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
Trang 1trung binh (46,6%) Loai thieu mau dang sac
hong cau binh thffdng chiem 59,3% 6 2 5 % thieu
mau khdng do cac benh ly tiiy xffdng vdi tiiy d d
binh thffdng hoac tang sinh lanh tfnh dong HC
Benh mau ac tinh la nguyen nhan gay thieu mau
chiem 2 3 , 1 % Tiiy dd la bffdc quan trong 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 3 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
T6M TAT
Nghien ciTu mo ta cat ngang dffpc thffc hien tren
400 ngi/di nghien chfch ma tuy tai 02 co sd dieu trj
Methadone tai thanh phd Ha Npi Ket qua nghien cyu
cac hanh vi nguy cd lay nhiem HIV nhi/ tud'i bat d'au
tiem chich ma tuy, sff dung chung bdm kim tiem khi
hem chfch ma tuy 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 trong nhdm ngffdi nghien chich ma tuy
S U M M A R Y
EVALUTION ON I N J E C H O N DRUGS USERS
( I D U S ) I N T W O 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
daig use, sharing needles used to inject drugs and not
Bui Thi Nga*, Nguyen Anh Quang*,
Nguyen Thanh Long** 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 ngay 30/6/2013 so cac trffdng hdp nhiem HIV con sdng la 213.413 ngffdi, trong do cd 63.373 ngufli
bi AIDS va 65.133 ngffdi tff vong do AIDS [1) Cac dffdng lay truyen HIV chii yeu d Vi|t Nam la diing chung bdm kim tiem (BKT) khi tiem chich
ma tuy (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 ai 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
Trang 2nhiem HIV, Dung chung BKT vdi mot ngu'di co
ten so tiem chich tren 1 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 2 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 do tudi cd nhu cau
quan he tinh due cao, nhieu ngu'di NCMT cdn
hijp nay cang lam cho nguy cd lay nhiem HIV ra
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, trong do
5.272 tru'dng hdp chuyen sang giai doan AIDS va
3.802 ngirdi tir vong do AIDS Hien nay dich van
cao nhat la trong nhdm NCMT (67,4%), Hep den
la quan he tinh due 22,8 % Dich HIV/AIDS d
Thanh pho 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 tuy tham gia chddng trinh
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 tuy sii dung cac loai ma tuy 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 trong 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 Nhom tuoi
< 20 tuoi
2 0 - 2 9
3 0 - 3 9
>40
Hoc van
Mil chii'
Tieu hoc
Phd thong cd sd
Phd thdng trung hoc
Dai hoc, cao dang
Ty le (»/o)
3,80 47.00 33,70 15,50
0,50 13,30 44,00 38,80 3,40
Trtmg so 400 doi tudng nghien cdu nhdm tuoi td20 den 29 chiem 47.0%, tiep den la nhdm tudi td30
den 39 (33,7%), thap nhat la dddi 20 tuoi (3,8%) Ve Trinh do hoc van: Nhin chung cac doi tddng co 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 do Dai hgc, cao dang chiem (3,4%), dSc biet cd 0,5% doi
Trang 3Bieu 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 6 :
N h a n \'ien phi.ic \ 1.1 b i l l haiiE ^ | ^ S
N h a n \ ien n h a n i r a c | 0 "
Trong nghiin c&u cho thiy Ng&di NCMT lam rit nhieu nganh nghi khac nhau trong dd tap trung chij yiu la nghi t&do (60,5%), nhan vlin ban hang (8,5%) va lam rugng (7,5%) Ngoai ra cdn mgt so cong viec khac nh&: chu kinh doanh (6,2%), sinh vlin (2,5%), nhan vien Nha n&dc (0,7%)) Dac biet,
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 tuy trong 1 thang qua
it hon ! Imvngay S.7
I lan/ngay
2-3 larVngay \,^l
Tren 3 lan/ngay H H | 6
Ty le ng&di NCMT dting TCMT mgt ian mot ngay chiim 31,8%, ddng hai din ba lan mpt ngay chiim
ty li cao nhit 53,5%, It hdn 1 lan/ngay chiim 8,7 %, dt/ng trin S lan/ngay chiim 6,0 % Tan suit siJ' dung thudc trong ngay khong nhu'ng phu thupc vao m&c dp nghiin nang hay nhe, ma con phu thugc vao kha nang kinh ticua ng&di NChlT
Bieu do 3 Hanh vi diJng chung BKT khi TCMT trong 1 thang qua
iCo MK.li6n2
Kit qua cho thiy co 91,7%) ng&di NCMT khong s&dung chung BICT nh&ng van con tdi 8,3% ng&di
Trang 4Bleu ad 4 Tan suat diing BCS khi QHTD vdi GMD trong 12 thang qua
Khong bao gid
Doi khi
Da sd cac lan
Tat ca cac Ian
0.7
LI 2.5
:,:;^ , J 87.9
80 100
Kit gua cho thay tan xuat sd dung BCS khi quan he tinhd due (QHTB) vdi gai mai dam (GMD) trong
12 thang qua kha cao chiem 87,9% trong 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'
Dac tinh
Trinh dp hpc van
Thdi gian nghien
< Idp 9
> Idp 9 Tir 2 nam trd len Dddi 2 nam
Sii dung chung BKT
Co
25 (28,7)
8 (2,6)
31 (10,9) 2(1,7)
Khong
62 (71,3)
305 (97,4)
253 (89,1)
114 (98,3)
OR 15,4 6,9
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 pho 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 ra la cd s& khac biet trong hanh vi s&dung chung BKT cua nhung ng&di NCMTco thdi gian nghiin d&di 2 nam va tren 2 nam nhii'ng ng&di NCMT trin 2 nam cd nguy cd s&dung chung BKT gip 6,9 lan so vdi ng&di NCMT d&di 2 nam
Bie'u do 5 Ty le nhiem HIV trong nhdm ngffdi NCI^T
\ 100
• 80
6 0
^.•m Ha Dong Tir liem
y Duong tinh HAm tmh
I
Kit qua xet nghiim HIV trong nhdrrTbinh nhan NCMT tham gia dieu tri nghien thay the Methadone 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 tuy tap trung d dp tuoi lao dpng, de tiep can vdi ma tiiy dac biet la tiem chich ma tuy, do dd lam gia tang manh sir phat trien te nan ma tiiy trong nhu'ng nSm gan day
Da 50 ngudi NCMT dang trpng dp tuoi lap dpng
W
Trang 5va la nhffng tru cdt cua gia dinh do 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 2 den 3
lan/ngay, 1 lan/ngay la 31,8% Ty le cd tan suat
TCMT tren 3 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 do
dac thu cua ngffdi NCMT la thffdng giau diem cac
hiem cua sff dung chung BKT [ 6 ]
Trong nghien cffu nay cdn tdi 8,3% ngffdi
NCMT van sff dung chung BKT Viec sff dung
nhiem HIV nhanh nhat do xac suat lay nhiem qua
dffdng tiem chfch la rat cao Ben canh d d , viec
ngffdi NCMT chiu anh hffdng Idn tff cac thanh
vien khac trong nhdm nen viec hp cd hanh vi
tiem chich chung la dieu de xay ra, cang de lam
tang nguy cd lay nhiem HIV trong nhdm Tuy
nhien ket qua hanh vi sff dung chung BKT nay
thap hdn so vdi vdi ket qua nghien cffu giam sat
hanh vi nam 2005 d TP Hd Chf Minh 3 7 % , An
Giang 33%, Oa N i n q 2 9 % , Can T h d 2 5 % [ 3 ]
Trong nghien cffu cd den 87,9% ngffdi sff
dung BCS khi QHTD vdi gai mai dam trong 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 trong
nhdm nay 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 ra
cd nguy cd nhiem HIV/STIs cao gap tff 2 den 20
lan nhdm GMD thffdng xuyen sff dung BCS [ 3 ]
Ket qua nghien cffu cho thay ty le ngffdi
nghien chfch nhiem HIV la 2 3 % , vdi nhffng ngffdi
nghien chfch nay neu khdng sff dyng BKT sach
va sff dung BCS khdng thffdng xuyen la mpt trong
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 v d , con va nhffng ban tinh cua hp Theo ket qua nghien cffu ciia cac
quan he tinh due cang sdm thi nguy cd nhiem HIV
canci cao do kien thffc ve each plidng chdng lay ban than trffdc nguy cd nhiem HIV [3], [ 5 ]
V KET L U A N Ngffdi nghien chi'ch ma tuy tai Thanh phd Ha Noi dang phai i5di mat vdi cac hanh vi nguy cd chiem 31,8%, dung hai den ba lan mdt ngay chiem ty le cao nhat 53,5%, I t hdn 1 lan/ngeiy chiem 8,7 % , dung tren 3 lan/ngay chiem 6^0 %,
Cd tdi 8,3% ngffdi nghien chfch ma tuy van su' dung chung bdm kim tiem Trong 400 ngffdi nghien chi'ch ma tuy tham gia vao nghien cffu, 7,0% d Ha Eidng va 1 8 % 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 6 thang dau va phffijng hi/dng nhiem vy 6 thang cudi nam 2013
2 Bo Y t e (2007), Chydng trinh hanh dpng Quoc gia can thiep giam tac hai trong 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 trong nguy cd lay nhiem HIV trong 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 t r u ' d n g Giang, Walter Dvilles (2000), "Yeu td nguy cd nhiem HIV va dung chung bdm kim tiem d ngffdi nghien ma tuy tai thanh phd Hd Chi Minh", Tap chf Y hoc thut hanh, sd 182
6 Trung t a m phong chdng H I V / A I D S Hh N$i
(2013), Bao cao ket qua hoat ddng phong chong HIV/AIDS 6 thang dau va phu'dng hffdng n h i ^
vu 6 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