發(fā)布時間：2018-05-13 13:41

  本文選題：艾滋病 + 母嬰傳播�。� 參考：《中國疾病預防控制中心》2008年博士論文

【摘要】： 背景 我國投入了大量的資源來遏制艾滋病的流行,且不斷加大投入力度,但仍然不能滿足全方位開展艾滋病防治工作的需求。預防艾滋病母嬰傳播是有效減少新發(fā)HIV感染的干預措施,但隨著女性受艾滋病影響程度的增加,需要不斷增加資源的投入以應對預防艾滋病母嬰傳播工作所面臨的巨大需求。然而目前國內(nèi)缺乏關于預防艾滋病母嬰傳播資源投入與利用的研究,缺乏從經(jīng)濟學的角度對干預措施的評價,缺乏指導資源投入、優(yōu)化、合理配置與利用的科學依據(jù)。 研究目的 本研究緊密結(jié)合我國實際,主要從項目全成本角度對預防艾滋病母嬰傳播資源投入進行了描述,對干預措施進行了經(jīng)濟學評價與分析,對資源投入與利用的影響因素進行分析并對服務需求進行預測。為衛(wèi)生決策部門科學制定適合我國國情,經(jīng)濟、有效、可行的預防艾滋病母嬰傳播相關策略提供依據(jù)。 研究方法 通過現(xiàn)場調(diào)查收集2003年～2006年廣西賀州八步區(qū)、新疆伊寧市、云南隴川縣和瑞麗市預防艾滋病母嬰傳播資源投入狀況,以及項目實施期間孕產(chǎn)婦HIV抗體篩查情況,以及為HIV感染孕產(chǎn)婦及其所生嬰兒提供干預服務的情況,對各項干預措施進行成本測算,并通過計算每發(fā)現(xiàn)1例HIV感染孕產(chǎn)婦、避免1例兒童新發(fā)感染HIV和挽救1個殘疾調(diào)整壽命年(DALY)的成本對項目進行成本效果分析。運用偏相關分析方法對可能影響資源投入的6個經(jīng)驗因素及運用主成分分析擬合的3個綜合因素進行相關分析。構(gòu)建“需求指數(shù)1”,運用多元線性回歸構(gòu)建資源需求預測模型。通過現(xiàn)場調(diào)查獲得有關參數(shù)信息,建立決策樹模型,比較不同服務策略的差異,并進行敏感度分析,。 研究結(jié)果 2003～2006年研究地區(qū)共投入艾滋病母嬰傳播防治資源折合人民幣4,440,951元,國家財政投入是主要來源,占85.58%。運用這些資源,共為7,064人次提供了預防艾滋病母嬰傳播能力培訓;為75,797名(63.75%)孕產(chǎn)婦提供了免費的HIV抗體篩查,篩查率逐年上升(P＜0.001);通過項目確診485例HIV感染孕產(chǎn)婦,其中126人自愿終止妊娠,359人分娩,活產(chǎn)嬰兒355例;項目為213例(59.33%)分娩產(chǎn)婦和283例(79.72%)HIV感染母親所生嬰兒提供了免費的抗病毒藥物,為87.8%的隨訪嬰兒提供了免費的奶粉。依據(jù)HIV母嬰傳播率為13.8%進行估計,項目地區(qū)共避免95例兒童感染HIV,挽救2,375個DALYs。依照全成本核算的角度,每例孕產(chǎn)婦HIV抗體篩查平均費用為人民幣36.51元,孕產(chǎn)期明確1例HIV感染孕產(chǎn)婦的平均成本為5,512.03元,每避免1例兒童感染HIV的成本是46,747元,每挽救1個DALY的成本是1,870元人民幣,折合231美元。但項目中HIV感染母親所生嬰兒超額死亡抵消了19.6%的項目所挽回DALYs損失。 研究地區(qū)預防艾滋病母嬰傳播資源投入逐年增長,不同地區(qū)間資源投入有差異,與地區(qū)人均國民收入(P＜0.01)、地區(qū)人口規(guī)模(P＜0.01)、女性HIV感染水平(P＜0.1)與服務需求(P＜0.05)等指標相關(P＜0.1)。4個研究地區(qū)資源流向構(gòu)成差異有顯著性(P＜0.001)。在人群HIV感染率為0.036%是常規(guī)提供孕產(chǎn)期HIV抗體篩查,項目成本效益均等�！疤峁┟赓M的HIV檢測,孕婦可以知情拒絕檢測(opt-out)”的篩查策略凈現(xiàn)值指數(shù)在成人HIV感染水平和母嬰傳播率的不同點值均高于自愿選擇HIV檢測策略。 主要結(jié)論 研究地區(qū)預防艾滋病母嬰傳播資源投入隨著需求而增長,資源流向基本合理,但資源流向模式尚未成熟。預防艾滋病母嬰傳播資源利用取得了良好的效果,服務覆蓋面不斷擴大,干預措施效果明確,有效減少兒童艾滋病的新發(fā)感染。預防艾滋病母嬰傳播干預措施成本控制良好,以較低的成本避免了新發(fā)兒童HIV感染;應適時擴大預防艾滋病母嬰傳播干預服務的覆蓋面,“提供免費的HIV檢測,孕婦可以知情拒絕檢測”策略具有更高的效率。地區(qū)人口規(guī)模、女性HIV流行水平及婦幼衛(wèi)生服務需求等因素影響預防艾滋病母嬰傳播資源的投入。然而,我國預防艾滋病母嬰傳播干預服務需求巨大,整體投入尚顯不足;HIV感染孕產(chǎn)婦所生嬰兒超額死亡是預防艾滋病母嬰傳播項目面臨的巨大挑戰(zhàn)。
[Abstract]:background
China has invested a lot of resources to curb the epidemic of AIDS, and continued to increase investment, but still can not meet the needs of the overall development of AIDS prevention and control work. Prevention of mother to child transmission of AIDS is an effective intervention to reduce the new HIV infection. However, as women are affected by the increase in the impact of AIDS, it is necessary to increase resources In order to cope with the huge demand for the prevention of mother to child transmission of AIDS, there is a lack of research on the investment and utilization of AIDS mother to child transmission resources in China, the lack of evaluation of intervention measures from the perspective of economics, and the lack of scientific basis for guiding the investment, optimization and rational allocation and utilization of AIDS.
research objective
This study is closely combined with the reality of our country, mainly from the point of full cost of the project to describe the input of mother to child transmission of AIDS prevention, the economic evaluation and analysis of the intervention measures, the analysis of the factors affecting the investment and utilization of resources and the pre test of the service demand. National, economic, effective and feasible strategies to prevent mother to child transmission of HIV / AIDS are provided.
research method
Through field investigation, we collected the status of mother to child transmission of AIDS in the eight step area of Hezhou in Guangxi from 2003 to 2006, Yining city of Xinjiang, Longchuan County of Yunnan and Ruili, as well as the status of HIV antibody screening for pregnant and parturient women during the project implementation, and the intervention services for HIV infected pregnant and parturient women and their babies. By calculating the cost of 1 cases of HIV infected pregnant and lying in women, 1 cases of children's newly infected HIV and 1 disability adjusted life years (DALY) were avoided, and the cost-effectiveness analysis of the project was carried out. By using partial correlation analysis, the 6 empirical factors which could affect the resource input and the 3 synthesis of the application of principal component analysis were used. The factors are analyzed. The "demand index 1" is constructed, and the resource demand forecasting model is constructed by multiple linear regression. The relevant parameters information is obtained through the field survey, the decision tree model is established, the difference of different service strategies is compared, and the sensitivity analysis is carried out.
Research results
In the 2003~2006 years, the prevention and treatment of mother to child transmission of AIDS in the 2003~2006 years was 4440951 yuan. The national financial input was the main source, accounting for the use of these resources. A total of 7064 people were provided with training for the prevention of mother to child transmission of AIDS, and a free screening rate of HIV antibodies was provided for 75797 (63.75%) pregnant women. Year by year (P < 0.001); 485 cases of pregnant and parturients were diagnosed by HIV infection through the project, of which 126 were voluntarily terminated in pregnancy, 359 were delivered and 355 were born, and 213 cases (59.33%) gave birth to mothers and 283 (79.72%) HIV infected mothers to provide free antiviral drugs for 87.8% infants, which provided free milk powder for 87.8% infants. Based on HI V mother to child transmission rate was estimated at 13.8%. In the project area, 95 cases of children infected with HIV were avoided, and 2375 DALYs. were saved according to the total cost accounting. The average cost of HIV antibody screening for each pregnant woman was RMB 36.51 yuan. The average cost of pregnant and maternal HIV infection pregnant and lying in pregnant women was 5512.03 yuan, and the cost of avoiding 1 children infected with HIV was avoided. It was 46747 yuan, and the cost of saving 1 DALY was 1870 yuan and $231. But the excess death of HIV infected mothers in the project offset the DALYs loss of 19.6% of the projects.
The research area to prevent mother to child transmission of AIDS is increasing year by year, the resource input is different in different regions, the per capita national income (P < 0.01), the area population size (P < 0.01), the level of female HIV infection (P < 0.1) and service demand (P < 0.05), etc. (P < 0.1), there are significant differences in the distribution of resource flows in the research areas of the region (P < 0.1). Sex (P < 0.001). The rate of HIV infection in the population was 0.036% in the routine provision of prenatal HIV antibody screening, and the cost and benefit of the project was equal. The net present value index of the screening strategy of free HIV detection, pregnant woman's informed rejection test (opt-out) was higher than that of voluntary HIV detection at both the level of adult HIV infection and the maternal and infant transmission rate. Strategy.
Main conclusions
The research area to prevent mother to child transmission of AIDS is increasing with the demand, the flow direction is basically reasonable, but the flow pattern of resources is not mature. Prevention of mother to child transmission of AIDS has achieved good results, the coverage of services is expanding, the effect of intervention measures is clear, and the prevention of new infection of AIDS in children is effectively reduced. The cost control of AIDS mother to child transmission intervention is good, and the new children's HIV infection is avoided at a lower cost; the coverage of the prevention of mother to child transmission of AIDS should be expanded in a timely manner. The strategy of "providing free HIV testing, pregnant women can be informed and refusing to detect" has higher efficiency. The scale of regional population and the prevalence of female HIV The needs of maternal and child health services and other factors affect the investment in preventing mother to child transmission of AIDS. However, there is a huge demand for the prevention of mother to child transmission of AIDS in China, and the overall investment is still insufficient. The excess death of HIV infected pregnant and lying in women is a great challenge to prevent mother to child transmission of AIDS.

【學位授予單位】：中國疾病預防控制中心
【學位級別】：博士
【學位授予年份】：2008
【分類號】：R183

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本文編號：1883373