| Objective:To understand the feature of local permanent resident population,infectious status and relevant factors by mass screening for HIV among permanent residents in a county of western China(hereinafter referred as County A),and to explore the effect of HIV/AIDS prevention and control in population screening,thus provide scientific basis for HIV/AIDS prevention and control measures for Western China,even for the whole country.Method:To acquire the baseline data of County A by mass screening for HIV among permanent residents.To establish mass baseline roster database,mass screening database,HIV/AIDS epidemic database,follow-up database and treatment database,then check with the general database.Split the general database into several sub-databases in accordance with specific research purpose.Descriptive statistical method is used to analyze morbidity rate and constituent ratio of each characteristic.x 2 test is used to compare the difference.Univariate and unconditional multivariate logistic regression models are used to analyze relevant factors.Results:1.General situation and coverage of HIV screeningThe permanent resident population of County A is in the transition from expansive to stationary.The number of respondents in the investigation was 445961 and mass screening for HIV was 337175,mainly dominated by the population below:0-19 years old(32.76%,110467/337175),peasants(75.44%,254367/337175),non-Han minority(57.45%,193718/337175),married(57.73%,194648/337175),junior middle school education(50.62%,170690/337175)and living in rural area(96.06%,323876/337175).Sex ratio was 103:100 and average age was 32.77 ± 20.49.Coverage rate of mass screening was 75.61%.2.HIV-positive rate,epidemiological characteristics of screening population and relevant factors of HIV infectionA total of 337175 people were tested in the mass screening for HIV with 341 cases found positive.The positive rate was 0.10%.337 out of 226708 participants aged over 20 years were tested positive and the positive rate was 0.15%.Participants with the following characteristics had a higher positive rate:aged over 60 years(0.37%),male(0.21%),divorced/widowed(0.50%),etc.(P<0.05)The results of univariate analysis indicated that there was a significant difference between HIV-positive population aged over 20 years and screening population among age,sex,marital status,educational level(P<0.05).The main features were ≥60 years old,male,divorced/widowed and primary school education.The results of multivariate analysis indicated that the risk factors of HIV infection in the screening population were ≥40 years old(40-59 years old,OR=4.86,95%CI:3.23-7.31;≥60 years old,OR=8.75,95%CI:5.66-13.51),spinsterhood(OR=6.21,95%CI:4.23-9.10),divorced/widowed(OR=2.33,95%CI:1.62-3.37)and primary school education(OR=1.85,95%CI:1.12-3.04);while the infection rates of female(OR=0.39,95%CI:0.31-0.49)and senior high school education(OR=0.33,95%CI:0.13-0.83)were relatively low.3.Previous reported HIV-positive rate,epidemiological characteristics of non-screening population and relevant factors of HIV infectionThere were 108786 permanent residents who didn’t test for HIV in the baseline survey,of which 126 cases had already been reported HIV-positive and the reported positive rate was 0.12%.92422 residents were aged over 20 years,of which 125 had been reported HIV-positive and the reported positive rate was 0.14%.People with the following characteristics had a higher positive rate:aged over 60 years(0.41%),male(0.20%),non-peasants(0.32%),Han population(0.17%),divorced/widowed(0.73%),illiteracy(0.59%)and living in non-rural area(0.18%).(P<0.05)The results of univariate analysis indicated that there was a significant difference between reported HIV-positive population aged over 20 years and non-screening population among age,sex,occupation,nationality,marital status,educational level and urban area(P<0.05).The main features were ≥60 years old,male,non-peasants,Han population,divorced/widowed,illiteracy and living in rural area.The results of multivariate analysis indicated that the risk factors of HIV infection in the non-screening population were ≥60 years old(OR=2.05,95%CI:1.13-3.71),non-peasant(OR=3.24,95%CI:2.06-5.08)and divorced/widowed(OR=3.05,95%CI:1.73-5.37)while the infection rates of female(OR=0.23,95%CI:0.15-0.35),primary school education(OR=0.56,95%CI:0.32-0.98),junior middle school education(OR=0.19,95%CI:0.10-0.37),non-Han minority(OR=0.64,95%CI:0.44-0.93)and above senior high school education(OR=0.44,95%CI:0.19-0.99)were relatively low.4.Characteristics and difference of HIV-positive cases between non-screening population and mass screening population,and relevant factors of mass screening for HIVThe results of univariate analysis indicated that there was a significant difference between reported HIV cases from non-screening population and HIV cases detected from mass screening population among age,sex,occupation,nationality,educational level and CD4+ level for the first time(P<0.05).The main features of HIV cases detected from mass screening population were those aged 45-59 years,female,non-Han minority,peasants,primary school education and CD4+>200.The results of multivariate analysis indicated that HIV-positive cases with characteristics such as aged 45-59 years(OR=3.38,95%CI:1.22-9.34),≥60 years old(OR=4.27,95%CI:1.49-12.28),primary school education(OR=6.27,95%CI:2.69-14.64),junior middle school education(OR=6.95,95%CI:2.48-19.52),non-Han minority(OR=1.87,95%CI:1.07-3.26)and CD4+>200(OR=2.16,95%CI:1.25-3.73)were easily to be detected in mass screening while non-peasant(OR=0.34,95%CI:0.14-0.80)were easily left out.5.Characteristics and difference between routine surveillance and mass screening for HIV new reported cases,and new relevant factors of mass screening5.1 Characteristics and difference between previous routine surveillance and mass screening for HIV new reported cases,and new relevant factors of mass screeningThere were 393 positive cases of previous routine surveillance in County A during the year of 2010-2012.225 new cases were detected during the mass screening for HIV.The results of univariate analysis indicated that there was a significant difference between cases of previous routine surveillance and mass screening among age,nationality,occupation,marital status,educational level,course of disease stage and CD4+ level for the first time(P<0.05).The main features of new cases detected from mass screening were ≥45 years old,non-Han minority,peasants,married,primary school education,HIV infected and CD4+>200.The results of multivariate analysis indicated that cases with characteristics such as aged 45-59 years(OR=4.02,95%CI:1.35-11.95),≥60 years(OR=5.41,95%CI:1.79-16.32),primary school education(OR=8.49,95%CI:3.13-23.06),and junior middle school education(OR=9.63,95%CI:3.30-28.12)were easily to be detected in mass screening while non-peasant(OR=0.15,95%CI=0.05-0.47)were easily to be found in previous routine surveillance.5.2 Characteristics and difference between new reported HIV-positive cases of synchronous routine surveillance and mass screening,and relevant factors of mass screening100 HIV-positive cases were reported in synchronous routine surveillance.The results of univariate analysis indicated that there was a significant difference between cases of synchronous routine surveillance and mass screening among age,nationality,occupation,course of disease stage and CD4-level for the first time(P<0.05).The main features of new cases detected from mass screening were ≥60 years old,non-Han minority,peasants,HIV infected and CD4+>200.The results of multivariate analysis indicated that cases with characteristics such as aged over 60 years(OR=5.58,95%CI:1.77-17.65),and primary school education(OR=4.60,95%CI:1.32-16.01)were easily to be detected in mass screening.5.3 Characteristics and difference between new reported cases of mass screening and reported cases of surveillance after 6 months,and relevant factors of mass screening41 HIV-positive cases were reported after mass screening 6 months later.The results of univariate analysis indicated that there was a significant difference between new cases of mass screening and reported cases of surveillance after 6 months among age and marital status(P<0.05).The main features of new cases detected from mass screening were ≥60 years old and married.The results of multivariate analysis indicated that there was no significant difference between new cases of mass screening and reported cases of surveillance after 6 months.Conclusion:1.The permanent resident population of County A is in the transition from expansive to stationary.HIV/AIDS epidemic situation is in the stage of hypoendemic.Total HIV-positive rate was 0.10%.HIV-positive rate of those aged over 20 years was 0.15%.2.Coverage(75.61%)of the mass screening for HIV was relatively high.Except for the relatively low constituent ratio in urban area,other characteristics of mass screening population were similar to general population,which could reflect local prevalence well.3.Among mass screening population aged over 20 years,those who were over 60 years old(0.37%),male(0.21%),peasant(0.15%),divorced/widowed(0.50%),primary school education(0.29%)and living in non-rural area(0.21%)had high positive rates.So measures like education and screening test should be carried out among these populations to detect latent HIV cases as soon as possible.4.Compared with routine surveillance,mass screening for HIV was more easier to diagnose positive cases with characteristics as aged over 60 years,non-Han Minority,married,HIV infector and CD4+>200.With the capacity of early detection and early diagnosis,latent positive cases could be detected by mass screening at early phase,which played an important role in understanding local HIV/AIDS’ epidemic situation and controlling secondary spread.5.Population screening not only plays an important role for HIV/AIDS prevention and control,but also brings great challenges to local health work.Therefore,whether to carry out population screening needs further research. |
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