性传播感染预防控制监测数据的利用

Hefei, Anhui Dr. Wiwat Rojanapithayakorn HIV/AIDS Team Leader WHO China Email: Website: /china Utilization of Surveillance Data for STI Prevention and Control 性传播感染预防控制监测数据的利用 Hefei, Anhui What Information can be obtained from STI Surveillance 性传播感染监测可获得的信息 STI situation: incidence and prevalence 性病疫情：发病率和患病率 Trends of STIs: overall and individual infection 性病流行趋势：整体和个体 Demographic characteristics of STI cases 性病报告病例的人口学特征（年龄、性别、 教育状况、职业、地区（城市、农村） Age, sex, education, occupation, location (urban-rural) Sources of STI: core populations, bridging populations, locations (hot spots) 性病感染的来源：核心人群，桥梁人群，地区（热点） 5. Behavioral data among target populations:目标人群的行为学数据 Sexual behavior, including sexual preference and the use of condoms性行为，包括性取 向和安全套使用情况 Health seeking behavior 求医行为 Access to treatment and type of commonly accessed facilities 治疗的可及性和通常寻求 治疗的医疗机构的类型 Assess quality of STI care and user-friendliness 评估性病服务和友好医患关系的质量 Treatment data: effectiveness of STI treatment, antimicrobial sensitivity 数据处理：性病治疗效果 ，抗生素敏感性 Development of prevention interventions based on STI surveillance data 在性病监测数据基础上制定预防干预的策略和措施 Success or failure of STI control 性病防治工作的成败 Hefei, Anhui What Information can be obtained from STI Surveillance (1)从性病监测可获得什么信息（1） STI situation: incidence and prevalence 性病疫情：发病率和患病率 2.Trends of STIs: overall and individual infection性病流行趋势：整体和个人的感染 Hefei, Anhui STI Cases Reported and Incidence Rate in China (1985-2004)中国性病病例报告和发病率 Source: China National Center for STD Control and Prevention来源：中国CDC性病控制中心 Hefei, Anhui Congenital Syphilis Cases Reported in China(1991- 2004)中国先天梅毒病例报告 Increase: 76.19% Source: China National Center for STD Control and Prevention Hefei, Anhui Incidence of Major STIs in Thailand, 1988 and 2000 泰国主要性病发病率 STI 1988 2000 病人数 Number Incidence Number Incidence 发 病率 of patients per 1,000 of patients per 1,000 Syphilis 21,7000.402,7610.04 Gonorrhea216,1074.015,6220.09 Chancroid 40,0030.741270.00 LGV 20,030 0.37780.00 NSU 85,323 1.587,0120.11 Total 383,1637.1115,6000.25 Hefei, Anhui What Information can be obtained from STI Surveillance (2) 从性病监测可获得什么信息？（2） Demographic characteristics of STI cases 性病报告病例的人口学特征 Age 年龄 Sex 性别 Education 教育状况 Occupation 职业 Location (region, urban-rural) 地区（城市 、农村） Hefei, Anhui What Information can be obtained from STI Surveillance (3) 从性病监测可获得什么信息？（3） Sources of STI 性病感染来源 Contacts 接触者 Primary contact 首发接触 Secondary contact 二代接触 Characteristics of contacts 接触者特征 Sex worker, spouse, casual partners, others性工作者 、配偶、偶然性伴及其他 Duration between the possible exposure and the development of disease 在可能的暴露和疾病发展之间的时间 The use of condom 安全套使用情况 Location to trace the contacts 性伴追踪确定感染场所 Hefei, Anhui Source of STIs Among Male Patients, Thailand, 1986- 1990 泰国男性性病病人来源 Year Number of % contracted Contracted patients from sex workers from others 1986 239,70497.52.5 1987 237,23797.52.5 1988 217,26696.73.3 1989 199,04896.33.7 1990 125,37996.13.9 Remark: Others = spouse, casual partners, etc.注：其他指配偶、偶然性伴等 从其他 来源感 染 性工作 者来源 感染 Hefei, Anhui What Information can be obtained from STI Surveillance (4)从性病监测可获得什么信息？（4） Behavioral data among target populations: 目标人群行为学数据 Sexual behavior, including sexual preference and the use of condoms 性行为，包括性取向和安全套使用情况 2）Health seeking behavior 求医行为 3）Access to treatment and type of commonly accessed facilities治疗的可及性和通常寻求治疗的医疗机 构的类型 Hefei, Anhui What Information can be obtained from STI Surveillance (5)从性病监测可获得什么信息？ （5） Treatment data, including antibiotic sensitivity 治疗数据，包括抗生素敏感性 Number of STI clinic clients 性病门诊就诊者数量 Number with STIs 性病病人数量 Number complete treatment 全程治疗人数 Number cured 治愈人数 Clinical characteristics of STIs 性病病例临床特征 Differentiation of STI pathogens 性病病原体的区别 Antimicrobial sensitivity pattern 抗生素敏感性模式 Hefei, Anhui Etiology of male urethral discharge, Fujian provincial STD clinic 福建省性病门诊男性尿道分泌物的病因学 Source: China National Center for STD Control and Prevention 淋球菌 衣原体 淋球菌与衣原体 未查出病原体 Hefei, Anhui Proportion of Neisseria Gonorrhoeae Isolates Resistant to Ciprofloxacin分离的奈瑟氏淋球菌对环丙沙星耐药的比例 Source: China National Center for STD Control and Prevention Hefei, Anhui What Information can be obtained from STI Surveillance (6)从性病监测可获得什么信息？ （6） Development of prevention interventions based on STI surveillance data在性病监测数据基础上制定预防干预的 策略和措施 Case finding activities: syphilis screening programme 病例发现：梅毒筛查项目 Contact tracing and partner notification性伴追踪与 性伴通知 Control sources of infections (e.g. Regular check- up of sex workers) 控制感染来源（例如，性工作者常规体 检） The 100% condom use programme 100%安全套使用项目 Hefei, Anhui What Information can be obtained from STI Surveillance (6)从性病监测可获得什么信息？ （6） Success or failure of STI control 性病控制工作的成败 Assessment of disease situation and trends 评估疾病疫情和趋势 Evaluation of control programme 评估性病防治项目 Hefei, Anhui Number of Sexually Transmitted Disease Cases in Thailand, 1970-2000 泰国性病病例数 X 1000 cases Hefei, Anhui X 1000 casesRate of condom use 100% Number of STI Cases, 1970-2004, and Condom Use Rate in Sex Establishments, Thailand 泰国性病病例数，性服务场所安全套使用 率 Hefei, Anhui Use of Surveillance Data for STI/HIV/AIDS Prevention and Control 利用性病/艾滋病预防控制的监测数据 Hefei, Anhui Utilization of STI surveillance data begin with correct interpretation of the data 正确解读数据-利用性病监测数据的第一要务 Examples:举例 Ineffective STI treatment 性病治疗效果较差 Low level of health seeking behavior 求医行为比例 较低 Low level of acceptance of public STI services 公共性病服务的可接受性较低 Ineffective prevention 预防措施效果较差 Hefei, Anhui Ineffective STI treatment性病治疗效果较差 Efforts to improve:改善措施 Improvement of diagnosis. 提高诊断率 Development and utilization of patient record forms. 设计 和使用病例记录表格 Appropriate lab support. 适宜的实验室技术支持 Test of cure (good patient follow-up). 对治愈者的检测（良 好的病例随访） Antimicrobial susceptibility vs resistance data. 抗生素敏感性与耐药性监测数据 National treatment guidelines. 国家诊疗指南 Trainings of STI personnel. 培训性病防治人员 Hefei, Anhui Low level of health seeking behavior 求医行为比例较低 Efforts to improve:改善措施 Education (IEC) on STI and HIV/AIDS 针对性病和艾滋病的健康教育（信息教育交流） Advertisement on STI services. 性病服务的宣传广告 User-friendly STI services 针对就诊者友好的性病服务 Hefei, Anhui Low level of acceptance of public STI services公共性病服务的可接受性较低 Efforts to improve:改善措施 User-friendly STI services: staff attitudes, short waiting time, less boring, less noisy, privacy, instruction on the services, good quality of services, good public utility (toilet, public phone). 针对就诊者友好的性病服务：工作人员的态度，缩短候诊 时间，避免嘈杂的环境，注重保护隐私，就诊服务指导， 良好的服务质量，良好的公用设施（卫生间、公用电话等 ） Collaboration with private STI services and pharmacies. 与私人性病诊疗服务和药房的协作 Hefei, Anhui Ineffective STI prevention性病预防措施效果较差 Efforts to improve:改善措施 Epidemiological approach in the STI clinics. 性病门诊的流行病学方法 Contact tracing and partner notification; 性伴追踪和性伴通知 Individual health education and STI counseling; 个体化健康教育和性病咨询 Provision of condoms. 安全套供应 Screening among some target groups. 在某些目标人群实施筛查 Monitoring partner (contact) management. 性伴（接触者）管理的监督 Monitoring sources of STI infections. 性病感染来源的监测 Referral system for clinical management of contacts. 性伴临床管理的转介系统 Implementing effective prevention programme: The 100% Condom Use Programme. 开展有效的预防项目：100%安全套使用项目 Hefei, Anhui Approaches for Effective Uses of STI Data有效利用性病数据的方法 1. Management of sexual contacts or partners 性接触者或性伴管理 Development of contact tracing guideline: 设计性伴追踪指南 Management guideline for primary contacts 首发接触者的管理指南 Management guideline for secondary contacts 二代接触者的管理指南 Setting-up contact tracing mechanism 建立性伴追踪机制 Collection of Data: getting information of contacts from clinical interview 数据收集：接诊就诊者获得相关信息 Performing contact tracing activity 开展性伴追踪活动 Monitoring and assessment of contact tracing activities 监督和评估性伴追踪活动 Hefei, Anhui 2. Assessing the risk situation on STI transmission 性病传播危险性的评估 Collection of Data: 数据收集 (1) collect information from clinical interviews with clinic clients, 接诊临床病人时收集信息 (2) sentinel s