贵州省男男性行为人群个体HIV感染风险评估工具应用与预测能力分析

钱晓涵; 郑敏; 张玉琼; 何佳谕; 姚永明; 陶锐; 马琳; 李东民; 袁智

Abstract

钱晓涵,郑敏,张玉琼,何佳谕,姚永明,陶锐,马琳,李东民,袁智.贵州省男男性行为人群个体HIV感染风险评估工具应用与预测能力分析[J].Chinese journal of Epidemiology,2021,42(4):672-676

贵州省男男性行为人群个体HIV感染风险评估工具应用与预测能力分析

Analysis on prediction power of HIV infection risk assessment tool in men who have sex with men in Guizhou province

Received:September 23, 2020

DOI：10.3760/cma.j.cn112338-20200923-01180

KeyWord: 男男性行为人群艾滋病病毒危险因素风险评估预测能力

English Key Word: Men who have sex with men HIV Risk factor Risk assessment Prediction power

FundProject:贵州省科技厅科技支撑项目（2017-2886）；贵州省科技厅基础研究项目（2018-1095）

Author Name	Affiliation	E-mail
Qian Xiaohan	Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
Zheng Min	Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China	4456668@qq.com
Zheng Yuqiong	Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
He Jiayu	Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
Yao Yongming	Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
Tao Rui	Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
Ma Lin	Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
Li Dongmin	National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Yuan Zhi	Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China

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Abstract:

目的评估MSM个体HIV感染风险评估工具的预测能力及在贵州省MSM中的适用性。方法通过滚雪球方式招募MSM研究对象，应用MSM个体HIV感染风险评估工具（包括8个风险评估问题）进行调查，结合HIV血清学检测结果，对评估工具的风险预测能力进行分析评价。结果 2018年1月至2019年12月共招募3 379例MSM，HIV感染率为3.3%（111/3 379）。HIV阳性者和HIV阴性者风险得分平均值分别为（12.15±3.08）和（12.07±3.07），差异有统计学意义（t=8.69，P<0.001）。按照决策树原理，个体风险得分为3类：≤11.96、11.97～和>14.80分，HIV感染率分别为0.8%、4.3%和8.6%，个体风险得分越高，HIV感染率越高（趋势χ²=88.18，P<0.001）。多因素logistic回归分析结果显示，个体风险得分越高，感染HIV的风险也越高，相比于得分≤11.96组，得分11.96～14.80组和>14.80组的aOR值（95%CI）分别为6.34（3.38～11.88）和14.07（7.44～26.61）；HIV感染风险的相关因素中，苗族高于汉族（aOR=1.83，95%CI：1.04～3.21），小学及以下文化程度高于本科或大专（aOR=2.50，95%CI：1.06~5.88），双性恋高于同性恋（aOR=1.95，95%CI：1.19～3.19），既往未检测HIV者高于HIV检测者（aOR=1.53，95%CI：1.01～2.33）。对HIV感染预测的受试者工作特征曲线下面积为0.751（95%CI：0.710～0.792，P<0.001），约登指数最大的点为个体风险得分为12.56（灵敏度和特异度分别为0.838和0.412）。结论贵州省MSM个体HIV感染风险评估工具个体风险得分越高，感染HIV的风险也越高，可以较好地用于评估MSM个体的HIV感染风险，但该工具的特异度尚有待提高。

English Abstract:

Objective To evaluate the prediction power of HIV infection risk assessment tool and the applicability in MSM in Guizhou province. Methods MSM were recruited through snowball sampling method. Questionnaire surveys were conducted among the MSM using HIV infection risk assessment tool, and combined with HIV serologic test results, the risk prediction power of HIV infection risk assessment tool was evaluated. Results A total of 3 379 MSM were recruited from January 2018 to December 2019 in Guizhou. The HIV infection rate was 3.3%(111/3 379). The mean risk scores of HIV positive and HIV negative MSM were (12.15±3.08) and (12.07±3.07), respectively. The difference in risk score was significant between MSM with different HIV status (t=8.69, P<0.001). According to the principle of decision tree, individual risk scores were divided into following three categories: ≤ 11.96, 11.97-14.80 and >14.80, the HIV infection rate was 0.8%, 4.3% and 8.6% respectively, suggesting that the higher the individual risk score was, the higher the HIV infection rate was (trend χ²=88.18, P<0.001). Multivariate logistic regression analysis showed that the higher the individual risk score was, the higher the risk of HIV infection was. Compared to the total score ≤ 11.96, the aOR values at total scores of 11.97-14.80 and >14.80 were 6.34 (95%CI:3.38-11.88) and 14.07(95%CI:7.44-26.61), respectively. The risk of HIV infection in Miao ethnic group was higher than that in Han ethnic group (aOR=1.83, 95%CI:1.04-3.21), and the risk of HIV infection in those with education level of primary school and below was higher than that in undergraduates or those with education level of junior college and above (aOR=2.50, 95%CI:1.06-5.88), and the risk of HIV infection was higher in those who had bisexual behaviors than in those who had homosexual behaviors (aOR=1.95, 95%CI:1.19-3.19). The risk of HIV infection was higher in those who had never received HIV testing (aOR=1.53, 95%CI:1.01-2.33). The area under the receiver operating characteristic (ROC) curve and area under ROC (AUC) for HIV infection prediction was 0.751 (95%CI:0.710-0.792, P<0.001). The maximum Youden's index was individual risk score of 12.56, and the sensitivity of the risk assessment tool was 0.838, and its specificity was 0.412. Conclusions The results of HIV infection risk assessment tool in Guizhou indicated that in MSM the higher the individual risk score, the higher the risk of HIV infection is. The tool can be used to evaluate the risk of HIV infection in MSM, but the specificity should be improved.

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