上传用户：sqqpyubefo资料价格：5财富值&&『』文档下载 ：『』&&『』学位专业：&关 键 词 ：&&&&&&&&权力声明：若本站收录的文献无意侵犯了您的著作版权，请点击。摘要:（摘要内容经过系统自动伪原创处理以避免复制，下载原文正常，内容请直接查看目录。）第一部门：高档暗娼HIV沾染率研讨目标：同中高级暗娼比拟,高档暗娼HIV沾染率更高。同时,高档暗娼亦运动于分歧的场合。本研讨旨在懂得分歧场合高档暗娼的HIV沾染率。并经由过程剖析分歧场合高档暗娼的社会生齿学特点、任务特点、性行动特点等的差异,商量高HIV沾染率场合的人群沾染的相干身分。办法：2012年11月至2013年1月,在广西柳州市战争南县,湖南张家界市和江华县展开横断面查询拜访。研讨对象招募为便利抽样。查询拜访进程包含面临面问卷查询拜访及采血检测HIV/梅毒。HIV检测采取高危人群以监测为目标的检测战略,即便用两种(高敏理性和高特异性)ELISA停止初筛和复检。若两种检测办法均为阳性,则将这些阳性研讨对象归入数据剖析；梅毒检测采取TPPA和RPR两种检测办法。两种检测办法均为阳性,则记载为梅毒现症沾染；数据剖析采取描写性剖析、卡方磨练和Logistic回归模子。成果：(1)高档暗娼HIV沾染率招募高档暗娼580名,完成问卷查询拜访和采血检测的研讨对象共385名(应对率≈66‰)。依据研讨对象地点场合属性的分歧,分为组织型高档暗娼(任务场合为推拿屋\\洗脚屋\\小发廊\\小旅社)和自在型高档暗娼(任务场合为小我出租屋或乡镇赶集出租屋)。全体研讨对象的HIV沾染率为2.5%。个中组织型高档暗娼HIV沾染率为0.5%,自在型高档暗娼为5.0%(P<0.0001)；全体研讨对象的梅毒沾染率为10.4%。个中组织型高档暗娼梅毒沾染率为2.0%,自在型高档暗娼为19.9%(x2=33.112P<0.0001)。(2)高档暗娼几类特点比拟：——社会生齿学特点：组织型高档暗娼均匀年纪33岁,年纪年夜于35岁组占43.6%。自在型高档暗娼均匀年纪40岁,年纪年夜于35岁组占75.1%(x2=39.209,P<0.0001)；组织型高档暗娼在婚者占69.9%,自在型高档暗娼中占76.8%。二者在婚姻状况散布上无差异；组织型高档暗娼中小学或文盲的占57.8%,自在型高档暗娼中占75.1%(x2=12.779,P=0.005)；组织型高档暗娼中,户籍地非当地的比例为52.0%,自在型高档暗娼中占65.2%(χ2=6.902,P=0.009)。——性病/艾滋病常识知晓、HIV检测史：组织型高档暗娼未据说过性病的比例为10.3%,自在型高档暗娼为21.0%(x2=8.642,P=0.004)；组织型高档暗娼艾滋病常识得分<6分的占30.4%,自在型高档暗娼中占43.1%(χ2=6.687,P=0.010)；在比来六个月自发性病症状和比来1年HIV检测方面,二者无差异。——任务特点：37.7%的组织型高档暗娼和48.6%的自在型高档暗娼从事性办事年数年夜于2年(χ2=4.630,P=0.031)；组织型高档暗娼中天天主人量年夜于5个占25.0%,自在型高档暗娼中占39.8%(x2=9.635,P=0.002)；33.8%的组织型高档暗娼估量嫖客年纪年夜于50岁,68.5%的自在型高档暗娼估量嫖客年纪年夜于50岁(χ2=46.152,P<0.0001)；36.3%的组织型高档暗娼免费到30元及以下,64.6%的自在型高档暗娼免费在30元及以下(χ2=30.870,P<0.0001)。——性行动和吸毒行动组织型高档暗娼与熟客比来1个月每次应用平安套率为44.1%,自在型高档暗娼为27.7%(x2=5.923,P=0.015)；组织型高档暗娼与生客比来1个月每次应用平安套率为52.5%,自在型高档暗娼为32.6%(χ2=15.414,P<0.0001)。全体研讨对象中无打针吸毒者。结论：自在型高档暗娼在某些社会生齿学特点、性病/艾滋病常识知晓、任务特点和行动特点方面均与组织型高档暗娼有差异。年纪年夜、任务年限久、奇特的嫖客群体能够是她们更具HIV沾染风险的影响身分。针对自在型高档暗娼的干涉办法可从嫖客特点动手,挖掘有用的男用平安套应用会谈技能及测验考试在场合展开嫖客干涉；扩展检测,晚期发明晚期医治；或摸索女用平安套和裸露前预防用药的应用。第二部门：高档暗娼对干涉办法的可接收性研讨目标：高档暗娼高HIV沾染率与低男用平安套应用率为女用平安套和裸露前预防用药在这人群的运用供给了前提。本研讨旨在(1)比拟组织型和自在型高档暗娼对女用平安套的可接收性,商量哪类高档暗娼具有更高的可接收性和相干身分；(2)比拟组织型和自在型高档暗娼对裸露前预防用药可接收性,商量哪类高档暗娼具有更高的可接收性及相干身分。办法：(1)高档暗娼对女用平安套的可接收性研讨——应用前志愿性查询拜访于第一部门HIV沾染率查询拜访进程中停止,研讨现场和样本量雷同,有关女用平安套应用前志愿性的成绩添加在统一张问卷。——随访查询拜访(应用率及应用后可接收性)2013年6月到11月,在3个研讨现场柳州市、平南县和张家界市完成女用平安套基线发放和随访进程。基线进程包含基线问卷查询拜访及每人发放10只女用平安套；发放后1个月后随访,随访进程包含随拜访卷查询拜访及应用后包装计数。(2)高档暗娼对裸露前预防用药的可接收性研讨——服药前志愿性查询拜访于第一部门HIV沾染率查询拜访进程中停止,研讨现场和样本量雷同,有关裸露前预防用药服药前志愿性的成绩添加在统一张问卷。——服药随访查询拜访(允从性)自2013年6月至11月,在柳州市、平南县和张家界市招募服药对象。开端服药前完成知情赞成、服药前体检。服药后每2周随访,共随访3个月。成果：(1)高档暗娼对女用平安套的可接收性研讨——应用前志愿性查询拜访成果204名组织型高档暗娼中,112名(54.9%)情愿应用；181名自在型高档暗娼中,116名(64.4%)情愿应用(x2=2.517,P=0.067)。——随访查询拜访成果(应用率及应用后可接收性)共发放312名高档暗娼,个中组织型高档暗娼194名,自在型高档暗娼118名,全体研讨对象均完成1个月随访。组织型高档暗娼中158名(81.4%)应用过,115名(97.4%)自在型高档暗娼应用过(x2=17.204,P<0.0001)；在应用的性伴类型方面,42.8%的组织型高档暗娼和生客应用过,自在型高档暗娼有30.5%的人和生客应用过(χ2=4.686,P=0.030)；62.7%的组织型高档暗娼和熟客应用过,自在型高档暗娼有94.8%的人和熟客应用过(x2=38.594,P=0.030)。组织型高档暗娼往后情愿持续应用FC的有50名(31.6%),自在型高档暗娼有66名(57.4%)(χ2=18.054,P<0.0001)。(2)高档暗娼对裸露前预防用药可接收性研讨——服药前志愿性查询拜访成果204名组织型场合研讨对象中,114名(55.9%)情愿服药。181名自在型场合研讨对象中,125名(69.1%)情愿服药(x2=7.705,P=0.008)。——服药随访查询拜访成果(允从性)共招募服药对象105名,终究85名归入服药。完全加入3个月随访的研讨对象为50名,整体积累坚持率为58.8%。个中自在型高档暗娼32名,积累坚持率为72.7%。组织型高档暗娼18名,积累坚持率为43.9%(χ2=7.396,P=0.0070)；在粗漏服率方面,初次随访漏服率较高,算计达30%。个中组织型高档暗娼初次随访漏服率为40%,自在型高档暗娼为20%(χ2=3.829,P=0.050)。而跟着随访次数的增长,二者漏服率逐步下降,而且以后的漏服率没有差异；在调剂漏服率方面,初次随访漏服率较高,算计达20%。个中组织型高档暗娼初次随访漏服率为25%,自在型高档暗娼为15%。二者在初次随访漏服率、和以后的随访漏服率均没有差异。结论：(1)自在型高档暗娼女用平安套应用率更高、应用后可接收性更高,成为在高档暗娼惯例男用平安套发放基本上添加女用平安套的潜伏首选对象。详细的发放战略可起首肯定自在型高档暗娼集合地,慢慢推动；其次肯定宣扬重点,应用以熟客为主,逐步拓展生客；最初需增强女用平安套的应用培训,削减初次应用掉败的负面效应。(2)自在型高档暗娼服药积累坚持率更高,成为将来在高档暗娼中展开PrEP有用性研讨的潜伏目的人群。在该人群中展开PrEP有用性研讨需综合斟酌研讨药物的选择、研讨人群的当选尺度、增强允从性丈量及反作用监测等多种身分。Abstract:The first part: the HIV contamination rate target high-end prostitutes: compared with senior prostitutes, sex workers with higher rates of high-grade HIV. At the same time, high-end prostitutes also different occasions in motion. This study aims to understand the differences among the HIV contamination rate of high-grade occasions. And through the analysis of the process of different occasions high-end prostitutes socio demographic characteristics, task characteristics, action characteristics differences and discuss high HIV infected rate occasions people infected with the relevant element. Methods: from November 2012 to January 2013 in Liuzhou City, Guangxi Zhangjiajie city Hunan war Nanxian, and Jiang Hua County cross-sectional survey. The study recruited for convenience sampling. The investigation process includes face-to-face questionnaire survey and blood samples were collected to detect HIV/ syphilis. Detection of HIV take high-risk groups to monitor for target detection strategy, even with two (reason of high sensitivity and high specificity) ELISA stop screening and rechecking. If the two kinds of detection methods were positive, the positive analysis of these dat syphilis detection taken two ways to detect TPPA and RPR. Two methods of detection were positive, then record for malaria in data analysis adopts the descriptive analysis, chi square to hone and logistic regression model. Results: (1) the high-end sex workers HIV contamination rate high-end sex workers enrolled 580, completing the questionnaire survey and blood samples were collected to detect the research object of 385 (response rate = 66 per 1000). Based on the research object and place where attribute differences, massage house wash house small salon small hostel) and free type high-end sex workers (in the workplace for personal rental housing or township market rental housing for tissue type high-grade commercial sex workers (in the workplace). The research object of HIV with the rate of 2.5%. Medium organization type of high-grade commercial sex workers HIV contamination rate is 0.5%, comfortable type of high-grade commercial sex workers (CSWS) was 5.0% (P & 0.0001). All the research object of syphilis infected rate was 10.4%. The organization type high grade sex syphilis contamination rate was 2%, comfortable type high grade prostitutes in 19.9% (x2=33.112P&0.0001). (2) high-end prostitutes some characteristics comparison:: socio demographic characteristics: tissue type high-grade commercial sex workers (CSWS) average age 33 years old, dating night in 35 years old was 43.6%. Comfortable type of high-grade commercial sex workers (CSWS) uniform age of 40 year reign night to 35 age group accounted for 75.1% (x2=39.209, P & 0.0001); tissue type high-grade FSWs in marriage accounted for 69.9%, comfortable type high-end sex workers accounted for 76.8%. In marital status
tissue type high-grade commercial sex workers (CSWS) primary and secondary schools or illiterate accounted for 57.8%, comfortable type of high-grade commercial sex workers (CSWS) accounted for 75.1% (x2=12.779, P = 0.005); tissue type high-grade commercial sex workers, household non local proportion was 52.0% and comfortable type of high-grade commercial sex workers (CSWS) accounted for 65.2% (x2 2=6.902, P = 0.009). Of STD / AIDS knowledge, history of HIV testing: tissue type high-grade commercial sex workers (CSWS) not according to the proportion of said disease 10.3%, comfortable type high-end prostitutes for 21.0% (x2=8.642, P = 0.004); tissue type high-grade commercial sex workers (CSWS) AIDS knowledge scores 6 points accounted for 30.4%, comfortable type of high-grade commercial sex workers (CSWS) accounted for 43.1% (x2 2=6.687, P = 0.010); spontaneous venereal symptom and the recent 1 year HIV testing aspects in the recent six months, two no difference. , high-grade high- measure of high-grade measure of high-grade (x2=9.635, task characteristics: 37.7% of the tissue type of high-grade commercial sex workers (CSWS) and 48.6% of the free type high-end sex workers engaged in service for a number of years in the eve of the 2 years (x2 2=4.630, P = 0.031), tissue type high-grade commercial sex workers in every host in the eve of the five accounted for 25.0%, comfortable type high grade sex workers accounted for 39.8% and P = 0.002, respectively); 33.8% of the tissue type sex clients in annals of night to 50 years old, 68.5% of free sex clients in annals of night in 50 years old (x2 2=46.152 P & 0.% of the tissue type sex workers free to 30 yuan and the following, 64.6% at ease among commercial sex workers (CSWS) free of charge in 30 yuan and below (x2 2=30.870 P & 0.0001). - action and drug action organization type ratio high-end prostitutes VIP 1 months every time the application of safety to cover rate was 44.1%, comfortable type high-end prostitutes was 27.7% (x2=5.923, P = 0.015); tissue type high-grade commercial sex workers (CSWS) and stranger ratio 1 months every time the application of safety to cover rate was 52.5%, comfortable type high-grade commercial sex workers (CSWS) P & 0.0001 to 32.6% (x2 2=15.414). Not all the research object in drug injection. Conclusion: comfortable type of high-grade commercial sex workers in some socio demographic characteristics, STD / AIDS knowledge, task characteristics and the action of the hand were with tissue type high-grade commercial sex workers (CSWS) differences. Age, long life, strange task groups can influence their clients as more HIV contamination risk. For comfortable type of high-grade commercial sex workers (CSWS) interfere measure can be from the characteristics of the clients hands-on, mining useful male condom application talks skills and test on occasion launched
expansion detection, inchoate dis or fumble female condom and bare preventive administration before the application. The second part: high-end prostitutes on interference measures for reception of the purpose of the study: high-end sex workers with high HIV contamination rate and low male condom using rate for female condom and bare of preventive medication use in this population offerred a condition. This study aims to (1) compare tissue type and free type high-end prostitutes for female condom acceptability, discuss what kind of high-end sex workers have higher receptivity a (2) compared with tissue type and free type high-end prostitutes of naked preventive medication can be received, the business volume which kind of high-end sex workers have higher receptivity and relevant element. Method: (1) high-end prostitutes of female condom can receive research -- before the application of voluntary query visit to department the first HIV contamination rate query visit process, the research field and the sample size is similar, the female condom before application of voluntary score added in the system a questionnaire. - the follow-up query visit application rate and application can be received) June 2013 to November, completed in three field studies Liuzhou City, Pingnan County and the city of Zhangjiajie female safe set of baseline distribution and follow-up process. Baseline process contains a baseline questionnaire survey and each issued 10 issued after 1 month follow-up. The follow-up process contains with visit query volume and application after the visit count packaging. (2) high-end sex workers exposed to preventive medications can receive research -- before taking voluntary query visit to department the first HIV contamination rate query visit process, the research field and the sample size is the same, the bare of preventive medication before voluntary score added in the same piece of questionnaire. -- Taking the follow-up survey (compliance) from June to November 2013, Liuzhou City, Pingnan County and the city of Zhangjiajie in the recruitment of medicine. Beginning before taking the medicine before taking the examination approval, complete informed. After every 2 weeks of follow-up, a total of 3 months of follow-up. Results: (1) the high-end prostitutes of female condom can receive research -- before the application of voluntary query survey results 204 tissue type high-grade commercial sex workers (CSWS) and 112 (54.9%) 181 comfortable type of high-grade commercial sex workers (CSWS), 116 (64.4%) prefer application (x2=2.517, P = 0.067). - follow up survey (application rates and application results can be received) issued a total of 312 high-end prostitutes, medium organization type high-end prostitutes 194, comfortable type high-grade commercial sex workers (CSWS) 118. All the research objects were completed 1 month follow-up. Tissue type high-grade commercial sex workers (CSWS) in 158 (81.4%) application, 115 (97.4%) free type of high-grade commercial sex workers (CSWS) application (x2=17.204, P & 0.0001); in the application with the types of, 42.8% of the tissue type high-grade commercial sex workers (CSWS) and stranger application, comfortable type of high-grade commercial sex workers (30.5% of people and customer application (x2 2=4.686, P = 0.030); 62.7% of the tissue type high-grade commercial sex workers (CSWS) and VIP application, comfortable high-end prostitutes 94.8% and VIP application (x2=38.594, P = 0.030). Tissue type high-end sex workers back to willingly and continuously FC applications of 50 (31.6%), comfortable type high-grade commercial sex workers (CSWS) 66 (57.4%) (x2 2=18.054, P & 0.0001). (2) high-end sex workers exposed to prevent medication can receive research -- before taking voluntary query survey results 204 tissue type places the object of study, 114 (55.9%) prefer to medication. 181 free fields research object, 125 (69.1%) (x2=7.705, P=0.008) to medication. - follow-up survey (medication compliance) medication were recruited 105 subjects, all 85 in medicine. Full participation in the 3 months of follow-up study for 50, adhere to the overall accumulation rate was 58.8%. A comfortable type 32 high-end prostitutes, adhere to the accumulation rate of 72.7%. Tissue type high-grade commercial sex workers (CSWS) 18, the accumulation of adhere to the rate of P=0.% (x2 2=7.396); in the coarse leak service rate and initial follow-up leakage service rate is higher, the calculation of 30%. The organization type high grade prostitutes initial follow-up missed rate was 40%, comfortable type high grade prostitutes (20% x 2=3.829, P=0.050). And along with the growth in number of visits, the second leakage service rate gradually decreased, and leakage service and there was no si in adjusting the leakage service rate, initial follow-up leakage service rate is higher, calculated as 20%. The organization type high grade prostitutes initial follow-up missed rate was 25%, comfortable type high grade prostitutes 15%. Two in the initial follow-up missed rate and later follow-up, there were no differences between the missed rate. Conclusion: (1) the free type high-grade commercial sex workers (CSWS) female safe application rates higher, after the application can receive more, become in high-end prostitutes practice male condom distribution basically add female condom latent preferred target. With the release of strategic can chapeau certainly comfortable type of high-grade commercial sex workers, secondly affirm to promote key, the application is given priority to with regulars, and gradually first need to enhance women's safety to cover training, cut the first application off defeat negative effect. (2) comfortable type high-grade commercial sex workers (CSWS) drug accumulation rate of adhering to the more high, become the future in high-end prostitutes expansion potential to population of prep useful research. In the group PrEP need comprehensive consideration on useful discussion of drug selection, study population scale, enhance compliance was measured and the reaction monitoring factors.目录:摘要6-10Abstract10-13第一部分：低档暗娼HIV感染率研究14-38&&&&一、研究背景14-16&&&&二、研究假设16&&&&三、研究目的16&&&&四、研究过程16-20&&&&&&&&4.1 研究现场和研究对象16-17&&&&&&&&4.2 预调查17&&&&&&&&4.3 伦理审查17&&&&&&&&4.4 横断面调查17-19&&&&&&&&&&&&4.4.1 招募研究对象17&&&&&&&&&&&&4.4.2 知情同意17-19&&&&&&&&&&&&4.4.3 采血检测19&&&&&&&&&&&&4.4.4 问卷询问19&&&&&&&&&&&&4.4.5 发放补助和安全套19&&&&&&&&&&&&4.4.6 实验室检测19&&&&&&&&&&&&4.4.7 结果告知及转介19&&&&&&&&4.5 统计分析19-20&&&&五、研究结果20-32&&&&&&&&5.1 不同场所低档暗娼HIV感染率20-22&&&&&&&&5.2 不同场所低档暗娼各类特征比较22-28&&&&&&&&&&&&5.2.1 社会人口学特征22&&&&&&&&&&&&5.2.2 性病艾滋病知晓、HIV检测史22-24&&&&&&&&&&&&5.2.3 工作特征24-25&&&&&&&&&&&&5.2.4 行为特征25-28&&&&&&&&&&&&5.2.5 自由型低档暗娼的嫖客特征28&&&&&&&&5.3 多因素分析28-32&&&&六、讨论32-36&&&&&&&&6.1 研究的真实性与可靠性32&&&&&&&&6.2 研究结果的讨论32-36&&&&&&&&&&&&6.2.1 自由型低档暗娼HIV感染率更高32&&&&&&&&&&&&6.2.2 自由型低档暗娼HIV感染影响因素32-34&&&&&&&&&&&&6.2.3 自由型低档暗娼干预方法34-36&&&&七、局限性36-37&&&&八、创新点37&&&&九、结论37-38第二部分：低档暗娼对干预措施的可接受性研究38-80&&&&一、研究背景38-46&&&&&&&&1.1 干预措施之一：女用安全套38-42&&&&&&&&&&&&1.1.1 女用安全套作用及设计进展38&&&&&&&&&&&&1.1.2. 我国暗娼对女用安全套的可接受性研究38-42&&&&&&&&1.2 干预措施之二：暴露前预防用药42-46&&&&&&&&&&&&1.2.1 暴露前预防用药临床试验进展42-43&&&&&&&&&&&&1.2.2 我国暗娼对暴露前预防用药的可接受性研究43-46&&&&二、研究假设46-47&&&&三、研究目的47&&&&四、研究过程47-54&&&&&&&&4.1 低档暗娼对女用安全套的可接受性研究47-50&&&&&&&&&&&&4.1.1 女用安全套可接受性定义47-49&&&&&&&&&&&&4.1.2 研究现场和研究对象49&&&&&&&&&&&&4.1.3 使用前意愿性调查49&&&&&&&&&&&&4.1.4 使用随访调查49-50&&&&&&&&&&&&4.1.5 统计分析50&&&&&&&&4.2 低档暗娼对暴露前预防用药的可接受性研究50-54&&&&&&&&&&&&4.2.1 暴露前预防用药可接受性定义50-51&&&&&&&&&&&&4.2.2 研究现场和研究对象51&&&&&&&&&&&&4.2.3 服药前意愿性调查51&&&&&&&&&&&&4.2.4 服药随访调查51-54&&&&&&&&&&&&4.2.5 统计分析54&&&&五、研究结果54-70&&&&&&&&5.1 低档暗娼对女用安全套的可接受性研究54-61&&&&&&&&&&&&5.1.1 不同场所低档暗娼使用前意愿性结果54-55&&&&&&&&&&&&5.1.2 不同场所低档暗娼使用随访结果55-61&&&&&&&&&&&&5.1.3 多因素分析61&&&&&&&&5.2 低档暗娼对PrEP的可接受性研究61-70&&&&&&&&&&&&5.2.1 不同场所低档暗娼服药前意愿性结果61-63&&&&&&&&&&&&5.2.2 不同场所低档暗娼服药随访结果63-69&&&&&&&&&&&&5.2.3 多因素分析69-70&&&&六、讨论70-78&&&&&&&&6.1 研究的真实性与可靠性70-72&&&&&&&&6.2 研究结果的讨论72-78&&&&&&&&&&&&6.2.1 低档暗娼对女用安全套的可接受性72-75&&&&&&&&&&&&&&&&6.2.1.1 自由型低档暗娼更适合女用安全套发放72-73&&&&&&&&&&&&&&&&6.2.1.2 低档暗娼中发放女用安全套的建议73-75&&&&&&&&&&&&6.2.2 低档暗娼对暴露前预防用药的可接受性75-78&&&&&&&&&&&&&&&&6.2.2.1 自由型低档暗娼更适合纳入PrEP有效性研究75-76&&&&&&&&&&&&&&&&6.2.2.2 低档暗娼中开展PrEP有效性研究的建议76-78&&&&七、局限性78-79&&&&八、创新点79&&&&九、结论79-80参考文献80-86综述86-96&&&&参考文献93-96附件96-113&&&&第一部分：低档暗娼HIV感染率研究96-103&&&&&&&&附件1-1：知情同意书96-97&&&&&&&&附件1-2：调查问卷97-103&&&&第二部分：低档暗娼对干预措施的可接受性研究103-113&&&&&&&&附件2-1：女用安全套基线调查表103-105&&&&&&&&附件2-2：女用安全套随访调查表105-107&&&&&&&&附件2-3：暴露前预防用药知情同意书107-109&&&&&&&&附件2-4：暴露前预防用药基线调查表109-110&&&&&&&&附件2-5：暴露前预防用药随访调查表110-112&&&&&&&&附件2-6：暴露前预防用药副作用监测流程112-113致谢113-115个人简历115分享到：相关文献|