目的 应用Spectrum/EPP模型估计新疆兵团成人艾滋病(acquired immune deficiency syndrome,AIDS)疫情及发展趋势预测,为AIDS防治策略制定提供有效参考数据和科学基础.方法 收集整理新疆兵团1996-2022年的AIDS相关历史数据,利用Spectrum模型将全人群分成8类亚人群,结合新疆兵团人口学数据、AIDS流行参数和监测数据、抗病毒治疗及预防母婴传播数据对新疆兵团AIDS疫情进行估计和预测.结果 截至2022年底,新疆兵团累计存活≥15岁人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者/AIDS病例数共1 547例,各类人群感染HIV情况,其中吸毒人群37例、暗娼人群26例、嫖客人群114例、男同性恋人群190例、献血人群25例、感染者配偶/性伴人群86例、剩余男730例、剩余女323例和母婴传播16例.同EPP-Spectrum模型估计结果比较发现,累计存活病例比例高达91.43％,经Spectrum/EPP模型估计,新疆兵团AIDS疫情仍呈逐年上升趋势,估计2022年新疆兵团≥15岁人群HIV感染率为7/10万,传播途径主要以异性传播为主.经过R-Spline模型分别拟合各类亚人群HIV阳性率,暗娼人群HIV阳性率逐渐上升与中位数数值趋势偏离,男男性行为者(men who have sex with men,MSM)人群HIV阳性率呈缓慢上升趋势;注射吸毒者人群HIV阳性率整体处于先升后降的趋势;嫖客人群HIV阳性率一直处于平稳状态;有偿献血人群HIV阳性率为下降趋势;配偶/性伴人群HIV阳性率高于其他亚人群,阳性率在快速上升之后转至平滑曲线.结论 经过Spectrum/EPP模型预测发现,新疆兵团仍属于AIDS低流行地区,嫖客、MSM和配偶/性伴人群将是新疆兵团今后AIDS防控工作的重点关注人群.针对不同人群及时做好干预工作以及宣传教育,及时发现更多的HIV感染者,从而降低新疆兵团AIDS发病率.
Predictive research on HIV/AIDS epidemic in Xinjiang Production and Construction Corps based on EPP/Spectrum model
Objective Using the Spectrum/EPP model to estimate the epidemic and developmental trend of AIDS among adults in Xinjiang Corps,aimed to offer valuable reference data and a scientific foundation for the development of AIDS prevention and treatment strategies.Methods Historical data pertaining to AIDS in Xinjiang Corps from 1996 to 2022 were gathered and systematically organized.Utilizing the Spectrum model,the entire population was categorized into eight subpopulations,which were then integrated with demographic data,AIDS prevalence parameters,surveillance data,antiviral treatment records,and prevention of mother-to-child transmission data.This comprehensive approach enabled the estimation and prediction of the AIDS epidemic in Xinjiang Corps.Results By the conclusion of 2022,the cumulative count of surviving individuals(aged ≥15 years)with human immunodeficiency virus(HIV)infection/AIDS in Xinjiang Corps reached 1 547 cases.Among these cases,HIV infections were observed in various populations:37 cases in the drug-addicted population,26 cases in the clandestine prostitute population,114 cases in the prostitute population,190 cases in the gay and lesbian population,25 cases in the blood donation population,86 cases in the infected spouses/sexual partners population,730 cases in the remaining male population,323 cases in the remaining female population,and 16 cases of mother-to-child transmission.Comparison with estimates from the EPP-Spectrum model revealed that the proportion of surviving cases found was remarkably high,reaching 91.43％.However,the Spectrum/EPP model estimation indicated a continuous upward trend in the AIDS epidemic in Xinjiang Corps,with an estimated HIV infection rate of 7/100 000 among the population aged 15 years or older in 2022.Heterosexual transmission remained the primary route of transmission.Upon fitting the R-Spline model to the HIV-positive rates of various subpopulations,it was observed that the HIV-positive rate in the clandestine prostitute population gradually increased and deviated from the median trend.The HIV-positive rate among men who have sex with men(MSM)population exhibited a slow but steady rise.The overall HIV positivity rate among injection drug users initially increased and subsequently declined.While the rate among the client population remained stable,among the paid blood donors showed a downward trend.The HIV positivity rate in the spouse/sexual partner population was higher than that in other subgroups,and the positivity rate transitioned to a smooth curve after a rapid increase.Conclusions According to the Spectrum/EPP model,Xinjiang Corps is projected to remain a low-prevalence area for AIDS.The model highlights that clients of prostitutes,MSM,and spouses/sexual partners will be the key populations requiring attention for AIDS prevention and control in the future.To address this,timely interventions,along with effective publicity and education campaigns,will be implemented for these diverse populations,aiming to enhance early detection of HIV-infected individuals and reduce the incidence rate of AIDS in Xinjiang Corps.
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