2)	106(50.5)
35~	87(20.7)	52(24.8)	35(16.7)
45~	46(10.9)	25(11.9)	21(10.0)
≥55	48(11.4)	21(10.0)	27(12.8)
婚姻状况				0.112
未婚	248(59.1)	116(55.2)	132(62.9)
在婚	172(40.9)	94(44.8)	78(37.1)
个人月收入(元)				0.029
＜2 000	60(14.3)	39(18.6)	21(10.0)
2 000~	87(20.7)	48(22.8)	39(18.6)
4 000~	99(23.6)	44(21.0)	55(26.2)
≥6 000	174(41.4)	79(37.6)	95(45.2)
文化程度				0.056
初中及以下	78(18.6)	49(23.3)	30(14.3)
高中或中专	69(16.5)	34(16.2)	35(16.7)
大专及以上	272(64.9)	127(60.5)	145(69.0)
户籍				0.694
是	234(55.7)	95(45.2)	91(43.3)
否	186(44.3)	115(54.8)	119(56.7)

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表 3 基于QOL指标的CDSM效果评估

Table 3. Evaluation of CDSM effects based on QOL indicators

评价指标	分组	基线(x±s)	终末(x±s)	差值(95%CI)	P值
评价指标	分组	基线(x±s)	终末(x±s)	差值(95%CI)	前后	组间
GH	I	60.48±16.18	64.90±17.94	4.42(1.46~7.38)	0.004	0.063
	C	60.21±17.62	61.95±16.18	1.74(-1.26~4.74)	0.257
PF	I	82.34±21.66	84.91±30.21	2.57(-4.03~5.54)	0.091	0.033
	C	80.63±23.94	81.52±29.31	0.89(-2.11~3.89)	0.562
RF	I	92.14±24.89	97.09±52.42	4.95(1.98~7.93)	0.001	0.134
	C	87.38±28.44	94.71±42.28	7.33(4.32~10.33)	< 0.001
SF	I	83.71±20.41	80.96±29.22	-2.75(-5.72~0.22)	0.071	0.060
	C	80.47±23.43	77.97±20.20	-2.50(-5.50~0.50)	0.104
CF	I	79.85±16.78	76.63±22.40	-3.22(6.19~-2.45)	0.034	0.045
	C	75.64±20.78	73.45±13.46	-2.19(-5.19~0.81)	0.154
PN	I	88.20±14.13	86.45±18.23	-1.75(-4.72~1.22)	0.249	0.738
	C	87.93±14.63	85.92±13.14	-2.01(-5.01~0.99)	0.191
MH	I	66.95±16.18	65.36±17.56	-1.59(-4.56~1.38)	0.295	0.091
	C	63.60±17.06	62.68±16.48	-0.92(-3.92~2.08)	0.549
VT	I	63.28±17.74	62.65±19.39	-0.63(-3.60~2.34)	0.678	0.038
	C	60.88±17.62	59.36±16.68	-1.52(-4.53~1.48)	0.322
HD	I	77.00±19.16	75.05±22.72	-1.95(-4.92~1.02)	0.199	0.007
	C	73.04±21.61	70.79±15.84	-2.25(-5.25~0.75)	0.143
QL	I	70.36±14.85	79.82±20.80	9.46(6.48~12.43)	< 0.001	< 0.001
	C	66.07±15.09	71.82±15.86	5.75(2.74~8.75)	< 0.001
HT	I	69.40±23.74	74.85±24.92	5.45(2.48~8.42)	< 0.001	< 0.001
	C	67.74±24.29	67.85±24.04	0.11(-2.89~3.11)	0.943
PHSS	I	54.46±8.04	55.55±9.41	1.49(-1.48~4.46)	0.327	0.210
	C	52.94±8.93	53.56±6.48	0.62(-2.38~3.62)	0.686
MHSS	I	51.06±8.17	59.95±10.33	8.89(5.92~11.86)	< 0.001	< 0.001
	C	48.82±9.26	51.25±7.49	2.43(-0.57~5.43)	0.114
注：I干预组，C对照组。

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表 4 相关指标的CDSM效果评估[n(%)]

Table 4. CDSM effect evaluation based on related indicators [n(%)]

评价指标	干预组[n(%)]		P值	对照组[n(%)]		P值
评价指标	基线	终末^a	P值	基线	终末^a	P值
抑郁			0.381			0.370
正常	178(84.7)	149(80.1)		166(79.0)	147(85.0)
轻度	26(12.4)	33(17.7)		32(15.2)	16(9.2)
中度	5(2.4)	4(2.2)		11(5.2)	9(5.2)
重度	1(0.5)	0(0.0)		1(0.5)	1(0.6)
SAS			0.002			0.433
正常	129(61.4)	144(77.4)		148(70.5)	126(72.8)
轻度	72(34.3)	39(21.0)		50(23.8)	43(24.9)
中度	9(4.3)	2(1.1)		9(4.3)	3(1.7)
重度	0(0.0)	1(0.5)		3(1.4)	1(0.6)
安全套使用			0.034			0.044
从不	29(13.8)	11(5.9)		30(14.3)	12(6.9)
偶尔	90(42.9)	87(46.8)		79(37.6)	62(35.8)
经常	91(43.3)	88(47.3)		101(48.1)	99(57.2)
治疗依从性			0.046			0.016
能坚持按时服药	101(68.2)	108(78.8)		104(63.0)	121(75.6)
不能坚持	47(31.8)	29(21.2)		61(37.0)	39(24.2)
注：^a干预组(N=186)，对照组(N=173)。

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