南京市2018年艾滋病防治三个90%策略的进展及影响因素

徐园园; 吴苏姝; 苟莉莉; 刘黎; 郭璐; 李昕; 时红杰; 朱正平

doi:10.16462/j.cnki.zhjbkz.2020.12.009

南京市2018年艾滋病防治三个90%策略的进展及影响因素

doi: 10.16462/j.cnki.zhjbkz.2020.12.009

1.
210003 南京，南京市疾病预防控制中心性病艾滋病防治科
2.
210003 南京，南京市疾病预防控制中心健康教育科

基金项目:

南京市医学科技发展项目 YKK18176

南京市医学重点科技发展项目 ZKX19050

详细信息

通讯作者:
朱正平，E-mail：zzp@njcdc.cn

中图分类号: R181;R512.91
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出版历程
- 收稿日期: 2020-03-12
- 修回日期: 2020-08-11
- 刊出日期: 2020-12-10

Progress towards the UNAIDS 90-90-90 targets and factors associated with achieving these targets

1.
Department of STD/AIDS Prevention and Treatment, Nanjing municipal Center for Disease Control and Prevention, Nanjing 210003, China
2.
Department of Health Education, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China

Funds:

Nanjing Municipal Medical Development Program YKK18176

Nanjing Municipal Medical Development Program ZKX19050

More Information

Corresponding author: ZHU Zheng-ping, E-mail:zzp@njcdc.cn

摘要

摘要: 目的分析南京市2018年艾滋病防治策略“三个90%”目标的进展情况及其实现的影响因素。方法从艾滋病防治综合信息系统中获取南京市现存活的人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者/艾滋病(acquired immune deficiency syndrome, AIDS)患者检测发现、抗病毒治疗(antiviral therapy, ART)和病毒载量(viral load, VL)相关信息，分析“三个90%”进展情况，采用多因素Logistic回归分析模型分析影响因素。结果 2018年南京市“三个90%”目标分别达到74.0%、88.5%和96.7%。经同性传播的HIV/AIDS检测发现率较低(χ² =86.15, P < 0.001)。注射吸毒传播(aOR=0.263，95% CI：0.156~0.442，P < 0.001)、 < 25岁年龄组(aOR=0.697，95% CI：0.540~0.899，P=0.005)以及监管场所发现(aOR= 0.353，95% CI：0.193~0.646，P=0.001)的HIV/AIDS治疗覆盖率较低；而同性传播(aOR=1.840，95% CI：1.390~2.434，P < 0.001)、35~44岁年龄组(aOR=1.826，95% CI：1.260~2.645，P=0.001)、汉族(aOR=1.797，95% CI：1.038~3.109，P=0.036)、大专及以上文化程度(aOR=1.652，95% CI：1.005~2.717，P=0.048)、已婚有配偶(aOR=1.466，95% CI：1.051~2.046，P=0.024)的HIV/AIDS治疗覆盖率较高。结论南京市朝着2020年实现“三个90%”的防治目标迅速迈进，但仍有一定的挑战，需要继续扩大HIV检测发现，加强吸毒人群、低龄和老年人等重点人群治疗关怀服务。
- 艾滋病 /
- 防治策略 /
- "三个90%"目标 /
- 影响因素
Abstract: Objective To analyze the current status towards the UNAIDS 90-90-90 targets and factors associated with achieving these targets in Nanjing. Methods Data from the Chinese HIV/AIDS Comprehensive Response Information Management System regarding testing, ART and VL in Nanjing were collected. Multivariate Logistic regression analysis was performed to analyze the associated factors with achieving the 90-90-90 targets. Results The progress towards the 90-90-90 UNAIDS targets was at 74.0%, 88.5%, and 96.7% in Nanjing by 2018. HIV/AIDS infected by homosexual contact were less likely to be diagnosed (χ² =86.15, P < 0.001) People living with HIV (PLWH) infected through injecting drug use (aOR=0.263, 95% CI:0.156-0.442, P < 0.001), aged < 25 years (aOR=0.697, 95% CI:0.540-0.899, P=0.005) and identified from custodial institutions (aOR=0.353, 95% CI:0.193-0.646, P=0.001) were less likely to engage on ART. PLWH infected through homosexual contact (aOR=1.840, 95% CI:1.390-2.434, P < 0.001), aged 35-44 years (aOR=1.826, 95% CI:1.260-2.645, P=0.001), ethnic group of Han (aOR=1.797, 95% CI:1.038-3.109, P=0.036), of college degree or above (aOR=1.652, 95% CI:1.005-2.717, P=0.048) and married (aOR=1.466, 95% CI:1.051-2.046, P=0.024) were more likely to engage on ART. Conclusions Nanjing is rapidly moving towards achieving the UN targets. However, some challenges still exist. We need to continue to expand HIV testing and strengthen the treatment and care services for drug users, young people and the elderly.
- AIDS /
- Prevention and treatment strategies /
- 90-90-90 targets /
- Associated factors

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图 1 不同传播途径的HIV/AIDS三个90%的进展情况

Figure 1. Progress towards the UNAIDS 90-90-90 targets by routes of transmission

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表 1 南京市2018年检测发现率进展情况及相关因素分析

Table 1. Progress towards detection rate and related factors in Nanjing City by 2018

变量	估计数	报告数(%)	χ²值	P值
性别			1.403	0.236
女	376	288(76.6)
男	4 923	3 634(73.8)
感染途径			86.148	< 0.001
异性传播	1 202	993(82.6)
同性传播	3 978	2 820(70.9)
注射吸毒	104	94(90.4)
血液/母婴传播	15	15(100.0)

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表 2 南京市2018年抗病毒治疗覆盖率和病毒抑制率进展情况及相关因素分析

Table 2. Progress and related factors of antiviral therapy coverage rate and viral load suppression rate in Nanjing City by 2018

变量	现存活数	抗病毒治疗			病毒载量抑制
变量	现存活数	例数[n(%)]	aOR(95% CI)值	P值	例数[n(%)]	aOR(95% CI)值	P值
性别
女	288	240(83.3)	1.000		233(97.5)	1.000
男	3 634	3 230(88.9)	0.997(0.669~1.484)	0.986	3 108(96.7)	0.502(0.197~1.279)	0.148
感染途径
异性传播	993	857(86.3)	1.000		831(97.1)	1.000
同性传播	2 820	2 544(90.2)	1.840(1.390~2.434)	< 0.001	2 457(96.9)	1.019(0.583~1.782)	0.946
注射吸毒	94	54(57.4)	0.263(0.156~0.442)	< 0.001	40(80.0)	0.110(0.041~0.293)	0.000
血液/母婴传播	15	15(100.0)			13(100.0)		0.999
报告年龄(岁)
< 25	985	841(85.4)	0.697(0.540~0.899)	0.005	796(95.1)	0.346(0.202~0.591)	< 0.001
25~	1 363	1 206(88.5)	1.000	0.001	1 177(98.1)	1.000
35~	708	648(91.5)	1.826(1.260~2.645)	0.001	623(97.0)	0.935(0.448~1.951)	0.858
45~	562	511(90.9)	1.439(0.958~2.162)	0.079	497(97.3)	0.883(0.390~2.002)	0.766
≥55	304	264(86.8)	0.929(0.593~1.455)	0.748	248(93.9)	0.355(0.155~0.810)	0.014
民族
少数民族	90	72(80.0)	1.000		70(98.6)	1.000
汉族	3 832	3 398(88.7)	1.797(1.038~3.109)	0.036	3 271(96.7)	0.478(0.065~3.517)	0.469
文化程度
文盲/小学	196	164(83.7)	1.000		151(93.8)	1.000
初中/高中	1 662	1 459(87.8)	1.308(0.829~2.065)	0.249	1 398(96.3)	1.997(0.934~4.270)	0.075
大专及以上	2 064	1 847(89.5)	1.652(1.005~2.717)	0.048	1 792(97.3)	3.020(1.293~7.055)	0.011
婚姻状况
未婚	2 236	1 948(87.1)	1.000		1 864(96.4)	1.000
已婚有配偶	1 149	1 042(90.7)	1.466(1.051~2.046)	0.024	1 014(97.4)	1.545(0.805~2.967)	0.191
离异或丧偶	537	480(89.4)	1.203(0.811~1.785)	0.359	463(96.5)	1.164(0.564~2.400)	0.682
样本来源
医疗机构	1 420	1 275(89.8)	1.000		1 228(96.5)	1.000
检测咨询	1 809	1 602(88.6)	0.813(0.636~1.039)	0.098	1 544(96.8)	0.971(0.620~1.521)	0.898
监管场所	70	43(61.4)	0.353(0.193~0.646)	0.001	34(89.5)	0.959(0.254~3.620)	0.951
专题调查	285	259(90.9)	0.966(0.609~1.530)	0.882	250(97.3)	1.168(0.504~2.708)	0.718
其他	338	291(86.1)	0.793(0.552~1.139)	0.210	285(97.9)	1.709(0.705~4.145)	0.236
开始抗病毒治疗时CD4计数(个/μl)
< 200		1 160			1 110(95.7)	1.000
201~		1 114			1 081(97.0)	1.561(0.976~2.496)	0.063
≥351		1 180			1 150(97.5)	1.880(1.149~3.078)	0.012

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