愛滋病病毒匿名篩檢陽性及重複篩檢的相關因子

Anonymous Testing and Counseling for Human Immunodeficiency Virus Infection: Factors Associated with Positive Results and Repeat Testing

愛滋病毒匿名篩檢，不論是國內、外，在愛滋病的防治及照護上一直都是扮演相當重要的角色。然而此篩檢的目的是在找出愛滋病毒感染者，並進而轉介進入醫療系統接受醫療照護。本研究期能找出受檢者感染愛滋病毒之相關因子，並試圖評估在重複篩檢的人當中，在衛教措施介入之後對受檢者性行為模式的影響。本研究採橫斷式調查法，分析自2006年5月至2007年7月，1008位主動至本大學附設醫院接受愛滋病毒匿名篩檢之民眾，在篩檢前自行填寫之問卷。在15個月的研究期間中，1,008位民眾共受檢1194次（其中有152人曾重複受檢，複檢率12.7％），其中35位受檢者愛滋病毒抗體呈陽性反應（陽性篩檢率3.4％），有29位（82.8％）接受轉介至感染科就醫。在多元迴歸邏輯分析中，與非愛滋病毒感染者相較，愛滋病毒感染者較高比例是：曾經得過性病、曾經使用違禁藥品、曾經有肛交的行為、自述自己是靜脈毒癮者、教育程度較低、年齡較大、非透過網路得知此項服務而前來做篩檢（p<0.05）。在2006年5月至2007年4月中，有254位受檢者，第一次受檢時間是在空窗期內，至2007年7月，僅81位（31.8％）回來複檢；比較有回來複檢者（81位）與未回來複檢者（173位）發現，重複篩檢者以男性居多、教育程度較高、異性戀多於同性戀／雙性戀、單身多於已婚。進一步比較此81位複檢者之第一、第二次問卷，其中與固定伴侶使用保險套的比例（56.7％ vs 54.3％），並沒有明顯的改善。同時我們也比較篩檢期間有重複受檢者，共152位之第一、第二次問卷，發現重複受檢者在與固定性伴侶使用保險套比例（61.7％ vs 59.8％），並未因篩檢諮商而有差異。在此研究中預測出與愛滋病毒抗體呈陽性的相關因子，並分析重複篩檢裡在介入衛教措施後危險行為的改變情形，然而在重複受檢的民眾並未因一次的諮商、衛教而有減少其危險行為的機率，但是愛滋病毒匿名篩檢前後的諮商與衛教仍可提供受檢者一個認識愛滋病並進而改變其危險行為的管道，對於高危險族群而言，確實是一個很重要的預防措施！

The voluntary anonymous testing for human immunodeficiency virus (HIV) infection plays an important role in the prevention of HIV infection and provides an entry point for HIV care. A cross-sectional questionnaire-based survey was performed among 1008 subjects who voluntarily came to the National Taiwan University Hospital for anonymous HIV testing during May 2006 and July 2007. Over this 15-month study period, 1,008 subjects received 1194 tests. HIV infection was diagnosed in 35 subjects (3.4%) by particle agglutination for anti-HIV antibody followed by confirmation with Western blot. Multiple logistic regression analysis showed that, compared with the non-HIV infected subjects, HIV-infected subjects were older and were more likely to have had sexually-transmitted diseases, had used illicit drugs, had anal sex, and achieved a low level of education (p<0.05). HIV-infected subjects were more likely to learn the information of the anonymous HIV test via the Internet. Of the 254 subjects who received the first test in the window period, only 81 subjects returned for the second test (31.8%) by July 2007. Those subjects who returned for the second test were more likely to be men, highly educated, heterosexual and single. Comparing the first and second questionnaires completed by the 81 subjects who repeated the test, we found that the rate of condom use with their regular sex partners did not differ significantly (56.7% vs 54.3%). Comparisons of the first and second questionnaires completed by the 152 subjects who repeated the test during the study period showed that the rate of condom use with regular sex partners did not significantly differ as a result of counseling. In conclusion, HIV infection was related to a history of sexually- transmitted diseases, use of illicit drugs, anal sex behavior, and having a HIV-positive spouse or partner among those who sought voluntary HIV testing and counseling. It seems that risk behaviors for the subjects who repeated the test remained unchanged after the one-time counseling. More studies are need to identify effective methods of counseling in order to promote safe sex among the subjects seeking anonymous HIV testing.