| Objective Through epidemiological analysis and time-space characteristics analysis of historical cumulative reported HIV / AIDS cases data and data from2013 to 2015 of a large-scale special health examination including HIV testing on permanent residents,in a special demonstration county in Guangxi(hereinafter referred to as A county),to understand the historical and recent HIV infection situations and related factors in A county.To discover the role of AIDS population screening.To explore the role of spatial analysis technology in the field of AIDS prevention,and develop scientific,comprehensive prevention and control measures targeted to provide evidence.Method Export the cumulative reported HIV / AIDS cases data of A county between January 1,1998 to December 31,2012,from national science and technology major projects in Guangxi comprehensive AIDS information management system.Take two rounds of screening(including HIV testing)to household population of ≥18 months of age and reside in the local foreign population more than three months and ≥18 months of age of A county,collect special medical information,access to special examination data.Excel 2010 was used in data cleaning and databases building,PASW Statistics18.0 was used for statistical analysis.Arc GIS10.2 software was used in spatial analysis.Using descriptive statistical analysis to describe morbidity and demographic characteristics constitute,using χ2 test to compare different population demographic characteristics constitute,inverse distance weighting interpolation analysis and spatial auto-correlation analysis was used for spatial analysis.Results 1 A county HIV / AIDS epidemic situation over the years1.1 Time Distribution: A county cumulative reported HIV / AIDS cases was3142,1998-2012 each year the reported number was respectively to18,7,12,62,59,74,109,277,264,332,294,289,385,659,301,showed a rapid upward trend.1.2 Population distribution1.2.1 Overall situation: Male peasants / workers,AIDS,Han nationality,primary school education,history of heterosexual sexual contact,heterosexual transmission,was the main feature of cumulative reported HIV / AIDS.Male to female ratio was 2.61: 1.Average age at diagnosis was 43.9 ± 16.5,the average survival time after diagnosis was 1.5 ± 2.0,the average age of death was 48.6± 17.1.1.2.2 Disaggregated by gender: Men and women showed a rising trend in the number of reports,which each year from 1998 to 2012 the male-female ratio was respectively to 8.00: 1,2.50: 1,5.00: 1,4.17: 1,5.56: 1,3.11: 1,3.95: 1 3.07:1,2.22: 1,2.73: 1,2.16: 1,2.07: 1,2.63: 1,2.51: 1,2.58: 1.1.2.3 Disaggregated by infection routes: The number of cases the report transmit by injecting drug use had a rise from 1998 to 2006,then had a downward trend.cases reported by heterosexual transmission has continued to rise,each year from 1998 to 2012 ratio of heterosexual transmission as follows:0.00%,57.14%,8.33%,4.84%,22.03%,22.97%,22.94%,40.43%,62.50%,69.28%,71.43%,81.31%,92.21%,94.23%,94.35%.other routes of transmission of the number of reported cases remained stable.1.2.4 Disaggregated by age groups: 15 age group grew slowly.15-29 age group had a downward trend since 2005.30-44 age group the number of reports rose significantly compared to the year 2005,followed by stable;45-59 age group,60-74 age group,75 years and over age group grew slowly,but after 2011 the growth rate faster than other age group,reaching peak growth.1.2.5 Disaggregated by occupation: Farmer / workers showed a rising trend,its constituted ratio increased by 33.90% in 2002 increased to 76.41% in2012.The slow growth of other types of occupation,trade / services sectors constitute declining from 49.15% in 2002 to 10.30% in 2012.1.2.6 Disaggregated by education level: Elementary,junior high school education grew faster than other types of education,the constitution had an upward trend.1.2.7 Disaggregated by type of disease: HIV-infected persons and AIDS patients showed a growth trend,AIDS grown faster than HIV,AIDS constituted ratio increased by 30.51% in 2002 to 66.45% in 2012.1.3 Spatial Distribution: A county 1998--2012 year cumulative report HIV /AIDS trends in the spatial distribution,in east-west direction,the north-south direction on the distribution showed a downward trend after the first rise.Inverse distance weighting interpolation analysis result,the distribution of cumulative reported positive cases exist locally high values,mainly in the a,b,d three towns.Each year Global Moran’s I coefficient greater than 0,Z values are greater than 1.96(P <0.05),each year the global Getis coefficient greater than 0,Z values were greater than 1.96,local Getis autocorrelation analysis found that exist in HIV each year / AIDS distribution of high-high adjacent enclave,mainly in b,d two towns.2 A County special medical examination situation2.1 Basic medical conditions: First round of examination was 217159 people,coverage rate was 60.55%,of which 1323 HIV-positive people,positive rate was 0.61%.The second round of medical examination was 272088 people,coverage rate was 80.1%,of which HIV 1531-positive people,positive rate was0.56%.To participate in the special medical examination at least once as a capacity of 306836 people,coverage rate was 90.33%(306836/339700).Including previous positive people,we found 1895 cases of HIV-positive people,including 57 new infections,emerging infection rate was0.21 ‰(57/272088),1047556 person-years were observed.2.2 Prevalence: The prevalence of the first round of examination was0.61%,in each age group prevalence rates were :less than 15 age group(0.02%),15-29 year-old age group(0.23%),30-44 years old age group(1.02%),45-59year-old age group(0.96%),60-74 year-old age group(1.04%),more than75-year-old age group(0.49%).The second round of examination prevalence of0.56% in each age group,the prevalence rates were :less than 15 age group(0.03%),15-29 year-old age group(0.15%),30-44 year-old age group(0.83%),45-59 age group(0.84%),60-74 year-old age group(1.06%),more than75-year-old age group(0.36%).Male prevalence in female prevalence.2.3 Comparison of examination positive population and the negative population of the first round: the first round of examination positive population had a total of 1323 people,male-female ratio was 2.1: 1,with an average age of47.9 ± 14.18.The first round of examination negative population had a total of215,834 people,male-female ratio was 0.98: 1,the average age was 34.89 ±21.91 years.The difference between positive and negative population groups in age,gender,ethnicity,marital status,occupation,education level had a statistical significance.2.4 Comparison of examination positive population and the negative population of the second round: the second round of a total of 1531 people physical positive people,male-female ratio was 2.18: 1,with an average age of49.81 ± 14.04.The second round of examination negative population total of270557 people,male-female ratio was 1.06: 1,the average age was 37.86 ±21.66 years.The difference between positive and negative population groups in age,gender,ethnicity,marital status,occupation,education level had a statistical significance.2.5 Comparison of two physical characteristics of positive people: two kinds of people in the presence of a statistically significant difference in terms of education level,other differences didn’t have statistically significant.2.6 Comparison of specific examination positive people and cumulative reported positive people: two kinds of people exist in a statistically significant difference in age,gender,ethnicity,marital status,occupation,education and other aspects.2.7 Spatial distribution of medical positive people: A county medical positive people in the two east-west direction and the north-south direction showed intermediate high,two side low trend.Inverse distance weighted interpolation analysis showed positive population population distribution are physical existence of local high value,mainly in b,d,e,g these four towns.Global Moran’s I coefficient of 0.277,Z value of 7.178,P = 0.000 <0.05,indicating that the overall spatial distribution of the population were aggregated.Global Getis coefficient of 0.051,Z value of 7.512,P 0.000,indicating that the special examination A county HIV / AIDS overall spatial distribution of the presence of high value enclave.Local Moran’s I analysis and local Getis analysis results,positive cases detected two high profile-a high value enclave,located at d,e two towns.Conclusion 1 The project of fighting AIDS had achieved some success in Guangxi.2 A county have 3142 of cumulative reported HIV-positive cases over the years,the basic HIV-positive number was large and have a serious epidemiological situation,the number of reported cases per year showed a rising trend,but in recent years the growth rate slow down.3 A County HIV positive cases reported in recent years feature in male,middle-aged,heterosexual transmission,the Han nationality,occupation as farmer / workers,mainly primary school education,but the proportion of middle-aged men has increased,suggesting that there is the risk of HIV infection in older persons increasing trend.The proportion of women living with HIV has increased in recent years.4 Two large healthy population coverage is high,reaching 90.33%,reach to a comprehensive understanding of HIV infection situations in A county.The first round of large-scale prevalence of healthy 0.61%,the second round of large-scale health examination prevalence of 0.56%,despite a large positive population base of A county,it’s still a low HIV prevalence areas.5 Spatial analysis techniques can be applied to visualize spatial distribution of disease,detection of disease "hot spots." In this study the high-high value accumulation regions of the special examination positive population data,had different with high-high value accumulation region of the over year reporting positive data,suggesting that disease hot-spots had changed.We should make appropriate measures against this change. |
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