【摘要】：背景：德宏州是我國艾滋病防治重點地區(qū),2004年以來國家每年投入1100萬元專項經(jīng)費。近幾年來病例報告數(shù)據(jù)顯示經(jīng)性途徑感染的比例有所上升,并超過經(jīng)吸毒感染的比例。準確掌握疫情流行形勢和現(xiàn)有經(jīng)費分配與使用效果,能夠幫助決策者合理配置資源。 目的：對德宏州艾滋病疫情模式的變化趨勢作出判斷,并對其艾滋病經(jīng)費的來源、分配以及使用效果進行評估,提出未來資源需求投入的建議方案。 方法：對歷年病例報告、檢測、哨點監(jiān)測以及經(jīng)性途徑傳播專項調(diào)查數(shù)據(jù)進行分析,并利用AEM模型和workbook模型對傳播模式的變化做出判斷。采用調(diào)查表調(diào)查德宏州經(jīng)費來源、分配及實際使用情況,利用SEX 2.0軟件和發(fā)病率法分別計算暗娼人群干預(yù)和美沙酮維持治療的效果并計算成本效果比。利用NEAR系統(tǒng)對2008-2012年資源需求及效果進行評價。 結(jié)果：2005-2007年病例報告中經(jīng)性傳播的比例為39.1%、46.9%、65.5%。AEM模型結(jié)果顯示2005-2007年,經(jīng)性傳播新發(fā)感染人數(shù)構(gòu)成比超過經(jīng)吸毒傳播,但二者均在50%左右。Workbook法估計現(xiàn)存活的HIV感染者中50.3%為經(jīng)注射吸毒傳播,48.4%為經(jīng)性傳播。德宏艾滋病疫情的傳播呈現(xiàn)經(jīng)注射吸毒和經(jīng)性途徑并重的模式。當(dāng)?shù)赜绊懓滩鞑チ餍械囊蛩貜?fù)雜。2000-2007年德宏州艾滋病防治經(jīng)費共計8059.7萬元,其中中央轉(zhuǎn)移支付經(jīng)費中預(yù)防干預(yù)分配經(jīng)費最多,占40.7%。暗娼干預(yù)的實際單位成本為294.8元,其成本效果比為13283元/避免1例HIV感染者。美沙酮維持治療的成本效果比為60574元/避免l例HIV感染者。德宏州2008-2012年艾滋病防治資源需求共計1.58億元,只增加吸毒人群干預(yù)資源投入方案避免的HIV感染者人數(shù)為1112人,其成本效果比為74146元/避免1例HIV感染者。按五年行動計劃覆蓋率要求增加各領(lǐng)域投入方案所避免的HIV感染者人數(shù)為1636人,其成本效果比為96353元/避免1例HIV感染者。 結(jié)論：德宏州艾滋病流行已轉(zhuǎn)變?yōu)榻?jīng)性途徑和注射吸毒傳播兩種途徑并重局面�，F(xiàn)有艾滋病防治經(jīng)費分配結(jié)構(gòu)基本合理,但總量不足。暗娼人群干預(yù)和美沙酮維持治療具有良好的成本效果。
[Abstract]:Background: Dehong is a key area of AIDS prevention and treatment in China. Since 2004, the state has invested 11 million yuan per year in special funds. Case report data in recent years show that the proportion of sexually transmitted infections has increased and exceeded the rate of drug-related infections. Accurate understanding of epidemic situation and the effect of allocation and use of existing funds can help decision-makers to allocate resources reasonably. Objective: to judge the changing trend of epidemic pattern of AIDS in Dehong prefecture, evaluate the source, distribution and effect of AIDS funds, and put forward some suggestions for the investment of resources in the future. Methods: the data of past years' case report, detection, sentinel monitoring and sexual transmission were analyzed. AEM model and workbook model were used to judge the change of transmission mode. The source, distribution and actual use of funds in Dehong were investigated by questionnaire. The effects of intervention and methadone maintenance treatment were calculated by SEX 2.0 software and incidence method, respectively, and the cost-effectiveness ratio was calculated. The NEAR system is used to evaluate the resource demand and effect in 2008-2012. Results the proportion of sexually transmitted infections in the case reports from 2005 to 2007 was 39.1% and 46.9%. The results of the AEM model showed that the proportion of new sexually transmitted infections in 2005-2007 was higher than that through drug use. But both of them were estimated at 50%. Workbook method. 50.3% of the surviving HIV patients were infected by injecting drug use. 48.4% of them were sexually transmitted. The spread of Dehong AIDS epidemic presents the pattern of injecting drug use and sexual approach. The local factors affecting the spread and epidemic of AIDS are complex. The total funds for AIDS prevention and control in Dehong Prefecture from 2000 to 2007 amounted to 80.597 million yuan, of which the allocation of funds for prevention and intervention was the largest among the funds for central transfer payment, accounting for 40.770 yuan. The actual unit cost of intervention was 294.8 yuan, the cost effect ratio was 13283 yuan / one case of HIV infection was avoided. The cost-effectiveness ratio of methadone maintenance therapy was $60574 / one case of HIV infection avoided. The total resource demand for AIDS prevention and treatment in Dehong from 2008 to 2012 was 158 million yuan. The number of HIV infected persons who only increased the resource input of intervention resources for drug users to avoid was 1112, and the cost effectiveness ratio was 74146 yuan / one case of HIV infection. According to the requirement of five-year action plan coverage, the number of HIV infected persons avoided by increasing the coverage of each field is 1636, and the cost effectiveness ratio is 96353 yuan / one case of HIV infection is avoided. Conclusion: the prevalence of AIDS in Dehong has changed into two ways: sexual approach and injecting drug use transmission. The existing AIDS prevention and treatment fund allocation structure is basically reasonable, but the total quantity is insufficient. The intervention of prostitutes and methadone maintenance therapy have good cost effect.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：博士
【學(xué)位授予年份】：2009
【分類號】：R183

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