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Article(id=1241771812929999159, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202404438, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1712505600000, receivedDateStr=2024-04-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773991071207, onlineDateStr=2026-03-20, pubDate=1729785600000, pubDateStr=2024-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773991071207, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773991071207, creator=13701087609, updateTime=1773991071207, updator=13701087609, issue=Issue{id=1241771801366299468, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773991068450, creator=13701087609, updateTime=1773991676896, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774353457681403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774353457681404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3799, endPage=3803, ext={EN=ArticleExt(id=1241771814976819560, articleId=1241771812929999159, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis on the late diagnosis of newly reported HIV/AIDS cases, Heibei Province, 2016-2022, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the late diagnosis of newly reported HIV/AIDS in Hebei province from 2016 to 2022, and to understand the proportion of late diagnosis of HIV/AIDS and its influencing factors.

Methods

The information of newly reported HIV/AIDS cases in Hebei province from 2016 to 2022 was collected through the national basic information system of HIV/AIDS, and identified relevant cases by definition of late diagnosis. Trend Chi-square test was used to analyze the changing trend of late diagnosis proportion, the influencing factors of late diagnosis were analyzed by Chi-square test and Logistic regression model.

Results

From 2016 to 2022, 14 689 HIV/AIDS cases were newly reported in Hebei province, and the proportion of late diagnosis was 33.1%. The proportion of late diagnosis showed an upward trend in each year (χ2=69.826, P<0.001). The results of Logistic regression showed that the proportion of late diagnosis was higher in the farmers, the source of testing consulting and medical institutions and other, and the higher age group. The OR (95%CI) of farmers was 1.154 (1.021-1.303) compared with the household workers, and the unemployed. Compared with the custodial population, the OR (95%CI) of testing counseling and medical institutional and other sources were 1.909 (1.236-2.949), 3.205 (2.08-4.938) and 1.808 (1.136-2.875). The OR (95%CI) of each age group was 1.945 (1.469-2.577), 3.279 (2.458-4.375), 3.996 (2.97-5.377), 5.223 (3.87-7.05) and 5.202 (3.814-7.095), respectively. The proportion of late diagnosis varies greatly in different cities, City 5, City 11 and City 1 was higher than the average of the whole province.

Conclusion

From 2016 to 2022, the proportion of late diagnosis HIV/AIDS cases in Hebei province is increased in each year, and there are big regional differences. Occupation, sample source and age are the influential factors of late diagnosis, targeted measures should be taken to prevent and improve the ability of early detection.

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目的

分析2016—2022年河北省新报告艾滋病病毒感染者/艾滋病患者(HIV/AIDS)晚发现情况，了解全省HIV/AIDS晚发现比例及影响因素。

方法

通过艾滋病防治基本信息系统获得2016—2022年河北省新报告HIV/AIDS数据库，按晚发现定义识别相关病例。采用趋势χ2检验分析晚发现比例变化趋势，采用χ2检验和logistic回归模型分析晚发现影响因素。

结果

2016—2022年河北省新报告HIV/AIDS病例数为14 689，晚发现比例为33.1%。各年度晚发现比例呈上升趋势（χ2=69.826，P<0.001）。不同城市晚发现比例不同。Logistic回归模型结果显示农民、检测咨询、医疗机构及其他来源、越高年龄组HIV/AIDS病例晚发现率更高，与家政、家务及待业人群相比，农民OR值（95% CI）为1.154（1.021～1.303）；与羁押人群相比，检测咨询与、医疗机构、其他来源的OR值（95% CI）分别为1.909（1.236～2.949）、3.205（2.08～4.938）和1.808（1.136～2.875）；与0～19岁组相比，各年龄组OR值（95% CI）分别为1.945（1.469～2.577）、3.279（2.458～4.375）、3.996（2.97～5.377）、5.223（3.87～7.05）和5.202（3.814～7.095）。

结论

2016—2022年河北省新报告HIV/AIDS晚发现比例逐年上升，地区差异大。职业、样本来源、年龄是晚发现的影响因素，应采取针对性的防控手段，提高早发现能力。

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吴小雪，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=IIwBzisqTRPao24/r9sn5Q==, magXml=ZiYVyVpNY49QK/sT6I11QQ==, pdfUrl=null, pdf=7a2R8rcOLd2J6uklqSxiow==, pdfFileSize=495228, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=dCuWcYV2D4krVWWJh1aaLQ==, mapNumber=null, authorCompany=null, fund=null, authors=

吴小雪（1989—），女，硕士，主管医师，研究方向：艾滋病防治工作

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吴小雪（1989—），女，硕士，主管医师，研究方向：艾滋病防治工作

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(In Chinese), articleTitle=HIV/AIDS case detection and influencing factors for late diagnosis in Hangzhou from 2013 to 2018, refAbstract=null), Reference(id=1241771829149373385, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2021, volume=27, issue=11, pageStart=1294, pageEnd=1295, url=null, language=null, rfNumber=[13], rfOrder=24, authorNames=冯爱娟, 王宇红, 宋萍, journalName=中国艾滋病性病, refType=null, unstructuredReference=冯爱娟，王宇红，宋萍，等．兰州市报告HIV/AIDS病例晚发现情况及影响因素分析[J]．中国艾滋病性病，2021，27（11）：1294-1295．, articleTitle=兰州市报告HIV/AIDS病例晚发现情况及影响因素分析, refAbstract=null), Reference(id=1241771829266813902, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2021, volume=27, issue=11, pageStart=1294, pageEnd=1295, url=null, language=null, rfNumber=[13], rfOrder=25, authorNames=Feng AJ, Wang YH, Song P, journalName=Chinese Journal of AIDS & STD, refType=null, unstructuredReference=Feng AJ, Wang YH, Song P, et al.Analysis on late discovery of newly reported HIV/AIDS cases in Lanzhou City[J]. Chinese Journal of AIDS & STD, 2021, 27(11): 1294-1295. (In Chinese), articleTitle=Analysis on late discovery of newly reported HIV/AIDS cases in Lanzhou City, refAbstract=null), Reference(id=1241771829363282899, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=11, pageStart=1197, pageEnd=1201, url=null, language=null, rfNumber=[14], rfOrder=26, authorNames=秦倩倩, 蔡畅, 金怡晨, journalName=中国艾滋病性病, refType=null, unstructuredReference=秦倩倩，蔡畅，金怡晨，等．2015—2022年我国报告≥50岁经商业异性性行为感染的HIV/AIDS患者特征分析[J]．中国艾滋病性病，2023，29（11）：1197-1201．, articleTitle=2015—2022年我国报告≥50岁经商业异性性行为感染的HIV/AIDS患者特征分析, refAbstract=null), Reference(id=1241771829455557589, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=11, pageStart=1197, pageEnd=1201, url=null, language=null, rfNumber=[14], rfOrder=27, authorNames=Qin QQ, Cai C, Jin YC, journalName=Chinese Journal of AIDS & STD, refType=null, unstructuredReference=Qin QQ, Cai C, Jin YC, et al. Analysis of reported HIV/AIDS patients aged 50 years old and above infected by commercial heterosexual sex in China from 2015 to 2022[J]. Chinese Journal of AIDS & STD, 2023, 29(11): 1197-1201. (In Chinese), articleTitle=Analysis of reported HIV/AIDS patients aged 50 years old and above infected by commercial heterosexual sex in China from 2015 to 2022, refAbstract=null), Reference(id=1241771829564609498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2023, volume=37, issue=12, pageStart=1401, pageEnd=1407, url=null, language=null, rfNumber=[15], rfOrder=28, authorNames=冯天达, 吴舒棋, 沈雪桥, journalName=中国皮肤性病学杂志, refType=null, unstructuredReference=冯天达，吴舒棋，沈雪桥，等．2017—2021年广西某综合医院新报告HIV/AIDS晚发现病例特征及影响因素[J]．中国皮肤性病学杂志，2023，37（12）：1401-1407．, articleTitle=2017—2021年广西某综合医院新报告HIV/AIDS晚发现病例特征及影响因素, refAbstract=null), Reference(id=1241771829686244316, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2023, volume=37, issue=12, pageStart=1401, pageEnd=1407, url=null, language=null, rfNumber=[15], rfOrder=29, authorNames=Feng TD, Wu SQ, Shen XQ, journalName=The Chinese Journal of Dermatovenereology, refType=null, unstructuredReference=Feng TD, Wu SQ, Shen XQ, et al. Epidemic characteristics and influencing factors of HIV/AIDS cases dectection late in a general hospital of Guangxi from 2017 to 2021[J]. The Chinese Journal of Dermatovenereology, 2023, 37(12): 1401-1407. (In Chinese), articleTitle=Epidemic characteristics and influencing factors of HIV/AIDS cases dectection late in a general hospital of Guangxi from 2017 to 2021, refAbstract=null), Reference(id=1241771829765936095, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2019, volume=23, issue=12, pageStart=1436, pageEnd=1441, url=null, language=null, rfNumber=[16], rfOrder=30, authorNames=曹文杰, 袁智, 姚永明, journalName=中华疾病控制杂志, refType=null, unstructuredReference=曹文杰，袁智，姚永明，等．2014—2018年贵州省新报告 HIV/AIDS病例晚发现比例及其影响因素[J]．中华疾病控制杂志，2019，23（12）：1436-1441．, articleTitle=2014—2018年贵州省新报告 HIV/AIDS病例晚发现比例及其影响因素, refAbstract=null), Reference(id=1241771829841433569, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2019, volume=23, issue=12, pageStart=1436, pageEnd=1441, url=null, language=null, rfNumber=[16], rfOrder=31, authorNames=Cao WJ, Yuan Z, Yao YM, journalName=Chinese Journal of Disease Control & Prevention, refType=null, unstructuredReference=Cao WJ, Yuan Z, Yao YM, et al. Analysis of late diagnosis and its influencing factors of newly reported HIV/AIDS in Guizhou Province from 2014 to 2018[J]. Chinese Journal of Disease Control & Prevention, 2019, 23(12): 1436-1441. (In Chinese), articleTitle=Analysis of late diagnosis and its influencing factors of newly reported HIV/AIDS in Guizhou Province from 2014 to 2018, refAbstract=null), Reference(id=1241771829979845604, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=7, pageStart=733, pageEnd=736, url=null, language=null, rfNumber=[17], rfOrder=32, authorNames=汤后林, 李东民, 秦倩倩, journalName=中国艾滋病性病, refType=null, unstructuredReference=汤后林，李东民，秦倩倩，等．传承与发展循证推进我国艾滋病监测工作高质量开展[J]．中国艾滋病性病，2023，29（7）：733-736．, articleTitle=传承与发展循证推进我国艾滋病监测工作高质量开展, refAbstract=null), Reference(id=1241771830076314598, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=7, pageStart=733, pageEnd=736, url=null, language=null, rfNumber=[17], rfOrder=33, authorNames=Tang HL, Li DM, Qin QQ, journalName=Chinese Journal of AIDS & STD, refType=null, unstructuredReference=Tang HL, Li DM, Qin QQ, et al.Inheritance and development, evidence-based AIDS surveillance in our country promoting high-quality development[J]. Chinese Journal of AIDS & STD, 2023, 29(7): 733-736. (In Chinese), articleTitle=Inheritance and development, evidence-based AIDS surveillance in our country promoting high-quality development, refAbstract=null), Reference(id=1241771830172783593, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2024, volume=30, issue=1, pageStart=6, pageEnd=10, 19, url=null, language=null, rfNumber=[18], rfOrder=34, authorNames=金琳, 张进, 秦义组, journalName=安徽预防医学杂志, refType=null, unstructuredReference=金琳，张进，秦义组，等．安徽省2018—2022年新诊断来源于医疗机构的HIV/AIDS晚发现影响因素分析[J]．安徽预防医学杂志，2024，30（1）：6-10, 19．, articleTitle=安徽省2018—2022年新诊断来源于医疗机构的HIV/AIDS晚发现影响因素分析, refAbstract=null), Reference(id=1241771830269252586, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, doi=null, pmid=null, pmcid=null, year=2024, volume=30, issue=1, pageStart=6, pageEnd=10, 19, url=null, language=null, rfNumber=[18], rfOrder=35, authorNames=Jin L, Zhang J, Qin YZ, journalName=Anhui Journal of Prevent Medicine, refType=null, unstructuredReference=Jin L, Zhang J, Qin YZ, et al.Analysis of the influential factors of late diagnosis among newly identified HIV/AIDS cases from medical institutions in Anhui Province from 2018 to 2022[J]. Anhui Journal of Prevent Medicine, 2024, 30(1): 6-10, 19. (In Chinese), articleTitle=Analysis of the influential factors of late diagnosis among newly identified HIV/AIDS cases from medical institutions in Anhui Province from 2018 to 2022, refAbstract=null)], funds=[Fund(id=1241771824908931932, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, awardId=20210728, language=CN, fundingSource=2021年度河北省医学科学研究课题(20210728), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241771817371767333, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, xref=null, ext=[AuthorCompanyExt(id=1241771817384350248, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, companyId=1241771817371767333, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of STD/AIDS Control and Prevention, Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei 050021, China), AuthorCompanyExt(id=1241771817392738858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, companyId=1241771817371767333, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=河北省疾病预防控制中心性病艾滋病防治所，河北 石家庄 050021)])], figs=[ArticleFig(id=1241771824057488185, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, language=EN, label=Table 1, caption=

The late diagnosis of newly reported HIV/AIDS cases in Hebei province from 2016 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
年份报告病例数晚发现数合计晚发现比例（%）
1类2类3类4类5类
20161 829803462013448126.3
20171 977924231734858329.5
20182 137895241205267731.7
20192 245825741326373432.7
20202 1951016582026084138.3
20212 409936802038588136.6
20221 897834821437866034.8
合计14 6896203 687116144204 85733.1
), ArticleFig(id=1241771824187511614, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, language=CN, label=表1, caption=

2016—2022年河北省新报告HIV/AIDS晚发现情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份报告病例数晚发现数合计晚发现比例（%）
1类2类3类4类5类
20161 829803462013448126.3
20171 977924231734858329.5
20182 137895241205267731.7
20192 245825741326373432.7
20202 1951016582026084138.3
20212 409936802038588136.6
20221 897834821437866034.8
合计14 6896203 687116144204 85733.1
), ArticleFig(id=1241771824309146438, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, language=EN, label=Table 2, caption=

The late diagnosis of HIV/AIDS in different cities from 2016 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
地区报告病例数晚发现数晚发现比例（%）
城市13 4701 23335.5
城市21 74155631.9
城市377918824.1
城市41 06233331.4
城市597840941.8
城市62 38377432.5
城市763420832.8
城市851817133.0
城市91 67348729.1
城市1086828332.6
城市1158321536.9
全省14 6894 85733.1
), ArticleFig(id=1241771824384643914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, language=CN, label=表2, caption=

2016—2022年各市报告HIV/AIDS晚发现情况

, figureFileSmall=null, figureFileBig=null, tableContent=
地区报告病例数晚发现数晚发现比例（%）
城市13 4701 23335.5
城市21 74155631.9
城市377918824.1
城市41 06233331.4
城市597840941.8
城市62 38377432.5
城市763420832.8
城市851817133.0
城市91 67348729.1
城市1086828332.6
城市1158321536.9
全省14 6894 85733.1
), ArticleFig(id=1241771824615330641, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, language=EN, label=Table 3, caption=

Late diagnosis proportion of HIV/AIDS with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量报告数[n(%)]晚发现单因素分析多因素分析
例数占比（%）χ2PPOR（95%CI）
性别0.0650.799
女1 361（9.3）40729.9
男13 328（90.7）4 03030.2
职业201.496<0.001
家政、家务及待业1 932（13.2）53527.71.00
农民5 694（38.8）2 08036.50.0211.154（1.021,1.303）
工人1 139（7.8）34630.40.9290.992（0.840,1.173）
其他5 924（40.2）1 47624.90.2070.925（0.820,1.044）
婚姻状况363.549<0.001
已婚有配偶6 991（47.6）2 45935.21.00
未婚5 296（36.1）1 09220.60.4780.959（0.856,1.076）
离异或丧偶2 315（15.8）85436.90.3311.051（0.950,1.164）
不详87（0.5）3236.80.6921.097（0.694,1.735）
文化程度198.872<0.001
大专及以上3 817（26.0）89323.41.00
高中或中专3 307（22.5）92227.90.5290.964（0.859,1.081）
初中5 567（37.9）1 82532.80.7470.982（0.879,1.097）
小学及以下1 998（13.6）79739.90.4031.062（0.922,1.224）
性病史4.1210.127
无11 374（77.4）3 39229.8
有1 447（9.9）44630.8
不详1 868（12.7）59932.1
感染途径102.604<0.001
注射毒品97（0.7）2020.61.00
同性传播9 620（65.5）2 68627.90.8331.06（0.617,1.821）
异性传播
配偶阳性616（4.2）17027.60.5610.844（0.476,1.495）
商业性行为1 422（9.7）50935.80.7371.099（0.634,1.904）
非婚非商业2 573（17.5）92435.90.7121.108（0.643,1.91）
非婚未分类84（0.6）2023.80.2450.642（0.305,1.355）
不详/其他277（1.8）10839.00.3701.314（0.724,0.384）
样本来源468.362<0.001
羁押人群193（1.3）2714.01.00
检测咨询5 590（38.1）1 30823.40.0041.909（1.236,2.949）
重点人群975（6.6）16817.20.3481.249（0.785,1.987）
医疗机构7 201（49.0）2 76338.4<0.0013.205（2.080,4.938）
其他730（5.0）17123.40.0121.808（1.136,2.875）
诊断年龄（岁）724.797<0.001
0～19592（4.0）6110.31.00
20～294 114（28.0）76718.6<0.0011.945（1.469,2.577）
30～393 503（23.8）1 02129.1<0.0013.279（2.458,4.375）
40～492 834（19.3）99235.0<0.0013.996（2.970,5.377）
50～592 356（16.0）1 01543.1<0.0015.223（3.870,7.05）
≥601 290（8.9）58145.0<0.0015.202（3.814,7.095）
), ArticleFig(id=1241771824736965463, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771812929999159, language=CN, label=表3, caption=

不同特征HIV/AIDS晚发现比例分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量报告数[n(%)]晚发现单因素分析多因素分析
例数占比（%）χ2PPOR（95%CI）
性别0.0650.799
女1 361（9.3）40729.9
男13 328（90.7）4 03030.2
职业201.496<0.001
家政、家务及待业1 932（13.2）53527.71.00
农民5 694（38.8）2 08036.50.0211.154（1.021,1.303）
工人1 139（7.8）34630.40.9290.992（0.840,1.173）
其他5 924（40.2）1 47624.90.2070.925（0.820,1.044）
婚姻状况363.549<0.001
已婚有配偶6 991（47.6）2 45935.21.00
未婚5 296（36.1）1 09220.60.4780.959（0.856,1.076）
离异或丧偶2 315（15.8）85436.90.3311.051（0.950,1.164）
不详87（0.5）3236.80.6921.097（0.694,1.735）
文化程度198.872<0.001
大专及以上3 817（26.0）89323.41.00
高中或中专3 307（22.5）92227.90.5290.964（0.859,1.081）
初中5 567（37.9）1 82532.80.7470.982（0.879,1.097）
小学及以下1 998（13.6）79739.90.4031.062（0.922,1.224）
性病史4.1210.127
无11 374（77.4）3 39229.8
有1 447（9.9）44630.8
不详1 868（12.7）59932.1
感染途径102.604<0.001
注射毒品97（0.7）2020.61.00
同性传播9 620（65.5）2 68627.90.8331.06（0.617,1.821）
异性传播
配偶阳性616（4.2）17027.60.5610.844（0.476,1.495）
商业性行为1 422（9.7）50935.80.7371.099（0.634,1.904）
非婚非商业2 573（17.5）92435.90.7121.108（0.643,1.91）
非婚未分类84（0.6）2023.80.2450.642（0.305,1.355）
不详/其他277（1.8）10839.00.3701.314（0.724,0.384）
样本来源468.362<0.001
羁押人群193（1.3）2714.01.00
检测咨询5 590（38.1）1 30823.40.0041.909（1.236,2.949）
重点人群975（6.6）16817.20.3481.249（0.785,1.987）
医疗机构7 201（49.0）2 76338.4<0.0013.205（2.080,4.938）
其他730（5.0）17123.40.0121.808（1.136,2.875）
诊断年龄（岁）724.797<0.001
0～19592（4.0）6110.31.00
20～294 114（28.0）76718.6<0.0011.945（1.469,2.577）
30～393 503（23.8）1 02129.1<0.0013.279（2.458,4.375）
40～492 834（19.3）99235.0<0.0013.996（2.970,5.377）
50～592 356（16.0）1 01543.1<0.0015.223（3.870,7.05）
≥601 290（8.9）58145.0<0.0015.202（3.814,7.095）
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2016—2022年河北省新报告HIV/AIDS晚发现情况分析
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吴小雪 , 马琳 , 张亚丽 , 王校丰 , 王敬丘 , 李保军 , 张玉琪 , 路新利
现代预防医学 | 疾病预防控制 2024,51(20): 3799-3803
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现代预防医学 | 疾病预防控制 2024, 51(20): 3799-3803
2016—2022年河北省新报告HIV/AIDS晚发现情况分析
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吴小雪 , 马琳, 张亚丽, 王校丰, 王敬丘, 李保军, 张玉琪, 路新利
作者信息
  • 河北省疾病预防控制中心性病艾滋病防治所，河北 石家庄 050021

    • 吴小雪（1989—），女，硕士，主管医师，研究方向：艾滋病防治工作

通讯作者:

吴小雪，E-mail:
Analysis on the late diagnosis of newly reported HIV/AIDS cases, Heibei Province, 2016-2022
Xiao-xue WU , Lin MA, Ya-li ZHANG, Xiao-feng WANG, Jing-qiu WANG, Bao-jun LI, Yu-qi ZHANG, Xin-li LU
Affiliations
  • Department of STD/AIDS Control and Prevention, Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei 050021, China
出版时间: 2024-10-25 doi: 10.20043/j.cnki.MPM.202404438
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摘要
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目的

分析2016—2022年河北省新报告艾滋病病毒感染者/艾滋病患者(HIV/AIDS)晚发现情况，了解全省HIV/AIDS晚发现比例及影响因素。

方法

通过艾滋病防治基本信息系统获得2016—2022年河北省新报告HIV/AIDS数据库，按晚发现定义识别相关病例。采用趋势χ2检验分析晚发现比例变化趋势，采用χ2检验和logistic回归模型分析晚发现影响因素。

结果

2016—2022年河北省新报告HIV/AIDS病例数为14 689，晚发现比例为33.1%。各年度晚发现比例呈上升趋势（χ2=69.826，P<0.001）。不同城市晚发现比例不同。Logistic回归模型结果显示农民、检测咨询、医疗机构及其他来源、越高年龄组HIV/AIDS病例晚发现率更高，与家政、家务及待业人群相比，农民OR值（95% CI）为1.154（1.021～1.303）；与羁押人群相比，检测咨询与、医疗机构、其他来源的OR值（95% CI）分别为1.909（1.236～2.949）、3.205（2.08～4.938）和1.808（1.136～2.875）；与0～19岁组相比，各年龄组OR值（95% CI）分别为1.945（1.469～2.577）、3.279（2.458～4.375）、3.996（2.97～5.377）、5.223（3.87～7.05）和5.202（3.814～7.095）。

结论

2016—2022年河北省新报告HIV/AIDS晚发现比例逐年上升，地区差异大。职业、样本来源、年龄是晚发现的影响因素，应采取针对性的防控手段，提高早发现能力。

HIV/AIDS  /  晚发现  /  影响因素
Objective

To analyze the late diagnosis of newly reported HIV/AIDS in Hebei province from 2016 to 2022, and to understand the proportion of late diagnosis of HIV/AIDS and its influencing factors.

Methods

The information of newly reported HIV/AIDS cases in Hebei province from 2016 to 2022 was collected through the national basic information system of HIV/AIDS, and identified relevant cases by definition of late diagnosis. Trend Chi-square test was used to analyze the changing trend of late diagnosis proportion, the influencing factors of late diagnosis were analyzed by Chi-square test and Logistic regression model.

Results

From 2016 to 2022, 14 689 HIV/AIDS cases were newly reported in Hebei province, and the proportion of late diagnosis was 33.1%. The proportion of late diagnosis showed an upward trend in each year (χ2=69.826, P<0.001). The results of Logistic regression showed that the proportion of late diagnosis was higher in the farmers, the source of testing consulting and medical institutions and other, and the higher age group. The OR (95%CI) of farmers was 1.154 (1.021-1.303) compared with the household workers, and the unemployed. Compared with the custodial population, the OR (95%CI) of testing counseling and medical institutional and other sources were 1.909 (1.236-2.949), 3.205 (2.08-4.938) and 1.808 (1.136-2.875). The OR (95%CI) of each age group was 1.945 (1.469-2.577), 3.279 (2.458-4.375), 3.996 (2.97-5.377), 5.223 (3.87-7.05) and 5.202 (3.814-7.095), respectively. The proportion of late diagnosis varies greatly in different cities, City 5, City 11 and City 1 was higher than the average of the whole province.

Conclusion

From 2016 to 2022, the proportion of late diagnosis HIV/AIDS cases in Hebei province is increased in each year, and there are big regional differences. Occupation, sample source and age are the influential factors of late diagnosis, targeted measures should be taken to prevent and improve the ability of early detection.

HIV/AIDS  /  Late diagnosis  /  Influential factors
吴小雪, 马琳, 张亚丽, 王校丰, 王敬丘, 李保军, 张玉琪, 路新利. 2016—2022年河北省新报告HIV/AIDS晚发现情况分析. 现代预防医学, 2024 , 51 (20) : 3799 -3803 . DOI: 10.20043/j.cnki.MPM.202404438
Xiao-xue WU, Lin MA, Ya-li ZHANG, Xiao-feng WANG, Jing-qiu WANG, Bao-jun LI, Yu-qi ZHANG, Xin-li LU. Analysis on the late diagnosis of newly reported HIV/AIDS cases, Heibei Province, 2016-2022[J]. Modern Preventive Medicine, 2024 , 51 (20) : 3799 -3803 . DOI: 10.20043/j.cnki.MPM.202404438
正文
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艾滋病是影响人类身体健康的重大传染病[1]，具有潜伏期长、急性感染症状不明显等特点，导致晚发现情况发生[2]。由于晚发现HIV/AIDS不能及时得到抗病毒治疗，容易发生各种机会性感染和肿瘤，导致病死率升高[3]。研究显示，晚发现病例诊断后一年内死亡率是非晚发现者的10倍[4]，并且由于病例发现晚，增加了潜在的传播风险[5]。本研究对2016—2022年河北省新报告HIV/AIDS晚发现情况进行描述性分析，并探讨其影响因素，为促进及早发现提供依据。
1　材料与方法
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1.1　资料来源
资料来源于中国疾病预防控制信息系统中的艾滋病防治基本信息系统。
1.2　研究对象
筛选2016—2022年期间当年新报告HIV/AIDS病例。按照报告地为“河北省”，审核标志为“已终审卡”，病例类型为“临床诊断病例”或“确诊病例”，地区类别排除“港澳台”和“外籍”，获得当年新报告HIV/AIDS数据库。收集性别、职业、婚姻状况、文化程度、性病史、感染途径、样本来源以及诊断年龄等信息。
晚发现定义：指当年新发现的HIV/AIDS中，以下五部分人所占比例，即：报告当年死亡且死亡原因为非意外者（第1类）；存活的和意外死亡（指死于吸毒过量或自杀）者中，CD4细胞计数低于200个/μl的AIDS（第2类）；CD4细胞计数在200～499个/μl的AIDS（第3类）；未做过CD4细胞检测的AIDS（第4类）；未接受过CD4细胞检测的HIV感染者中，晚发现人数按照除非意外死亡的其余新发现病例中做过CD4细胞检测者CD4细胞计数低于200个/μl的比例推算（第5类）。
1.3　统计学分析
采用Excel 2010软件对数据库进行整理，采用R 4.1.2软件进行统计分析。采用趋势χ2检验分析晚发现比例变化趋势，采用χ2检验和logistic回归模型分析晚发现影响因素。检验水准α=0.05。
2　结果
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2.1　HIV/AIDS病例晚发现情况
2016—2022年河北省新报告HIV/AIDS病例数为14 689，晚发现4 857人，晚发现比例为33.1%。晚发现比例由2016年的26.3%上升至2020年的38.3%（χ2=69.826，P<0.001），见表1。
2.2　不同地市晚发现情况
城市5晚发现比例最高为41.8%，城市3晚发现比例最低为24.1%。其中，城市5、城市11、城市1的晚发现比例高于全省平均水平（33.1%），见表2。
2.3　晚发现HIV/AIDS特征
因晚发现的第5类是通过推算获得，因此本部分仅分析第1～4类晚发现HIV/AIDS，共4 437例。男性占90.8%（4 030/4 437）；职业以农民为主，占46.9%（2 080/4 437）；已婚有配偶占55.4%（2 459/4 437）；文化程度为初中者占41.1%（1 825/4 437）；无性病史者占76.4%（3 392/4 437）；同性传播占60.5%（2 686/4 437）；62.3%（2 763/4 437）来源于医疗机构；诊断年龄中位数为44.0岁。
2.4　晚发现影响因素分析
不同职业、婚姻状况、文化程度、感染途径、样本来源、诊断年龄的晚发现比例差异有统计学意义（均P<0.05）。以晚发现（0-否，1-是）为因变量，以职业（1-家政、家务及待业；2-农民；3-工人；4-其他）、婚姻状况（1-已婚有配偶；2-未婚；3-离异或丧偶；4-不详）、文化程度（1-大专及以上；2-高中或中专；3-初中；4-小学及以下）、感染途径（1-注射毒品；2-同性传播；3-配偶阳性；4-商业性行为；5-非婚非商业；6-非婚未分类；7-不详/其他）、样本来源（1-羁押人群；2-检测咨询；3-重点人群；4-医疗机构；5-其他）、诊断年龄（1-0～19岁；2-20～29岁；3-30～39岁；4-40～49岁；5-50～59岁；6-≥60岁）为自变量纳入logistic回归分析。结果显示，农民、检测咨询、医疗机构及其他来源、越高年龄组HIV/AIDS病例晚发现风险更高，见表3。
3　讨论
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2016—2022年河北省新报告HIV/AIDS晚发现比例为33.1%，低于河南省、广东省和全国平均水平[6-8]，但高于内蒙古、甘肃等省份[3,9]。各年度晚发现比例呈逐年上升趋势，提示还有大量既往感染的HIV/AIDS尚未被发现，且并未随着扩大检测策略的实施得到明显缓解。虽然近年来检测量不断增大，但高危人群的检测数量并未得到大幅提高[10]。因此，在提高检测量的同时还应提升检测的针对性和精准性，及早发现HIV/AIDS病例，降低晚发现比例。
本研究结果显示，农民晚发现比例较高，可能与其受教育程度低、风险意识薄弱以及艾滋病防治知识不足有关[11]。因此，加强此类人群的宣传教育，大力普及艾滋病防治知识，提升防艾意识至关重要。年龄也是影响晚发现的重要因素，随着年龄的增长，晚发现比例明显升高，与国内许多地区结果一致[3,12-13]。这可能与中老年人存在侥幸心理，发生不安全性行为后主动检测意识差或害怕检出后被歧视有关[14]。由于监管场所要求入所人员均需进行HIV检测，因此羁押人群比其他来源病例的晚发现比例低。检测咨询来源病例虽然比羁押人群晚发现比例高，但相对处于较低水平。医疗机构的病例晚发现比例较高，究其原因是大部分病例在发生高危行为后没有及时进行HIV检测, 而在出现AIDS相关症状和机会性感染后或因其他疾病就医过程中才知晓自身感染状况[15]。因此，医疗机构不断强化主动检测服务，包括术前/输血前以及侵入性检查前HIV筛查、性病门诊等重点科室按照“知情不拒绝”原则主动提供检测咨询服务[16]，是及早发现病例，降低晚发现水平的重要手段。
晚发现比例分布存在地区差异，一方面可能经济状况、受教育水平以及医疗条件和卫生资源的差异造成的；另一方面是艾滋病防治工作开展情况不同。为降低晚发现比例，各地区要继续加大HIV检测力度,尤其要加强重点地区、重点人群HIV检测比例，对重点人群制定针对性筛查策略，提升检测发现效率[17]；加强宣传教育，提升艾滋病防治知识知晓率，强化风险意识，促进高危人群主动检测，减少病例的晚发现。另外，强化医护人员识别艾滋病高风险人群以及主动提供HIV检测的能力，提高对艾滋病指征性疾病的敏感度[18]。
本研究在进行影响因素分析时未将推算的晚发现比例纳入，可能会造成一部分信息的丢失，导致相关特征的OR值被低估。
综上所述，河北省HIV/AIDS的晚发现形势严峻，呈逐年上升趋势。农民、年龄越大、医疗机构来源的病例晚发现比例高。因此在今后的防控工作中应高质量开展宣传教育，提升公众防艾意识；不断推进筛查检测，提高早发现能力。
基金
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  • 2021年度河北省医学科学研究课题(20210728)
文献
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2024年第51卷第20期
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doi: 10.20043/j.cnki.MPM.202404438
  • 接收时间：2024-04-08
  • 首发时间：2026-03-20
  • 出版时间：2024-10-25
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  • 收稿日期：2024-04-08
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2021年度河北省医学科学研究课题(20210728)
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    河北省疾病预防控制中心性病艾滋病防治所，河北 石家庄 050021

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
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Percentage of total
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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