| ObjectivesTo understand the status on seroconverse spouses of serodiscordant couples sexual transmission among who received antiviral treatment in Yunnan Province between January 2017 and June 2018,and to explore the relevant influencing factors and problems in follow-up management service among serodiscordant couples,to provide basis for improving follow-up intervention and treatment service.Methods:A case-control design was conducted among 94 HIV sero-accordant couples and 98 serodiscordant couples who received antiviral treatment in Yunnan Province between January 2017 and June 2018.The content of questionnaire includes general demographic characteristics,basic health status,acceptance of ART and related AIDS services,sexual behavior characteristics,family situation,awareness of AIDS-related knowledge,and some AIDS network direct reporting system information.At the same time,a qualitative investigation was conducted one-on-one in-depth interviews with some families.The data of questionnaire was collated using pidata3.1,data analysis was conducted using SPSS21.0,the single factor analysis calculated OR,and multi-factor analysis used Logistic regression analysis.Results(1)A total of 384 quantitative questionnaires were completed,including 384 valid questionnaires The effective rate of the questionnaire was 100%.A total of 34 qualitative interviews were completed.98 HIV serodiscordant couples,Han nationality accounted for 59.18%(58/98),rural household registration accounted for 82.65%(81/98),primary school and junior high school culture accounted for 80.61%(79/98),98 serodiscordant couples,Han nationality accounted for 54.26%(51/94),rural household registration accounted for 87.23%(82/94),Primary and junior high school culture accounted for 74.47%(70/94).The composition ratios of heterosexual route infection in the positive side for the serodiscordant couples and the positive side for the serodiscordant couples are 87.76%(86/98)and 86.17%(81/94),respectively.Among two types of families demographic characteristics were not statistically different(?2=0.143-9.267,P>0.05).Spouse' status of two types of families were not statistically different on reproductive tract infections,the positive side first of two types of families were not statistically different on choice of medical treatment.There is no difference statistically in the frequency of sexual life between the two types of families.(2)Both sides of the 98 HIV serodiscordant couples(88.98%of the positive side and 80.00%of the spouse side)may spread AIDS,whose behavioral awareness rate is higher than that of both sero-accordant couples(78.30%of the proband side and 69.79%of the spouse side),and the two types of family positive probands have low awareness rate on treatment opportunities in antiviral therapy(serodiscordant 73.47%sero-accordant 78.72%)and side effects(sero-accordant 79.59%sero-accordant 71.28%).(3)The proportion of antiviral therapy(63.27%)started within 2 months after confirmation of the positive in the serodiscordant couples was higher than that in the positive party in the sero-accordant family(42.55%,?2=8.265,P=0.004).The detection rate of viral load of the positive of serodiscordant couples was higher than that of the positive of the HIV sero-accordant couples(?2=8.394,P=0.004).The proportion of VL<50 copies/mL(94.94%)of the positive side of the serodiscordant couples was higher than that of the positive side of sero-accordant couples(79.3 I%,?2=7.917,P=0.005).(4)There was difference statistically in the frequency of cndom use between the two types of families.At the same time,the serodiscordant couples is superior to the HIV sero-accordant couples in using condoms at all times,using condoms correctly and using condoms perseveringly every time.(5)The proportion of good spouse relationship between the two families in the serodiscordant couples was higher than that in the HIV sero-accordant(X2=6.093?14.84,P=0.001-0.048),and the proportion of self-informing spouses was also higher than the positive of sero-accordant couples,the proportion of sero-accordant spouses receiving HIV testing within 1 month is lower than that of sero-accordant couples.After the positive was detected positive results,83.67%and 83.67%of them had talked with their spouses about prevention of spouse infection and how to use condoms,which were higher significantly than 52.13%and 43.62%of the positive side of sero-accordant couples(?2=22.026?33.438,P<0.001).About 30.85%HIV sero-accordant and 27.55%HIV serodiscordant couples had fertility desire(6)Multivariate logistic regression analysis showed that the frequency of condom use,spouse relationship,discussing condom use with the spouse were independent factors for spouse sexual transmission of the sero-discordant couples.Conclusion98 HIV serodiscordant couples and 94 HIV sero-accordant couples have accepted ART couples in Yunnan Province,whose composition was mainly composed of farmers of Han nationality,primary and junior middle school culture.The use frequency of condom,spouse relationship,discussing condom use with the spouse,were independent factors for spouse sexual transmission of the sero-discordant couples.In addition,notification of spouse in time,receiving ART as early,frequency of sexual behavior,fertility desire,access to health services support are unignorable factors.From now on,we should carry notification of spouse well,further expanding the detection and find the infected person in time,increasing the investment on prevention and treatment work and setting up a full-time staff to be responsible for the follow-up and consultation of sero-accordant couples families,and paying attention to some key links of service consultation:knowledge to protect spouses from infection,offering condoms actively,treatment timing of antiviral treatment and side effects treatment of treatment,It is not feasible to ignore the risk warning of spouse infection only with a single VL<50 copies/mL for the positive side for the serodiscordant couples,the infected person should be tested regularly for viral load and urged to insist on using condoms. |
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