Mô tả hành vi nguy cơ nhiễm HIV và xác định tỷ lệ nhiễm của nhóm nghiệm ma túy tham gia chương trình dùng thuốc thay thế methadone tại thành phố hà nội

Y HOC VIET NAM THANG - SO 2/2014 trung binh (46,6%). Loai thieu mau dang sac hong cau binh thffdng chiem 59,3%. 62.5% thieu mau khdng cac benh ly tiiy xffdng vdi tiiy dd binh thffdng hoac tang sinh lanh tfnh dong HC. Benh mau ac tinh la nguyen nhan gay thieu mau chiem , % . Tiiy dd la bffdc quan de chan doan nhieu rdi loan huyet hoc gay thieu mau. TAI UEU T H A M KHAO 1. Ahmad SQ, Khan OU, Zafar N. Utility of Bone Marrow Examination in a Secondary Care Hospital JRMC 2011;15:40-1. 2. AsimMomani, RameKhasawneh (2012). Spectrum of Bone Man-ow aspirabon test resultsat Prince Rashid Hospital/Jordan. A Year Experienceint J Biol Med Res. 2012; 3(2): 1648-1650 Egesie OJ, Joseph DE, Egesie UG, Ewuga 03. Epidemiology of anemia necessitating bone marrow aspiration cytology in Jos. Niger Med J. 2009;50:61-1. Jha A, Sayami G, Adhikari RC, Panta D, Jha R. Bone marrow examination In cases of pancytopenia, J Nepal Med Assoc 2008;47:12-7. Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone Marrow Examination in Cases of Pancytopenia. JIACM 2001;2;55-9. Laishram S, Shimray R, Sharma AB, Pukhrambam G, Singh AM, Sharma LDC Neoplastic lesions in the bone marrow: a 10 year study in a teaching hospital. JIACM 2008;9;175-8. Pudasaini, Prasad KBR (2012). Interpretation of bone marrow aspiration in hematological disorder Journal of Pathology of Nepal (2012) Vol. 2, 309 -312 MO TA HANH VI NGUY C a NHIEM HIV VA XAC DINH TY LE NHIEM HIV C O A N H O M NGHIEN CHICH MA TUY THAM GIA CHU'ffNG TRINH DUNG THUOC THAY THE METHADONE TAI T H A N H PHO HA NOI Bui Thi Nga*, Nguyen Anh Quang*, Nguyen Thanh Long** T6M TAT Nghien ciTu mo ta cat ngang dffpc thffc hien tren 400 ngi/di nghien chfch ma tai 02 co sd dieu trj Methadone tai phd Ha Npi. Ket qua nghien cyu cho thay: Ngffdi nghien chfch ma dang doi mat vdi cac hanh vi nguy cd lay nhiem HIV nhi/ tud'i bat d'au tiem chich ma tuy, sff dung chung bdm kim tiem hem chfch ma va khdng sy dyng bao cao su cho tat ca cac lan quan he tinh dye. Day chfnh la cac hanh vi nguy cd can dupe can thiep nhSm lam giam ty le lay nhiem HIV nhdm ngffdi nghien chich ma tuy. SUMMARY EVALUTION ON I N J E C H O N DRUGS USERS ( I D U S ) I N TWO METHADONE TREATMENT CENTERS I N H A N O I CITY The cross - sectional descnptive study was done on 400 injecction drug users in 02 methadone treatment centers in Hanoi city. The study results showed that; injection drug users who are facing risks behavior for HIV injection such as mibabon of injection daig use, sharing needles used to inject drugs and not using condoms for all sex times. This is the risk behavior interventions should be aimed at reducing the prevalence of HIV infection among drug injectors. Tit khoa: HIV/AIDS, Nghien chich ma tuy, Hanli VI nguy cd. Ha Npi I. O J ^ T V A N D E Theo bao cao cua Bp Y te tinh den 30/6/2013 so cac trffdng hdp nhiem HIV sdng la 213.413 ngffdi, cd 63.373 ngufli bi AIDS va 65.133 ngffdi tff vong AIDS [1). Cac dffdng lay truyen HIV chii yeu d Vi|t Nam la diing chung bdm kim tiem (BKT) tiem chich ma (TCMT) va hanh vi hoat dpng tinh due khdng an toan. Khdng chi co hanh vi tiem chich va tinh due khdng an toan la cd nguy lay nhiem HIV ma tinh trang nguy cd cua ban tinh hoac ban chich cung cd vai trd dff bao nguy aJ * Trung tam phdng chdng HIV/AIDS Ha Ngi **BdYti Phan bign khoa hgc:lS. Nguyen Quoc Trffdng Y HQC VlgT NAM THANG - SO 2/2014 nhiem HIV, Dung chung BKT vdi mot ngu'di co ten so tiem chich tren lan mot ngay'hoac ngu'di CO tuoi^ddi nhieu (nghTa la nhjng ngu'di cd nguy cd nhiem trang qua khir Idn hdn) thi cd ty le nhiem HIV gap ian (43% so vdi 18%) so vdi nhu'ng ca the cd nguy cd thap [4], Hanh vi tiem chich ma tiiy ciia ngu'di nghien chi'ch ma tiiy (NCMT) la mot yeu to rat cao lam gia tang lay nhiem HIV d Chau A; dien hinh la Trung Qudc, Indonesia va Viet Nam. Phan Idn nhu'ng ngu'di NCMT dang d tudi cd nhu cau quan he tinh due cao, nhieu ngu'di NCMT cdn tham gia vao hoat dpng mua ban dam, sir ket hijp cang lam cho nguy cd lay nhiem HIV cpng dong. Tai Thanh php Ha Npi, tfnh den 30/6/2013, luy tich _cac tru'dng hdp ngu'di nhiem HIV di/dc phat hien la 20.524 hien cdn song, 5.272 tru'dng hdp chuyen sang giai doan AIDS va 3.802 ngirdi tir vong AIDS. Hien dich van dang giai doan tap trung va ty le nhiem HIV cao nhat la nhdm NCMT (67,4%), Hep den la quan he tinh due 22,8 %. Dich HIV/AIDS d Thanh Ha Npi cd lien quan mat thiet vdi tinh trang gia tang_^trong nhdm doi tiTdng NCMT [6]. DeJ:ai nham mijc tieu "Mo ta hanh vi nguy cd lay nhiem HIV va xac djnh ty le nhiem HIV ciia nhdm nghien chi'ch ma tham gia chddng trinh diing thuoc thay the Methadone tai Ha Npi" lam cd sd xay di/ng cac hoat dong can thiep, gdp phan lam giam sir lay truyen HIV [6], [7]. II. OOI TUplMG VA PHU'ONG PHAP NGHIEN OJll - Dia diem nghien ciru: Tai 02 quan/huyen Ha Ddng va Tir Liem, TP Ha Npi. - Thdi gian nghien ciru: tir thang 1/ 2012 den thang 12/2012 - Ddi tdOng nghien ciru: La ngirdi nghien chich ma sii dung cac loai ma bang bdm kim tiem theo tinh mach. - Phu'dng phap nghien cu'u: ap dung thiet ke nghien ciru md ta cat ngang. Cd mau du'dc tinh thep cong thirc tinh; " = Zn- 2, P-(l-p)/d' n ; la cd mau 2: la he sd tin cay, vdi ngu'dng sac xuat a = 5%, tacd: 2|,_„ ,,= 1,96 P = 0,4 - Ty le nhiem HIV nhdm dot tddng NCMT nam 2009 (theo dieu tra IBBS nam 2009 ciia TP Ha Npi). d = 0,023 sai sd cho phep - . n = 370 ngi/di. DU phdng phieu khong hdp le 10%, udc tinh bd cupc va lam trpn ta cd cd mau nghien ciJu la 400. III. Kft-QUA NGHIEN Cl>U 3.1. M§t so d^c tru'ng ca nhan cua ngu'di nghien chich ma tiiy Bang 1: Dac diem ve nhdm tud'i va trinh dp hpc van (n= 400) £)ac tru'ng Ty le (»/o) Nhom tuoi < 20 tuoi 3,80 20-29 47.00 30-39 33,70 >40 15,50 Hoc van Mil chii' 0,50 Tieu hoc 13,30 44,00 Phd thong cd sd Phd thdng trung hoc 38,80 3,40 Dai hoc, cao dang Trtmg so 400 doi tudng nghien cdu nhdm tuoi td20 den 29 chiem 47.0%, tiep den la nhdm tudi td3 den 39 (33,7%), thap nhat la dddi 20 tuoi (3,8%). Ve Trinh hoc van: Nhin chung cac doi tddng c trinh dg hpc van tddng ddi thap. Trong dd, phd thong cdsd chiem ty le cao nhat (44,0%), phd thdng tmng hgc (38,8%), tieu hoc (13,3%), dinh Dai hgc, cao dang chiem (3,4%), dSc biet cd 0,5% d tudng mu chd. Y HOC VIET NAM THANG - SO 2/2014 Bieu do.l. Phan bd theo nghe nghiep cua ngffdi nghien chich ma tuy_ • 60.5 C h u k i n h d o a i i i i ' b u o n biin ^ggg . : N h a n \'ien phi.ic \ 1.1. b i l l haiiE ^ | ^ N h a n \ ien n h a n i r a c S | 0." Trong nghiin c&u cho thiy Ng&di NCMT lam rit nhieu nganh nghi khac dd tap trung c yiu la nghi t&do (60,5%), nhan vlin ban hang (8,5%) va lam rugng (7,5%). Ngoai cdn mgt so cong viec khac nh&: chu kinh doanh (6,2%), sinh vlin (2,5%), nhan vien Nha n&dc (0,7%)). Dac bie CO 14,1% ddi t&dng khong co viec lam. Hau hit dd la nhu'ng cong viec lao dgng chin tay, tliu nhip thap va khong on dinh. 3.2. Cac yeu to hanh vi nguy cd lay nhilm HIV cua nhom NCMT BieudoZyhn suat tiem chich ma thang qua it hon ! Imvngay S.7 I lan/ngay . 2-3 larVngay Tren lan/ngay \,^l J 53.5 '•^.i-.:rji:i- ^rtidAaJ -J^V- . HH| 20 40 50 Ty le ng&di NCMT dting TCMT mgt ian mot chiim 31,8%, ddng hai din ba lan mpt chiim ty li cao nhit 53,5%, It hdn lan/ngay chiim 8,7 %, dt/ng trin S lan/ngay chiim 6,0 %. Tan suit siJ dung thudc khong nhu'ng phu thupc vao m&c dp nghiin nang hay nhe, ma phu thug vao kha nang kinh ticua ng&di NChlT. Bieu 3. Hanh vi diJng chung BKT TCMT thang qua iCo MK.li6n2 Kit qua cho thiy co 91,7%) ng&di NCMT khong s&dung chung BICT nh&ng van tdi 8,3% ng&d NCMT van s&dung chung BKT. Y HOC VIET NAM THANG - SO 2/2014 Bleu ad 4. Tan suat diing BCS QHTD vdi GMD 12 thang qua Khong bao gid Doi 0.7 LI 2.5 Da sd cac lan Tat ca cac Ian :,:;^ , J 87.9 20 80 60 100 Kit gua cho thay tan xuat sd dung BCS quan he tinhd due (QHTB) vdi gai mai dam (GMD) tron 12 thang qua kha cao chiem 87,9% tat ca cac lan. Tuy nhien van cdn 11,4% khong thddng xuyen va 0,7% khong bao gid sddung BCS. Bang 2. Mot .6 mdi lien quan tdi hanh vi sir dunq chunq bdm kim tien' Sii dung chung BKT Dac tinh OR Co Khong 25 (28,7) 62 (71,3) < Idp 15,4 Trinh dp hpc van 305 (97,4) > Idp (2,6) 253 (89,1) 31 (10,9) Tir nam trd len Thdi gian nghien 6,9 114 (98,3) 2(1,7) Dddi nam Phan tfch mdi liin quan gitj^ hanh vi s& dung chung BICT va nh&ng yiu td khac cho thiy: Nhung ng&di NCMT cd trinh dp hpc vin d&di thdng trung hgc co nguy cd s& dung chung BKT cao gip 15,4 lan so vdi ng&di co trinh dp hpc vin trin phd thdng trung hgc. Phan tich cijng chi la cd s& khac biet hanh vi s&dung chung BKT cua nhung ng&di NCMTco thdi gian nghiin d&di nam tren nam. nhii'ng ng&di NCMT trin nam cd nguy cd s&dung chung BKT gip 6,9 lan so vdi ng& NCMT d&di nam. Bie'u 5. Ty le nhiem HIV nhdm ngffdi NCI^T \ 100 • 80 60 ^.•m Ha Dong Tir liem y Duong tinh HAm tmh I Kit qua xet nghiim HIV nhdrrTbinh nhan NCMT tham gia dieu tri nghien thay the Methadon taicdsdhuyen TdUemcdtyle HIV dddng tinh la 18 % va d quan Ha Bong cd ty le HIV dddng tinh ii 7,0 %. IV. BAN LUAN Ket qua nghien ciru cho thay ty le benh nhan dutjc dieu tr| Methadone da phan la d lii'a tud'i tre tir 20 - 39: Trong dd nhdm tudi 20-29 chiem 47,0% va nhdm tud'i 30 - 39 chiem 33,7%. Cac doi tiTdng sir dung ma tap trung d dp tuoi lao dpng, de tiep can vdi ma tiiy dac biet la tiem chich ma tuy, dd lam gia tang manh sir phat trien te nan ma tiiy nhu'ng nSm gan day. Da 50 ngudi NCMT dang trpng dp tuoi lap dpng W Y HOC VIET NAM THANG - SO 2/2014 va la nhffng tru cdt cua gia dinh vay se lam anh hu'dng nghiem trpng den kinh te gia dinh ndi rieng va kinh te xa hpi ndi chung. Theo mdt so tac gia nghien cffu d nffdc ngoai da tong ket thi cd mdi lien quan rat ro ret giO'a tudi sff dung TCMT, QHTD va ty !e nhiem HIV, nghia la cang nhieu khach hang va dac biet la nhieu khach hang la thi cang tang nguy cd bj lay nhiem HIV. Trong nghien cffu cho thay, cd den 53,5% sd ngffdi NCMT cd tan suat TCMT tff den lan/ngay, lan/ngay la 31,8%. Ty le cd tan suat TCMT tren lan/ngay la 6,0%. Day cung chinh la hanh vi nguy cd lay nhiem HIV. Theo quan sat cua chung tdi, mac du BKT ludn san cd nhffng dac thu cua ngffdi NCMT la thffdng giau diem cac hanh vi tiem chich va thieu hieu biet ve tinh nguy hiem cua sff dung chung BKT [ ] . Trong nghien cffu cdn tdi 8,3% ngffdi NCMT van sff dung chung BKT. Viec sff dung chung BKT tiem chfch la hanh vi dan den nhiem HIV nhanh nhat xac suat lay nhiem qua dffdng tiem chfch la rat cao. Ben canh dd, viec ngffdi NCMT chiu anh hffdng Idn tff cac vien khac nhdm nen viec hp cd hanh vi tiem chich chung la dieu de xay ra, cang de lam tang nguy cd lay nhiem HIV nhdm. Tuy nhien ket qua hanh vi sff dung chung BKT thap hdn so vdi vdi ket qua nghien cffu giam sat hanh vi nam 2005 d TP Hd Chf Minh % , An Giang 33%, Oa N i n q % , Can T h d % [ ] . Trong nghien cffu cd den 87,9% ngffdi sff dung BCS QHTD vdi gai mai dam 12 thang qua, 11,4% sff dung khdng thffdng xuyen va khong bao gid sff dung chiem 0,7%. Nhff vay quan he tinh dye vdi GMD, la nhffng ngffdi khd cd the biet dffdc hg cd nhiem HlV^hay khdng la mdt nguy cd cao lam tang lay nhiem HIV nhdm va cho ban tinh cua hp. Oong thdi, hp cd the lam lay truyen HIV/STIs cho khach hang va ban tinh neu khdng su dyng BCS. Mpt sd nghien cffu trpng va ngoai nffdc cung da chi rang GMD khdng sff dung BCS thffdng xuyen se cd nguy cd nhiem HIV/STIs cao gap tff den 20 lan nhdm GMD thffdng xuyen sff dung BCS [ ] . Ket qua nghien cffu cho thay ty le ngffdi nghien chfch nhiem HIV la % , vdi nhffng ngffdi nghien chfch neu khdng sff dyng BKT sach va sff dung BCS khdng thffdng xuyen la mpt nhfftig nguy cd tiem an lam lan truyen HIV, dac biet lam lan truyen HIV tff ddi tffdng nguy cd cao sang doi tu'idng nguy cd thap la vd, va nhffng ban tinh cua hp. Theo ket qua nghien cffu ciia cac tac gia nu'dc thi tudi sff dung TCMT_tre va quan he tinh due cang sdm thi nguy cd nhiem HIV canci cao kien thffc ve each plidng chdng lay nhiem HIV han che, nen khdng tff bao ve dffdc ban than trffdc nguy cd nhiem HIV [3], [5]. V . KET L U A N Ngffdi nghien chi'ch ma tai Thanh phd Ha Noi dang phai i5di mat vdi cac hanh vi nguy cd lay nhiem HIV. Dung ma mdt lan mdt chiem 31,8%, dung hai den ba lan mdt chiem ty le cao nhat 53,5%, I t hdn lan/ngeiy chiem 8,7 % , dung tren lan/ngay chiem 6^0 %, Cd tdi 8,3% ngffdi nghien chfch ma van su' dung chung bdm kim tiem. Trong 400 ngffdi nghien chi'ch ma tham gia vao nghien cffu, ket qua xet nghiem HIV cd ty le dffdng tfnh la 7,0% d Ha Eidng va % d Tff Li^m. TAI UEU T H A M K H A O 1. Bp Y t e (2013), Bao cao ket qua hoat dong ptidng chong HIV/AIDS thang dau va phffijng hi/dng nhiem vy thang cudi nam 2013. 2. Bo Y t e (2007), Chydng trinh hanh dpng Quoc gia can thiep giam tac hai du" phong lay nhiem HIV/AIDS giai doan 2007-2010. 3. Bo Y t e (2006), Chffdng trinh giam sat ket fitff ha'nh vi va cac chi sd sinh hoc HIV/STI (IBBS) t?i Viet Nam 2005-2006, Ha Npi, tr. 12- 37. 4. Bp Y t e - Trung t a m Du* phong va Kiem so6t benh Hoa Ky-Chu'dng t r i n h AIDS toan cSu (2003), "Cac nguyen tac idu' phdng HIV nhdm sff dyng ma tiiy", Hpi thao ve dff phong nguy cd lay nhiem HIV nhdm nhu'ng ngu'S TCI^TJai Viet Nam, Ha Ndi, 30/9-3/10/2003. 5. N g u y i n Tran Hien, Le tru'dng Giang, Walter Dvilles (2000), "Yeu td nguy cd nhiem HIV va dung chung bdm kim tiem d ngffdi nghien ma tai phd Hd Chi Minh", Tap chf Y hoc thut hanh, sd 182. 6. Trung t a m phong chdng HIV/AIDS Hh N$i (2013), Bao cao ket qua hoat ddng phong chong HIV/AIDS thang dau va phu'dng hffdng n h i ^ vu thang cudi nam 2013. 7. Thu tu'dng Chinh phii (2012), Chien Iffdc quoc gia phdng chdng HIV/AIDS d Viet Nam den n5m 2020 va tam nhin 2030 . mijc tieu "Mo ta hanh vi nguy cd lay nhiem HIV va xac djnh ty le nhiem HIV ciia nhdm nghien chi'ch ma tuy tham gia chddng trinh diing thuoc thay the Methadone tai thanh pho Ha. in hematological disorder Journal of Pathology of Nepal (2012) Vol. 2, 309 -312 MO TA HANH VI NGUY Ca NHIEM HIV VA XAC DINH TY LE NHIEM HIV COA NHOM NGHIEN CHICH MA TUY THAM GIA . ban than trffdc nguy cd nhiem HIV [3], [5]. V. KET LUAN Ngffdi nghien chi'ch ma tuy tai Thanh phd Ha Noi dang phai i5di mat vdi cac hanh vi nguy cd lay nhiem HIV. Dung ma tuy mdt lan