A population-based study of human immunodeficiency virus in south India reveals major differences from sentinel surveillance-based estimates
A population-based study of human immunodeficiency virus in south India reveals major differences from sentinel surveillance-based estimates
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DOI：
10.1186/1741-7015-4-31
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发表时间：
2006-12-13
期刊：
影响因子：
9.3
通讯作者：
Dandona, Rakhi
中科院分区：
文献类型：
--
作者：
Dandona, Lalit;Lakshmi, Vemu;Dandona, Rakhi
背景：通过直接推断公共部门产前和性传播感染(STI)诊所和一些高危人群的年度哨点监测数据，官方估计了印度成年人中人类免疫缺陷病毒(HIV)的负担。这些推断的有效性尚未通过基于人口的大样本研究进行系统检验。方法：我们采用分层随机抽样的方法，从印度南部安得拉邦贡图区的66个城乡聚集区抽取了13838名15-49岁的成年人。我们采访了抽样的参与者，从他们那里获得了干血迹，并检测了血液中的艾滋病毒抗体、抗原和核酸。根据这些数据计算贡图区艾滋病病毒感染者人数，并与哨点监测数据和方法估计的人数进行比较，并利用卫生服务机构的数据进行分析以了解差异。结果：总共有12617人(91.2%)提供了血液样本。调整后HIV感染率为1.72%(95%可信区间1.35-2.09%)，男性1.74%(1.27-2.21%)，女性1.70%(1.36-2.04%)，农村1.64%(1.10-2.18%)，城市1.89%(1.39-2.39%)。在生活水平指数(SLI)的下半部和上半部人群中，艾滋病毒感染率分别为2.58%和1.20%。在过去两年中怀孕的妇女中，21.1%的人在参与哨点监测的大型公共部门医院使用过产前护理。在这组人群中，SLI最低四分位数(44.7%)的比例过高，艾滋病毒感染率为3.61%，而其余孕妇为1.08%。由于私人执业医生将艾滋病毒阳性/疑似妇女转诊到公立医院，即使在SLI相同的一半(下半部分4.39%，上2.63%)的妇女比后者(下半部分4.39%，上1.05%)匹配的妇女中，该组的艾滋病毒流行率也更高。哨点监测方法(艾滋病毒流行率：产前诊所3%，性病诊所22.8%，女性性工作者12.8%)导致贡图区15-49岁艾滋病毒携带者估计为112635人(4.38%)，是我们基于人口研究估计的45942人(1.79%)的2.5倍。结论：印度官方方法导致对该地区艾滋病毒负担的严重高估，因为性病诊所增加了大量额外的艾滋病毒估计，这是将艾滋病毒阳性/疑似患者转诊到公立医院的常见做法，以及让社会经济阶层较低的人优先使用公立医院。目前使用的官方估算方法可能高估了印度的艾滋病毒负担。
Background: The human immunodeficiency virus (HIV) burden among adults in India is estimated officially by direct extrapolation of annual sentinel surveillance data from public-sector antenatal and sexually transmitted infection (STI) clinics and some high-risk groups. The validity of these extrapolations has not been systematically examined with a large sample population-based study.Methods: We sampled 13838 people, 15-49 years old, from 66 rural and urban clusters using a stratified random method to represent adults in Guntur district in the south Indian state of Andhra Pradesh. We interviewed the sampled participants and obtained dried blood spots from them, and tested blood for HIV antibody, antigen and nucleic acid. We calculated the number of people with HIV in Guntur district based on these data, compared it with the estimate using the sentinel surveillance data and method, and analysed health services use data to understand the differences.Results: In total, 12617 people (91.2% of the sampled group) gave a blood sample. Adjusted HIV prevalence was 1.72% (95% confidence interval 1.35-2.09%); men 1.74% (1.27-2.21%), women 1.70% (1.36-2.04%); rural 1.64% (1.10-2.18%), urban 1.89% (1.39-2.39%). HIV prevalence was 2.58% and 1.20% in people in the lower and upper halves of a standard of living index (SLI). Of women who had become pregnant during the past 2 years, 21.1% had used antenatal care in large public-sector hospitals participating in sentinel surveillance. There was an over-representation of the lowest SLI quartile (44.7%) in this group, and 3.61% HIV prevalence versus 1.08% in the remaining pregnant women. HIV prevalence was higher in that group even when women were matched for the same SLI half (lower half 4.39%, upper 2.63%) than in the latter (lower 1.06%, upper 1.05%), due to referral of HIV-positive/suspected women by private practitioners to public hospitals. The sentinel surveillance method (HIV prevalence: antenatal clinic 3%, STI clinic 22.8%, female sex workers 12.8%) led to an estimate of 112635 (4.38%) people with HIV, 15-49 years old, in Guntur district, which was 2.5 times the 45942 (1.79%) estimate based on our population-based study.Conclusion: The official method in India leads to a gross overestimation of the HIV burden in this district due to addition of substantial extra HIV estimates from STI clinics, the common practice of referral of HIV-positive/suspected people to public hospitals, and a preferential use of public hospitals by people in lower socioeconomic strata. India may be overestimating its HIV burden with the currently used official estimation method.