Analysis of late diagnosis and its influencing factors of newly reported HIV/AIDS in Guizhou Province from 2014 to 2018
-
摘要:
目的 了解2014-2018年贵州省新报告人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者/艾滋病（acquired immune deficiency syndrome，AIDS）患者（简称HIV/AIDS病例）晚发现比例及其影响因素。 方法 通过中国艾滋病综合防治信息系统，选择2014-2018年贵州省新报告的全部HIV/AIDS病例进行分析，运用二分类Logistic回归分析模型分析病例晚发现的影响因素。 结果 2014-2018年贵州省新报告HIV/AIDS病例共33 611例，新报告病例的晚发现比例分别为35.46%、34.49%、38.35%、39.74%和38.80%；来源于医疗机构的晚发现病例构成比逐年上升（χ2=64.603，P < 0.001）；分析不同样本来源病例的晚发现比例，发现医疗机构检测新报告病例的晚发现比例高于通过检测咨询、阳性者配偶或性伴检测报告的病例（χ2=276.033，P < 0.001）；多因素分析显示，性别、婚姻状况、传播途径、职业、民族及样本来源是影响新报告病例发现晚的主要因素（均有P < 0.05）。 结论 2014-2018年贵州省新报告HIV/AIDS病例晚发现比例呈缓慢上升趋势。一方面应继续加强全人群艾滋病的宣传教育，提高人群的HIV主动检测意识，另一方面，应继续在全省推进扩大检测，提高病例的早发现能力。 Abstract:Objective To find late diagnosis and its influencing factors of newly reported HIV/AIDS in Guizhou Province from 2014 to 2018. Methods Through the Chinese National Comprehensive HIV/AIDS Prevention and Care Information System, all newly reported HIV/AIDS cases from 2014 to 2018 in Guizhou Province were analyzed and related factors of late diagnosis were analyzed using binary Logistic regression model. Results From 2014 to 2018, there were 33 611 newly reported HIV/AIDS cases in Guizhou Province, and the late diagnosis rates of newly reported cases were 35.46%, 34.49%, 38.35%, 39.74% and 38.80% respectively. The analysis showed that the proportion of late diagnosis cases from medical institutions increased year by year (χ2=64.603, P < 0.001). By analyzing the late diagnosis rate of cases from different sample sources, medical institutions was significantly higher than that reported by voluntary counseling and testing, positive spouses or sexual partners(χ2=276.033, P < 0.001). Multivariate analysis showed that gender, marital status, route of transmission, occupation, ethnicity and source of samples were associated with the late diagnosis of newly reported cases (all P < 0.05). Conclusions It shows a slow upward trend of late diagnosis rate among HIV/AIDS reported in Guizhou Province from 2014 to 2018.On the one hand, it is of great significance to continue to strengthen the publicity and education of the whole population in Guizhou, in order to improve the awareness of HIV active detection. On the other hand, we should continue to expand HIV testing in Guizhou Province to improve the early detection level of HIV/AIDS. -
Key words:
- AIDS /
- New reported /
- Late diagnosis /
- Related factors /
- Active detection
-
表 1 2014-2018年贵州省HIV/AIDS晚发现病例样本来源构成[n(%)]
Table 1. The sample source distribution of HIV/AIDS in Guizhou Province from 2014 to 2018[n(%)]
报告时间
(年)其他就诊者
检测a检测咨询 术前检测 阳性者配偶或
性伴检测羁押人员
检测性病门诊 孕产期
检测无偿献血
人员检测专题调查 其他 2014 730(56.3) 222(17.1) 134(10.3) 70(5.4) 17(1.3) 22(1.7) 12(0.9) 18(1.4) 16(1.2) 55(4.2) 2015 960(59.6) 311(19.3) 127(7.9) 87(5.4) 15(0.9) 12(0.7) 11(0.7) 10(0.6) 14(0.9) 64(4.0) 2016 1 438(67.6) 268(12.6) 146(6.9) 115(5.4) 24(1.1) 24(1.1) 9(0.4) 14(0.7) 17(0.8) 72(3.4) 2017 1 629(64.2) 289(11.4) 246(9.7) 138(5.4) 30(1.2) 56(2.2) 11(0.4) 17(0.7) 15(0.6) 106(4.2) 2018 1 854(63.4) 303(10.4) 347(11.9) 129(4.4) 20(0.7) 75(2.6) 14(0.5) 25(0.9) 18(0.6) 139(4.8) 注：a其他就诊者检测主要是指医疗机构的内科住院病人、普通门诊病人接受HIV相关检测。 
下载: 导出CSV
表 2 2014-2018年贵州省不同样本来源HIV/AIDS病例的晚发现情况
Table 2. Late diagnosis of newly reported HIV/AIDS from different sample sources in Guizhou Province from 2014 to 2018
样本来源 2014年 2015年 2016年 2017年 2018年 发现病
例数(n)晚发现
比例a(%)发现病
例数(n)晚发现
比例a(%)发现病
例数(n)晚发现
比例a(%)发现病
例数(n)晚发现
比例a(%)发现病
例数(n)晚发现
比例a(%)其他就诊者检测 2 126 52.26 2 745 49.47 3 767 54.18 4 361 56.47 5 326 49.24 检测咨询 909 32.07 1 174 32.76 1 077 31.14 1 145 34.19 1 061 35.84 术前检测 454 42.08 469 36.93 526 37.20 854 41.63 1 091 45.11 阳性者配偶或性伴检测 288 31.73 352 28.14 414 32.38 472 34.60 501 30.93 羁押人员检测 180 17.13 186 13.74 192 24.76 174 26.64 169 21.12 性病门诊 87 30.20 73 18.29 104 28.82 190 37.74 244 38.76 孕产期检测 92 17.35 86 14.50 85 14.29 111 12.95 94 19.12 无偿献血人员检测 111 22.65 70 16.43 110 16.09 104 20.24 113 28.91 专题调查 103 18.25 93 16.47 110 18.46 118 14.42 129 17.19 其他 183 44.03 224 40.31 254 39.19 314 50.83 396 48.63 注：a晚发现比例的计算依据晚发现定义。
下载: 导出CSV
表 3 2014-2018年贵州省不同市州新报告HIV/AIDS晚发现情况
Table 3. Late diagnosis of HIV/AIDS in different regions of Guizhou Province from 2014 to 2018
报告市州 报告数(n) 晚发现数(n) 晚发现比例(%) 贵阳 6 415 2 283 35.60 六盘水 2 909 1 282 44.06 遵义 5 155 2 034 39.47 安顺 4 657 2 215 47.57 铜仁 1 609 855 53.12 黔西南 2 144 932 43.47 毕节 3 236 1 433 44.28 黔东南 3 352 1 786 53.28 黔南 4 104 1 732 42.20 贵安 30 18 60.00 贵州省 33 611 14 534 43.24
下载: 导出CSV
表 4 贵州省2014-2018年新报告HIV/AIDS病例晚发现比例及影响因素
Table 4. Prevalence and influencing factors of late diagnosis of HIV/AIDS cases in Guizhou Province from 2014 to 2018
人口学特征 报告数(例) 晚发现数(%) 单因素分析 多因素分析 OR(95%CI)值 P值 OR(95%CI)值 P值 性别 男 23 447 7 738(33.0) 1.000 1.000 女 10 164 2 757(27.1) 0.756(0.718~0.796) ＜0.001 0.766(0.724~0.811) ＜0.001 民族 汉族 23 942 7 218(30.1) 1.000 1.000 苗族 2 592 870(33.6) 1.171(1.074~1.276) ＜0.001 1.205(1.102~1.316) ＜0.001 布依族 2 581 844(32.7) 1.126(1.032~1.228) 0.007 1.088(0.996~1.190) 0.063 侗族 1 577 658(41.7) 1.659(1.495~1.840) ＜0.001 1.562(1.403~1.739) ＜0.001 水族 973 338(34.7) 1.233(1.078~1.411) 0.002 1.061(0.924~1.218) 0.399 土家族 637 213(33.4) 1.164(0.985~1.375) 0.075 1.375(1.157~1.633) ＜0.001 彝族 529 128(24.2) 0.740(0.605~0.904) 0.003 0.846(0.689~1.039) 0.112 其他及不详 780 226(29.0) 0.945(0.808~1.106) 0.482 1.051(0.894~1.235) 0.545 文化程度 文盲 4 817 1 606(33.3) 1.000 1.000 小学 12 749 4 307(33.8) 1.020(0.951~1.094) 0.580 1.003(0.932~1.080) 0.937 初中 10 271 3 151(30.7) 0.885(0.822~0.952) 0.001 1.085(0.998~1.179) 0.054 高中及以上 2 978 817(27.4) 0.756(0.684~0.836) ＜0.001 1.097(0.976~1.234) 0.121 大专及以上 2 796 614(22.0) 0.563(0.505~0.627) ＜0.001 0.980(0.854~1.124) 0.772 婚姻状况 未婚 6 689 1 535(22.9) 1.000 1.000 已婚有配偶 15 203 4 855(31.9) 1.575(1.474~1.683) ＜0.001 0.900(0.824~0.983) 0.019 离异或丧偶 11 625 4 077(35.1) 1.814(1.693~1.942) ＜0.001 0.914(0.834~1.002) 0.054 不详 94 28(29.8) 1.424(0.912~2.224) 0.120 0.922(0.579~1.469) 0.733 感染途径 异性传播 30 333 9 873(32.5) 1.000 1.000 同性传播 2 294 432(18.8) 0.481(0.432~0.535) ＜0.001 0.873(0.763~1.000) 0.050 注射吸毒 552 86(15.6) 0.382(0.303~0.482) ＜0.001 0.861(0.657~1.129) 0.280 母婴传播 150 27(18.0) 0.455(0.300~0.690) ＜0.001 0.686(0.301~1.561) 0.369 其他及不详 282 77(27.3) 0.778(0.598~1.013) 0.062 0.931(0.705~1.231) 0.618 职业 农民及民工 20 668 6 984(33.8) 1.000 1.000 家政/家务/待业 6 070 1 662(27.4) 0.739(0.693~0.787) ＜0.001 1.018(0.949~1.093) 0.616 干部及离退人员 1 786 631(35.3) 1.070(0.967~1.184) 0.188 1.004(0.898~1.124) 0.938 商业服务 1 061 234(22.1) 0.554(0.478~0.643) ＜0.001 0.831(0.709~0.974) 0.022 学生 572 73(12.8) 0.287(0.224~0.367) ＜0.001 0.824(0.620~1.095) 0.181 工人 527 157(29.8) 0.831(0.688~1.004) 0.055 0.871(0.718~1.058) 0.164 其他及不详 2 927 754(25.8) 0.680(0.623~0.742) ＜0.001 0.921(0.836~1.015) 0.096 报告年龄(岁) 0~ 201 38(18.9) 1.000 1.000 15~ 2 954 378(12.8) 0.629(0.435~0.911) 0.014 0.497(0.243~1.014) 0.055 25~ 5 412 1 265(23.3) 1.308(0.914~1.873) 0.142 1.008(0.492~2.066) 0.982 35~ 6 530 2 041(31.3) 1.950(1.365~2.787) ＜0.001 1.473(0.719~3.018) 0.290 45~ 6 974 2 400(34.4) 2.251(1.576~3.215) ＜0.001 1.650(0.805~3.383) 0.171 ≥55 11 540 4 373(37.9) 2.617(1.835~3.733) ＜0.001 1.810(0.883~3.711) 0.105 样本来源 其他就诊者检测 18 325 6 611(36.1) 1.000 1.000 检测咨询 5 366 1 393(26.0) 0.621(0.580~0.665) ＜0.001 0.722(0.672~0.775) ＜0.001 术前检测 3 394 1 000(29.3) 0.740(0.683~0.802) ＜0.001 0.764(0.704~0.828) ＜0.001 阳性者配偶或性伴检测 2 027 539(26.6) 0.642(0.579~0.711) ＜0.001 0.664(0.597~0.739) ＜0.001 羁押人员检测 901 106(11.8) 0.236(0.192~0.290) ＜0.001 0.285(0.225~0.360) ＜0.001 性病门诊 698 189(27.1) 0.658(0.555~0.780) ＜0.001 0.787(0.662~0.936) 0.007 孕产期检测 468 57(12.2) 0.246(0.186~0.325) ＜0.001 0.491(0.368~0.656) ＜0.001 无偿献血人员检测 508 84(16.5) 0.351(0.277~0.444) ＜0.001 0.484(0.380~0.616) ＜0.001 专题调查 553 80(14.5) 0.300(0.236~0.381) ＜0.001 0.528(0.405~0.687) ＜0.001 其他 1 371 436(31.8) 0.826(0.735~0.929) 0.001 0.920(0.815~1.039) 0.178
下载: 导出CSV
-
[1] 贵州省疾病预防控制中心艾滋病性病皮肤病防治研究所. 2018年贵州省艾滋病综合防治数据信息报告[R]. 贵阳: 贵州省疾病预防控制中心, 2019.Institute of Dermatology and Prevention of AIDS and STD, Guizhou Center for Disease Control and Prevention. Data information report on comprehensive prevention and treatment of AIDS/HIV in Guizhou Province in 2018[R]. Guiyang: Guizhou Center for Disease Control and Prevention, 2019. [2] Ndiaye B, Salleron J, Vincent A, et al. Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007[J]. BMC infect Dis, 2011, 11(12): 11. DOI: 10.1186/1471-2334-11-11. [3] 曹家艳, 杨家奇, 周彩霞, 等. 2010-2014年遵义市HIV/AIDS晚发现的病例特征及影响因素分析[J]. 中国皮肤性病学杂志, 2016, 30(4): 380-385. DOI: 10.13735/j.cjdv.1001-7089.201505061.Cao Jy, Yang JQ, Zhou CX, et al. Analysis of characteristics and influencing factors of later found HIV/AIDS in Zunyi City from 2010 to 2014[J]. Chin J Dermatovenere, 2016, 30(4): 380-385. DOI: 10.13735/j.cjdv.1001-7089.201505061. [4] 曹文杰, 袁智, 郑敏, 等. 1995-2017年贵州省HIV/AIDS病例死亡情况分析[J]. 中华疾病控制杂志, 2019, 23(5): 512-516. DOI: 10.16462/j.cnki.zhjbkz.2019.05.004.Cao WJ, Yuan Z, Zheng M, et al. Mortality analysis among HIV/AIDS cases in Guizhou Province, 1995-2017[J]. Chin J Dis control Prev, 2019, 23(5): 512-516. DOI: 10.16462/j.cnki.zhjbkz.2019.05.004. [5] 中国疾病预防控制中心性病艾滋病预防控制中心. 全国艾滋病/性病/丙肝综合防治数据信息年报[R]. 北京: 中国疾病预防控制中心, 2019.Center for STD/AIDS Prevention and Control, Chinese Center for Disease Control and Prevention. Annual report on comprehensive prevention and treatment of AIDS/STD/hepatitis[R]. Beijing: Chinese center for disease control and prevention, 2019. [6] 王海, 王亚西, 何慧敏, 等. 贵州省铜仁市2011-2015年晚发现HIV/AIDS病例的特征及影响因素[J]. 中国艾滋病性病, 2017, 23(3): 217-220. DOI: 10.13419/j.cnki.aids.2017.03.12.Wang H, Wang YX, He HM, et al. Characteristics and influencing factors of late detected HIV/AIDS cases between 2011 and 2015 in Tongren city, Guizhou Province[J]. Chin J AIDS STD, 2017, 23(3): 217-220. DOI: 10.13419/j.cnki.aids.2017.03.12. [7] 杨跃诚, 张新灿, 叶润华, 等. 云南省德宏州2007-2013年HIV感染者晚发现率及其影响因素研究[J]. 中华疾病控制杂志, 2015, 19(10): 971-974. DOI: 10.16462/j.cnki.zhjbkz.2015.10.001.Yang YC, Zhang XC, Ye RH, et al. Studies on the impact factors of delayed diagnosis of HIV infection in Dehong Prefecture during 2007-2013, Yunnan Province[J]. Chin J Dis control Prev, 2015, 19(10): 971-974. DOI: 10.16462/j.cnki.zhjbkz.2015.10.001. [8] 刘少础, 杨峥嵘, 陈琳, 等. 深圳市2014年新报告MSM中HIV/AIDS晚发现情况分析[J]. 中国热带医学, 2016, 16(8): 793-795. DOI: 10.13604/j.cnki.46-1064/r.2016.08.13.Liu SC, Yang ZR, Chen L, et al. Analysis of late diagnosis of newly reported MSM HIV/AIDS cases in Shenzhen City, 2014[J]. Chin Trop Med, 2016, 16(8): 793-795. DOI: 10.13604/j.cnki.46-1064/r.2016.08.13. [9] Op de Coul, van Sighem A, Brinkman K, et al. Factors associated with presenting late or with advanced HIV disease in the Netherlannds, 1996-2014: resulting from a national observational cohort[J]. BMJ open, 2016, 32(3): 255-261. DOI: 10.1136/bmjopen-2015-009688. [10] 曾吉, 李洋, 叶景荣, 等. 2013年北京市新报告HIV/AIDS病人中晚发现病例的特征[J]. 中国艾滋病性病, 2015, 21(5): 388-391. DOI: 10.13419/j.cnki.aids.2015.05.11.Zeng J, Li Y, Ye JR, et al. Characteristics of late diagnosis cases of newly reported HIV/AIDS cases in Beijing, 2013[J]. Chin J AIDS STD, 2015, 21(5): 388-391. DOI: 10.13419/j.cnki.aids.2015.05.11. [11] 李健, 王斌, 杨常敏, 等. 甘肃省2013-2015年新报告艾滋病病毒感染者和艾滋病患者中的晚发现情况分析[J]. 中国病毒学杂志, 2017, 7(1): 54-58. DOI: 10.16505/j.2095-0136.2017.01.012.Li J, Wang B, Yang CM, et al. Analysis of late diagnosis cases of newly reported HIV/AIDS cases in Gansu Province (2013-2015)[J]. Chin J Vir Dis, 2017, 7(1): 54-58. DOI: 10.16505/j.2095-0136.2017.01.012. [12] 梁红梅, 聂晓勇, 穆生财, 等. 2011-2016年山西省HIV/AIDS病例晚发现情况及影响因素[J]. 中国艾滋病性病, 2018, 24(11): 1097-1100. DOI: 10.13419/j.cnki.aids.2018.11.07.Liang HM, Nie XY, Mu SC, et al. Late diagnosis of newly identified HIV/AIDS cases and its influencing factors in Shanxi, 2011-2016[J]. Chin J AIDS STD, 2018, 24(11): 1097-1100. DOI: 10.13419/j.cnki.aids.2018.11.07. [13] 曹文杰, 郑敏, 杨梨丽, 等. 铜仁市重点地区HIV/AIDS病例晚发现情况及影响因素调查[J]. 贵州医药, 2019, 43(2): 307-310.Cao WJ, Zheng M, Yang LL, et al. Late diagnosis and its influencing factors of newly reported HIV/AIDS in some areas of Tongren[J]. Guizhou Med J, 2019, 43(2): 307-310. [14] 戴色莺, 沈张伟, 范引光, 等. 柳州市不同途径发现的HIV/AIDS的晚发现状况及其相关因素[J]. 中华疾病控制杂志, 2017, 21(12): 1250-1253, 1258. DOI: 10.16462/j.cnki.zhjbkz.2017.12.015.Dai SY, Sheng ZW, Fan YG, et al. Prevalence and associated factors with late HIV diagnosis among HIV/AIDS patients detected via different pathways in Liuzhou City[J]. Chin J Dis control Prev, 2017, 21(12): 1250-1253, 1258. DOI: 10.16462/j.cnki.zhjbkz.2017.12.015. [15] Trepka MJ, Fennie KP, Sheehan DM, et al. Late HIV diagnosis: differences by rural/urban residence, Florida, 2007-2011[J]. AIDS Patient Care STDS, 2014, 28(4): 188-197. DOI: 10.1089/apc.2013.0362. [16] 刘黎, 朱正平, 徐园园, 等. 南京市2011-2015年新报告艾滋病病毒感染者/艾滋病病人的晚发现率及其影响因素分析[J]. 中华疾病控制杂志, 2017, 21(12): 1245-1249. DOI: 10.16462/j.cnki.zhjbkz.2017.12.014.Liu L, Zhu ZP, Xu YY, et al. Analysis on the influencing factors of late diagnosis of newly identified HIV/AIDS Cases in Nanjing from 2011 to 2015[J]. Chin J Dis control Prev, 2017, 21(12): 1245-1249. DOI: 10.16462/j.cnki.zhjbkz.2017.12.014. [17] 金琳, 程晓莉, 秦义组, 等. 安徽省2011-2015年新诊断HIV感染者和艾滋病患者晚发现情况及相关因素分析[J]. 中华预防医学杂志, 2018, 52(4): 415-418. DOI: 10.3760/cma.j.issn.0253-9624.2018.04.015.Jin L, Cheng XL, Qin YZ, et al. Analysis of the influential factors of late diagnosis among newly identified HIV/AIDS cases in Anhui Province, 2011-2015[J]. Chin J Prev Med, 2018, 52(4): 415-418. DOI: 10.3760/cma.j.issn.0253-9624.2018.04.015. -
