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北京市HIV抗体快速检测为阳性的男男性行为人群后续确认检测行为的相关因素分析
作者:夏冬艳 刘国武 曾吉 李洋 苏雪丽 孙伟东 李佳 张琴 郝明强 叶景荣 辛若雷 赵月娟 王娟 卢红艳

摘要:

目的  分析北京市经HIV抗体快速检测为阳性的男男性行为人群(MSM)后续确认检测行为情况及其相关因素。方法  采用连续抽样的方法,选取2013年5月1日至12月31日在北京市参加中国卫生部-比尔及梅琳达盖茨基金会艾滋病防治合作项目延期项目的MSM为调查对象,纳入标准为:18岁以上,自报既往发生过男男性行为,经口腔黏膜渗出液HIV抗体快速检测为阳性,且非既往报告到中国疾病预防控制信息系统的HIV抗体阳性者。共调查1 003例。根据项目策略,由MSM草根组织将调查对象转介到指定的CDC或医院进行后续确认检测,包括HIV抗体指尖血快速检测、静脉血ELISA法HIV抗体检测、静脉血Western blot HIV抗体检测。采用χ2检验比较不同特征调查对象后续确认检测情况差异,采用多因素二分类非条件logisitc回归模型分析调查对象后续确认检测的相关因素。结果  1 003例调查对象的年龄为(30.9±9.1)岁,87.8%(881例)接受了HIV抗体指尖血快速检测,阳性率为85.4%(752/881),其中98.0% (737/752)接受了静脉血ELISA和Western blot确认检测,阳性率为94.4%(696/737)。与前往CDC进行后续确认检测的MSM相比,前往医院者接受后续确认检测的OR (95%CI)值为5.10(1.69~15.36);与近6个月无肛交行为/或有肛交每次使用安全套的MSM相比,有时使用安全套和从未使用安全套者接受后续确认检测的OR (95%CI)值分别为5.81(2.14~15.77)和3.45 (2.00~5.97);与通过网络被干预动员的MSM相比,浴池、公园/公厕和酒吧被干预动员者后续确认检测的OR(95%CI)值分别为0.17 (0.05~0.53)、0.10(0.04~0.29)和0.22 (0.06~0.79);随着MSM近3个月男性性伴数的增加,接受后续确认检测的可能性降低,OR(95%CI)值为0.92(0.86~0.99)。结论  在浴池、公园/公厕和酒吧被动员的MSM后续确认检测率较低,肛交行为中不能每次使用安全套者的后续确认检测率较高。由医疗机构进行后续确认检测可以增加快检阳性的MSM进行后续确认检测的可能性,男性性伴数与是否接受后续确认检测呈负相关。

关键词:同性恋,男性;HIV抗体;影响因素;横断面研究

Abstract:

Objective  To analyze the proportion and associated factors of taking subsequent confirmation test among men who have sex with men (MSM) after being tested positive in oral fluid HIV antibody test.Methods  By using successive sampling, 1 003 MSM, who were tested positive in oral fluid HIV antibody test in China-Bill & Melinda Gates Foundation AIDS prevention Program (Extension program) in Beijing during May 1 to December 31, 2013, were recruited. The inclusion criteria included: the objects were men who reported having sex with men; the objects aged more than 18 years old; the objects were tested positive in oral fluid HIV antibody test; the objects had not been reported as HIV positives in China Information System for Disease Control and Prevention previously. According to the program strategy, MSM grassroots organizations transferred the respondents to seek subsequent confirmation tests in specific Center for Disease Control and Prevention (CDCs) or hospitals. The subsequent confirmation tests included: fingertip blood HIV antibody rapid test, venous blood Enzyme Linked Immunosorbent Assay (ELISA) HIV antibody test and venous blood Western Blot (WB) HIV antibody test. Chi-square test was adopted to compare the proportion of taking subsequent confirmation tests in different groups. Nonconditional multivaritae binarylogistic regression analysis was taken to identify the associated factors with whether taking subsequent confirmation tests and to calculate the OR (95%CI) values.Results  The 1 003 respondents were (30.9±9.1) years old. Among all objects, 87.8% (881/1 003) of them took fingertip blood HIV antibody rapid tests and the positive rate was 85.4% (752/881). 98.0% (737/752) of those who were identified as positive in fingertip blood HIV rapid tests took ELISA and WB tests, and the positive rate was 94.4% (696/737). Comparing with those who were expected to seek subsequent confirmation tests in CDCs, the OR (95%CI) value of those who were expected to seek tests in hospitals was 5.10 (1.69-15.36). The OR (95% CI) values of those who used condom sometimes and those who never used condom in anal sex were 5.81 (2.14-15.77) and 3.45 (2.00-5.97) respectively, in comparison with those who reported not having anal sex or using condom consistently in anal sex during the past 6 months. Comparing with the respondents recruited from the internet, the OR (95% CI) values of those recruited in bathrooms, parks/toilets and bars were 0.17 (0.05-0.53), 0.10 (0.04-0.29) and 0.22 (0.06-0.79) respectively. The likelihood of taking subsequent confirmation test decreased with the increase of number of male sexual partners in the past 3 months, and the OR (95%CI) value was 0.92 (0.86-0.99).Conclusion  The potential HIV positive MSM in the bathroom, park/toilet and bars are less likely to take subsequent confirmation test. Those who do not use condom consistently during anal sex are more likely to seek subsequent confirmation test. Medical organization conducting subsequent confirmation tests is more likely to increase the confirmation test rate of potential HIV positive MSM. The number of male sexual partners has negative correlation with whether to accept the subsequent confirmation test.

Key words: Homosexuality, male;HIV antibodies;Influence factors;Cross-sectional studies

发表日期:2016/2

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2016.02.010.T001:表1 不同特征HIV抗体快速检测为阳性的男男性行为人群后续确认检测情况比较(n=1 003)

    10.3760/cma.j.issn.0253-9624.2016.02.010.T001:表1 不同特征HIV抗体快速检测为阳性的男男性行为人群后续确认检测情况比较(n=1 003)

  • 10.3760/cma.j.issn.0253-9624.2016.02.010.T002:表2 影响调查对象后续确认HIV检测的多因素非条件logistic回归分析(n=1 003)

    10.3760/cma.j.issn.0253-9624.2016.02.010.T002:表2 影响调查对象后续确认HIV检测的多因素非条件logistic回归分析(n=1 003)

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