HIV testing strategy for reaching the first 90% target: an analysis from Honghe Hani and Yi Autonomous Prefecture, Yunnan Province
YAN Wenjun and HUANG Nengmei contributed equally to this article
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摘要:
目的 分析实现90%检测发现目标的2022年云南省红河哈尼族彝族自治州(简称红河州)人类免疫缺陷病毒(human immunodeficiency virus, HIV)检测情况，为制定精准高效的HIV检测策略提供参考。 方法 在艾滋病综合防治信息系统的基础上，结合相关资料和工作报告，同时对红河州2022年新报告和既往HIV阳性病例开展溯源，以获悉不同来源的检测情况，使用logistic回归分析模型分析晚发现相关因素。 结果 2022年红河州共开展HIV抗体筛查3 611 496人次，参与筛查人次数占总人数的81.99%，检出HIV感染者1 002例，粗检出率为2.8/万。医疗机构、基层医疗卫生机构的HIV筛查人次数分别占总筛查人次数的35.88%和50.62%，发现HIV病例数分别占总病例数的51.30%和22.75%。HIV接触者溯源的粗检出率最高(1 077.8/万)，其次为自愿咨询检测(69.5/万)。医疗机构晚发现比例最高(49.22%)。多因素logistic回归分析模型分析结果显示，男性(aOR=2.47, 95% CI: 1.80~3.39)、≥50岁年龄组(aOR=1.66, 95% CI: 1.22~2.26)、样本来源为医疗机构(aOR=3.29, 95% CI: 1.80~6.02)的病例晚发现风险高，同性性传播(aOR=0.40, 95% CI: 0.17~0.91)的病例晚发现风险低(均P＜0.05)。 结论 为实现95%的检测发现目标，需发挥基层医疗卫生机构的作用，加强HIV接触者溯源检测，同时应进一步优化医疗机构检测发现策略。 Abstract:Objective This study evaluated the human immunodeficiency virus (HIV) testing coverage and performance achieving the 90% target for case identification in 2022 within the Honghe Hani and Yi Autonomous Prefecture (Honghe Prefecture), Yunnan Province. The aim was to provide evidence-based insights for the development of targeted and cost-effective HIV testing strategies. Methods Based on HIV/AIDS Comprehensive Response Information Management System, along with relevant documents and work reports, a contact tracing survey was conducted among newly reported and previously diagnosed HIV-positive cases in Honghe Prefecture in 2022 to understand the sources of HIV testing. A logistic regression model was used to analyze factors associated with late HIV diagnosis. Results In 2022, a total of 3 611 496 individuals underwent HIV antibody screening in Honghe Prefecture, representing 81.99% of the total population. Among them, 1 002 HIV-infected individuals were identified, resulting in a crude detection rate of 2.8 per 10 000. Medical institutions and community health facilities accounted for 35.88% and 50.62% of the total HIV testing volume, respectively, identifying 51.30% and 22.75% of the total cases. The crude detection rate was highest among HIV contact tracing (1 077.8 per 10 000), followed by voluntary counseling and testing (VCT) (69.5 per 10 000). The highest proportion of late HIV diagnosis occurred in medical institutions (49.22%). Multivariate logistic regression analysis showed that males (aOR=2.47, 95% CI: 1.80-3.39), individuals aged 50 years and older (aOR=1.66, 95% CI: 1.22-2.26), and those identified through medical institutions (aOR=3.29, 95% CI: 1.80-6.02) had higher risk of late diagnosis. In contrast, individuals infected through homosexual transmission (aOR=0.40, 95% CI: 0.17-0.91) had lower risk of late diagnosis (all P < 0.05). Conclusions To achieve the 95% case detection target, it is crucial to strengthen the role of community health facilities, enhance HIV contact tracing efforts, and further refine HIV testing strategies in medical institutions. -
Key words:
- Human immunodeficiency virus /
- Testing /
- Testing strategy
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图 1 2022年云南省红河哈尼族彝族自治州HIV接触者溯源检测
HIV：人类免疫缺陷病毒。
Figure 1. Flow chart of contact tracing for index HIV cases in Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, 2022
HIV: human immunodeficiency virus.
表 1 2022年云南省红河哈尼族彝族自治州不同来源人口HIV检测情况
Table 1. HIV testing by source population in Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, 2022
来源Sources 人数Number of people 筛查人次数Number of screenings② 阳性人次数Number of positive individuals③ 新报告阳性人数Number of newly reported cases④ 晚发现比例Proportion of late presentation/%⑤ 所有检测来源All sources of detection 4 405 000⑥ 3 611 496(81.99) 12 074(0.33) 1 002(2.8) 38.32 医疗机构Medical institutions 18 700 000⑦ 1 295 851(6.93) 7 137(0.55) 514(4.0) 49.22 术前检测Preoperative testing ― 262 104 1 257(0.48) 51(1.9) 45.10 受血(制品)前检测Pre-transfusion testing ― 33 489 30(0.09) 0(0) 0 性病门诊Sexually transmitted disease clinic ― 20 241 178(0.88) 14(6.9) 50.00 其他就诊者检测Testing for other patients ― 903 486 5 400(0.60) 443(4.9) 50.11 孕产期检查Prenatal and postnatal care ― 76 531 272(0.36) 6(0.8) 16.67 基层医疗卫生机构Community health facilities ― 1 828 290 2 620(0.14) 228(1.2) 28.07 社区动员检测Community-based testing ― ― ― 104 27.88 就诊者检测Patient testing ― ― ― 104 27.88 其他检测Others testing ― ― ― 20 30.00 自愿咨询检测Voluntary counseling and testing 9 492 9 492(100.00) 204(2.15) 66(69.5) 24.24 高危人群干预High-risk population 81 576 11 191(13.72) 159(1.42) 30(26.8) 16.67 暗娼人群Female sex workers 26 832 6 003(22.37) 23(0.38) 1(1.7) 0 MSM 11 016 2 524(22.91) 41(1.62) 20(79.2) 15.00 吸毒人群Drug users 43 728 2 664(6.09) 95(3.57) 9(33.8) 22.22 HIV接触者溯源HIV contact tracing 1 197⑧ 835(69.76) 234(28.02) 90(1 077.8) 35.56 羁押人群Incarcerated population ― 16 220 466(2.87) 20(12.3) 15.00 强制/劳教戒毒人员检测Compulsory isolation for drug rehabilitation testing ― 990 102(10.30) 5(50.5) 0 其他羁押人员体检Medical examination of other detainees ― 15 230 364(2.39) 15(9.8) 20.00 婚前检查(含涉外婚检) Pre-marital examination (including foreign-related pre-marital examination) ― 49 475 304(0.61) 30(6.1) 23.33 无偿献血人员检测Unpaid blood donor testing ― 43 659 6(0.01) 6(1.4) 16.67 其他检测Others testing① ― 356 483 944(0.26) 18(0.5) 16.67 注：MSM, 男男性行为者; HIV, 人类免疫缺陷病毒; “―”表示数据缺失。
① 其他检测包括出入境人员体检、娱乐场所人员体检、新兵体检等；② 检测率(%)：筛查人次数/人数；③ 阳性率(%)：阳性人次数/筛查人次数；④ 粗检出率(/万)：新报告阳性人数/筛查人次数；⑤ 晚发现比例：晚发现人数/新报告阳性人数；⑥ 来自2023年云南统计年鉴；⑦ 来自医保报销数据；⑧挖掘到的密切接触者人数。
Note: MSM, men who have sex with men; HIV, human immunodeficiency virus; "―" indicates that the data is missing.
① Other tests include physical examination of entry and exit personnel, physical examination of personnel in entertainment venues, physical examination of recruits, etc.; ② Detection rate(%): the number of screenings/the total number of people; ③ Positive rate(%): number of positive people/number of screenings; ④ Crude detection rate(/10 000): the number of newly reported positives/the number of screenings; ⑤ Proportion of late detection: number of late detections/number of newly reported positives; ⑥ From the 2023 Yunnan Statistical Yearbook; ⑦ From medical insurance reimbursement data; ⑧ The number of close contacts excavated.
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表 2 人口学特征在HIV晚发现病例中的分布情况及logistic回归分析
Table 2. Demographic distribution and logistic regression analysis of late HIV diagnosis cases
特征Characteristic 新报告病例数Number of newly reported cases①② 晚发现病例数Number of late presenters② 晚发现比例Proportion of late presentation/%③ 粗OR值value(95% CI) aOR值value(95% CI) 合计Total 1 002 384 38.32 ― ― 性别Gender 女Female 321 89 27.73 1.00 1.00 男Male 681 295 43.32 1.99 (1.49~2.66)④ 2.47 (1.80~3.39)④ 年龄组/岁Age group/years < 50 563 189 33.57 1.00 1.00 ≥50 439 195 44.42 1.58 (1.22~2.05)④ 1.66 (1.22~2.26)④ 民族Ethnicity 汉族Han 411 169 41.12 1.00 1.00 少数民族Ethnic minorities 591 215 36.38 0.82 (0.63~1.06) 0.97 (0.72~1.32) 文化程度Education 小学及以下Primary school and below 653 257 39.36 1.00 1.00 初中Junior high school 245 94 38.37 0.96 (0.71~1.30) 0.89 (0.64~1.25) 高中及以上Senior high school and above 104 33 31.73 0.72 (0.46~1.11) 0.75 (0.44~1.28) 婚姻状况Marital status 未婚Not married 244 92 37.70 1.00 1.00 已婚有配偶Married 447 162 36.24 0.94 (0.68~1.30) 0.94 (0.64~1.39) 离异或丧偶Divorced or widowed 311 130 41.80 1.19 (0.84~1.67) 1.05 (0.69~1.58) 职业Occupation 有工作Employed 856 317 37.03 1.00 1.00 无工作Unemployed 146 67 45.89 1.44 (1.01~2.05)④ 1.46 (0.95~2.24) 样本来源Sources of sample 自愿咨询检测Voluntary counseling and testing 66 16 24.24 1.00 1.00 医疗机构Medical institutions 514 253 49.22 3.03 (1.68~5.46)④ 3.29 (1.80~6.02)④ 基层医疗卫生机构Community health facilities 228 64 28.07 1.22 (0.65~2.30) 1.24 (0.65~2.38) 其他Others 194 51 26.29 1.12 (0.58~2.13) 1.23 (0.62~2.42) 传播途径Mode of transmission 异性性传播Heterosexual transmission 935 364 38.93 1.00 1.00 同性性传播Homosexual transmission 44 9 20.45 0.40 (0.19~0.85)④ 0.40 (0.17~0.91)④ 其他Others 23 11 47.83 1.44 (0.63~3.29) 1.75 (0.70~4.40) 注：“―”表示数据无法获取。
①新报告病例数：统计时间内新报告HIV/AIDS患者的人数；②表示新报告病例数和晚发现病例数均按报告地区统计；③晚发现比例：新报告的HIV/AIDS中晚发现的比例，为晚发现病例数/新报告病例数；④P < 0.05。
Note："―" indicates that the data cannot be obtained.
① Number of newly reported cases: the number of newly reported HIV-infected individuals and AIDS patients within the study period; ② Both newly reported cases and late presenters are counted based on the reporting location; ③ Proportion of late presentation: refers to the proportion of late presenters among newly reported HIV-infected individuals or AIDS patients, calculated as the number of late presenters divided by the number of newly reported cases; ④ P < 0.05.
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