艾滋病感染家庭生育风险建模及低风险生育服务优化策略研究

The situation of HIV/AIDS prevention and control in China is still serious. The spread of HIV through sexual transmission has become the main route of transmission. Due to the influence of traditional Chinese culture, every family must face a fact of fertility. Childbearing is an important risk factor for HIV transmission between couples and from mother to child. Due to the progress of antiretroviral treatment, the trend of childbearing willingness of the family members in HIV infected couples is increasing. It also brings hope to most HIV infected families with fertility desire. The childbearing willingness of HIV infected families is an objective fact. Giving birth to their children is an important part of their social status among HIV infected couples. Due to the childbearing willingness of HIV infected families, the conception without the correct guidance of medical staff will lead to the transmission between spouses and from mother to child. There is a lack of childbearing risk assessment for HIV infected families with childbearing willingness and providing guidance on one-on-one full birth service for pregnancy. This study is to evaluate the HIV transmission risk between couples and from mother to child due to child birth and fertility through field investigation and by using the fuzzy comprehensive evaluation model. Based on risk assessment and combined with previous fertility counseling and intervention measures, a low fertility services optimization strategy is to be constructed for HIV infected families with childbearing willingness. This optimization strategy will provide adaptability, fertility decision making and maternity services according to the different types of HIV infection risk of families. Through the implementation and evaluation of the effectiveness and feasibility of the low fertility services optimization strategy, a low risk fertility service strategy suitable for HIV infected families with childbearing willingness in China is finally formed.

我国艾滋病防治形势严峻，性传播已成为艾滋病病毒传播的主要传播途径，艾滋病家庭内传播不容忽视。由于中国传统文化因素影响，生育子女是每个家庭要面对的事实，而生育行为是导致艾滋病感染家庭配偶感染的重要危险因素。由于抗病毒治疗进展，也给大多数有生育意愿的艾滋病感染家庭带来了希望，但是艾滋病感染家庭在缺乏医护人员正确指导而受孕，会导致配偶间传播和母婴传播的发生。目前对艾滋病感染家庭生育咨询和规范化干预严重不足，缺少艾滋病感染家庭生育风险评估，缺乏系统的低风险生育服务策略。本研究拟通过现场调查和运用模糊层次分析法的模糊综合评价模型评估其生育风险，并基于生育风险评估结果，结合既有生育咨询和干预措施，构建不同类型艾滋病感染家庭低风险生育服务优化策略，提供不同类型艾滋病感染家庭独适性的生育决策方式及生育服务，并通过策略实施并评估其效果和可行性，最终形成适合我国艾滋病感染家庭的低风险生育服务策略。

性传播已成为我国艾滋病主要传播途径，生育行为是导致艾滋病感染家庭配偶感染和母婴传播的重要危险因素。由于抗病毒治疗进展，给大多数有生育意愿的艾滋病感染家庭带来了希望，但是艾滋病感染家庭在缺乏医护人员正确指导而受孕，会导致配偶间传播和母婴传播的发生。本研究发现艾滋病感染家庭生育需求普遍存在，低风险生育认知比较缺乏，医务人员对艾滋病感染家庭生育服务技能不足。本研究基于模糊层次分析法建立了艾滋病感染家庭生育风险评价指标体系包括14个指标，其中抗病毒治疗、病毒载量水平和医护人员生育指导能力是最为重要的生育风险指标。在生育风险评价指标体系基础上，通过SWOT分析法对艾滋病感染家庭生育风险综合研判，从而为不同类型艾滋病感染家庭提供适宜生育决策。开发艾滋病感染家庭低风险生育指南，对每个有生育意愿的艾滋病感染家庭进行生育风险评估，并对存在的每个生育风险指标进行干预，从生育风险评估、孕前咨询、备孕准备、孕期监测、产后管理等环节由经培训的医务人员提供全程规范的服务。在医务人员全程指导下，采取针对性措施，将生育风险降到最低，期间未发生配偶间性传播和母婴传播。.截至2022年底我国现有艾滋病感染单阳家庭超过17万，每年艾滋病感染单阳家庭配偶传播年发生率在一些地区超过1%，母婴传播率超过3%，给已经遭受艾滋病影响的家庭带来更加沉重负担。本研究发现，近50%的18-45岁艾滋病感染家庭有生育需求，帮助这些家庭避免由于生育导致配偶间传播和母婴传播的发生至关重要。艾滋病感染家庭在医务人员的全程指导下，科学合理的选择生育方式，是可以生育健康孩子且同时可以避免因生育导致配偶间传播的发生，将风险降到最低。.本研究结果对于推进消除我国艾滋病母婴传播将起到积极作用，具有非常重要的科学意义和社会效益。项目研究成果应用于指导医务人员为各地艾滋病感染家庭提供及时、科学的低风险生育指导，减少因继续发生家庭内传播而导致的家庭经济负担和社会负担。