文章摘要
姚仕堂,叶润华,杨跃诚,项丽芬,王继宝,杜本丽,韩文香,聂永英,杨忠桔,李唯美,何纳,段松.云南省德宏州HIV感染者拒绝抗病毒治疗的比例及其影响因素[J].中华流行病学杂志,2014,35(12):1324-1328
云南省德宏州HIV感染者拒绝抗病毒治疗的比例及其影响因素
Proportion and related influencing factors of HIV-infected individuals that rejecting the antiretroviral therapy among all the HIV infections, Dehong prefecture,Yunnan province
收稿日期:2014-06-19  出版日期:2014-12-10
DOI:10.3760/cma.j.issn.0254-6450.2014.12.003
中文关键词: 抗病毒治疗;人类免疫缺陷病毒;拒绝
英文关键词: Antiretroviral therapy;Human immunodeficiency virus;Refusal
基金项目:国家重点地区艾滋病防治项目; 国家自然科学基金(81373062); 国家科技重大专项(2011ZX10004-903)
作者单位E-mail
姚仕堂 云南省德宏州疾病预防控制中心, 678400  
叶润华 云南省德宏州疾病预防控制中心, 678400  
杨跃诚 云南省德宏州疾病预防控制中心, 678400  
项丽芬 云南省德宏州疾病预防控制中心, 678400  
王继宝 云南省德宏州疾病预防控制中心, 678400  
杜本丽 芒市疾病预防控制中心  
韩文香 陇川县疾病预防控制中心  
聂永英 盈江县疾病预防控制中心  
杨忠桔 瑞丽市疾病预防控制中心  
李唯美 梁河县疾病预防控制中心  
何纳 复旦大学公共卫生学院流行病学教研室 公共卫生安全教育部重点实验室 nhe@shmu.edu.cn 
段松 云南省德宏州疾病预防控制中心, 678400 dhduansong@sina.com.cn 
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中文摘要:
      目的 了解云南省德宏州HIV感染者拒绝抗病毒治疗的比例及其影响因素.方法 对德宏州截止2013年12月31日拒绝抗病毒治疗、年龄≥16岁的所有存活HIV感染者进行调查.结果 德宏州存活的HIV感染者中拒绝抗病毒治疗的比例为7.4%(605/8 136).拒绝治疗的605例患者以男性、年龄31~45岁、农民、已婚、少数民族、小学及以下文化程度、性传播、CD4+T淋巴细胞计数>350 cell/mm3为主,构成比分别为72.9%、57.2%、75.4%、52.2%、41.3%、58.7%、61.2%、66.6%.多因素logistic回归分析显示:在控制了潜在混杂因素影响后,感染者所在县(市)、性别、年龄、民族、CD4+T淋巴细胞计数等特征与其拒绝抗病毒治疗有显著关联,盈江县、女性、年龄31~45岁的HIV感染者拒绝抗病毒治疗的比例显著低于瑞丽市、男性、年龄≤30岁感染者;而傣族、无CD4+T淋巴细胞计数的HIV感染者拒绝抗病毒治疗比例则显著高于汉族、CD4+T淋巴细胞计数≤350 cell/mm3的感染者.605例HIV感染者拒绝抗病毒治疗的原因:怕暴露84例(13.9%)、对抗病毒治疗认识有误区111例(18.3%)、自觉健康状况良好340例(56.2%)、其他70例(11.6%).其中181例CD4+T淋巴细胞计数≤350 cell/mm3的患者拒绝治疗的原因:怕暴露40例(22.1%)、对治疗认识有误区36例(19.9%)、自觉健康状况良好84例(46.4%)、其他21例(11.6%);不同县(市)、不同性别、不同年龄、不同婚姻状态、不同感染途径者其拒绝抗病毒治疗的原因显著不同.结论 德宏州有一定比例的HIV感染者拒绝抗病毒治疗,应针对不同特征及不同原因拒绝治疗的HIV感染者进行针对性的健康教育,进一步提高抗病毒治疗覆盖率.
英文摘要:
      Objective To examine the proportion and influencing factors on HIV-infected individuals who rejecting the antiretroviral therapy among all the HIV positives,in Dehong prefecture,Yunnan province. Methods A cross-sectional analysis was conducted on all the local HIV-infected survivals aged over 16 year old who refused to receive antiretroviral therapy (ART) by the end of 2013 in Dehong prefecture. Results The proportion of those rejecting the ART among HIV-infected survivals and aged over 16 years old in Dehong prefecture,was 7.4% (605/8 136). Factors related to the ‘rejection' among the 605 refusals would include:being male (72.9%),aged 31-45 years (57.2%), peasants (75.4%),married (52.2%),with minor ethnicity (41.3%),illiterate or only having primary school education (58.7%),infected through sexual contacts (61.2%),and with CD4+T cell counts >350 cells/mm3 (66.6%). Data from the multiple logistic regression analysis indicated that rejecting the ART was significantly associated with areas,gender,age,ethnicity and CD4+T cell counts of the HIV patients. Those who were from Yingjiang county,female,aged 31-45 years old had lower proportions of ART refusals than those who were from Ruili city,male,aged ≤30 year old. Those who were of Dai minority and had no records on CD4+T cell counts,had higher proportions of ART refusals than those who were of Han ethnicity and had CD4+T cell counts ≤350 cells/mm3. Reasons for the 605 HIV-infected patients with rejection to the ART would include fear of disclosure of HIV infection status (84,13.9%),misunderstandings of the effectiveness and side effects of ART (111,18.3%),self-realized wellness (340,56.2%) and others (70,11.6%). Of them,reasons for the 181 patients with CD4+T cell counts ≤350 cells/mm3 that rejecting ART would include fearfulness on the disclosure of HIV infection status (40,22.1%),misunderstandings of the effectiveness and side effects of ART (36,19.9%),self-realized wellness (84,46.4%) and others (21,11.6%). Among those who rejected ART,reasons for that would vary by areas,gender,age,marital status and routes of HIV transmission,according to the results from Chi-squared tests. Conclusion A substantial proportion of HIV-infected individuals rejected ART in Dehong prefecture of Yunnan province. It was urgently needed to enhance health education programs of ART tailored for those HIV-infected patients,according to different characteristics and reasons for rejection,so as to promote the ART in this prefecture.
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