...1...1...6...15...19...24...31...37...44...51...56 STDHIV...60...63...65...70
2002-1 -
- 2 -
- 3 -
247C 318-4 -
HIV - 5 -
HIV,,,,,,,,,,,,, - 6 -
7 1 2 3 4 5, 4 1 2 3 4-7 -
, - 8 -
- 9 -
2 1. 2. 3. - 10 -
2., RCT Quasi RCT quasi quasi quasi - 11 -
1. STD, 3 2.CEA CEA CEA CEA PID CEA 3. (CUA) CUA CEA QALY QALY QALY STD QALY CUA 4. (CBA) CBA CEA CEA PID - 12 -
CEA CUA - 13 -
STD 1 2 3 1 2 3 4 5 6 7 8 9 10, - 14 -
CDC 1. 2. 3. 4. - 15 -
- 16 -
3-17 -
9 HIV HIV HIV 1) 2) 3) 4) / 5) 6) 7) 8) 9) 10) 11) HIV 1) 2) 3) - 18 -
4-19 -
4-20 -
1. 2. 3. - 21 -
4 6 4 6-22 -
/ PTC RTC AETC 3 3 PTC RTC HIV AETC HIV - 23 -
- STD - 24 -
STD STD HIV STD STD STD STD 3 3 STD STD Pap HIV STD STD DIS HIV STD - 25 -
1.5 HIV HIV HIV DIS DIS DIS STD - 26 -
1 2 STD 3 4 STD DIS 5 1 23 STD 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 STD - 27 -
STD HIV HIV STD STD AIDS HIV HIV Mantoux HIV HIV HIV STD HIV STD - 28 -
STD 2 2 STD DIS STD/HIV STD CDC DIS STD DIS STD STD DIS - 29 -
STD STD HIV STD HIV STD STD 100% STD STD 24 55% 8% 12% - 30 -
STD STD STD STD STD HIV STD HIV STD HIV HIV HIV HIV HIV/AIDS HIV HIV STD HIV STD STD - 31 -
STD HIV HIV STD STD STD STD STD STD - 32 -
STD DIS DIS STD STD 7 STD STD - 33 -
HIV HIV 1. DIS DIS 2. DIS STD - DIS 3. 3 STD - 34 -
4. STD/HIV DIS 72 5. HIV 6. DIS STDSTD STD STD - 35 -
7. 1. 2. 3. 4. 5. 6. STD - 36 -
DIS DIS 24 48 NIH - 37 -
(CID) 1989 (RECAP) RECAP RECAP RECAP - 38 -
- 39 -
- 40 -
/HIV - 41 -
HIV Respect 6 (WINGS) 3 (AESOP) - 42 -
HIV HIV HIV CDC - 43 -
STD STD/HIV - 44 -
STD STD STD STD STD 25% STD STD STD STD / 48 DIS STD STD STD STD - 45 -
STD STD HIV STD STD STD /STD STD STD STD STD STD STD HIV STD STD STD STD CDC STD STD STD STD STD STD - 46 -
HMO 20 90 MCO MCO STD MCO STD STD STD STD MCO STD MCO MCO MCO STD STD (HEDIS) 2000 15 25 STD STD STD - 47 -
STD MCO STD STD CDC STD STD/HIV STD HIV HIV HIV STD HIV STD HIV STD STD HIV STD HIV STD HIV HIV HIV STD STD STD STD STD STD HIV STD HIV HIV STD HIV STD HIV (ACHSP) STD HIV STD HIV ACHSP STD HIV HIV STD - 48 -
HIV STD 20 90 HIV 9.96 7 10 STD HMA HMA 5 PRA 1 20 90 2 3 4 PRA PRA STD - 49 -
HIV STD STD STD STD STD STD STD STD STD STD HIV Program operations guidelines for STD prevention, www.cdc.gov - 50 -
20 STI STI STI STI STI HIV STI HIV STD HIV HIV 10 STI HIV-1 40% STI HIV STI 15 35 Over Piot STI 100 10 426 100 4278 WHO 1999 3.4 STI 1000-51 -
1 STI 15 49 ( ) ( ) (1/1000) ( ) 156 3 19 14 203 4 20 17 165 3.5 21 10 205 6 29 22 269 32 119 69 955 48 50 151 815 6 7 18 11 0.3 27 1 260 18.5 71 38 3040 116.5 340 24.1% 27% 70 75% 2 1995 1999 1995 1999 2.34 1.64 3.99 2.16 1.77 3.93 3.20 2.30 5.50 2.94 2.28 5.22 1.28 1.67 2.95 1.44 1.71 3.15 2.92 2.15 5.07 3.25 2.72 5.97 8.44 6.96 15.40 8.24 7.65 15.89 20.28 20.20 40.48 23.96 18.93 42.89 2.63 2.70 5.33 2.74 2.56 5.30 0.17 0.12 0.30 0.17 0.14 0.30 5.12 5.01 10.13 5.12 4.19 9.31 46.38 42.77 89.15 50.03 41.95 91.98-52 -
3 1995 1999 1995 1999 0.92 0.83 1.75 0.84 0.72 1.56 0.63 0.60 1.23 0.63 0.49 1.11 0.77 0.77 1.54 0.68 0.79 1.47 1.16 1.17 2.32 1.81 1.50 3.31 8.38 7.30 15.67 8.84 8.19 17.03 14.55 14.56 29.11 15.09 12.12 27.20 1.47 1.80 3.27 1.68 1.59 3.27 0.07 0.06 0.13 0.06 0.06 0.12 3.67 3.045 7.12 4.01 3.26 7.27 31.61 30.54 62.15 33.65 28.70 62.35-53 -
4 1995 1999 1995 1999 0.03 0.03 0.07 0.03 0.03 0.05 0.05 0.05 0.10 0.04 0.04 0.08 0.42 0.36 0.79 0.25 0.21 0.46 0.06 0.06 0.13 0.07 0.07 0.13 4.98 3.97 8.95 5.36 4.25 9.61 8.10 6.89 14.99 4.98 4.25 9.23 0.39 0.33 0.72 0.18 0.16 0.34 0.00 0.00 0.01 0.00 0.00 0.00 0.89 0.71 1.61 2.05 1.23 3.68 14.93 12.41 27.34 12.96 23.59 5 1995 1999 1995 1999 4.23 3.78 4.29 3.90 5.76 5.30 5.52 5.09 2.22 2.32 2.25 2.35 5.17 4.90 6.75 6.36 15.35 15.07 16.19 15.93 35.87 39.56 36.36 40.06 4.53 4.83 4.61 4.91 0.32 0.29 0.32 0.29 9.10 8.52 9.50 8.79 82.55 84.57 85.78 87.68 STI STD STI - 54 -
STI STI WHO 7 13 11 1994 3.3% 1998 49% 1993 0.3% 7 1993 0.1% 1997 5.6% 70% 1997 33.4% 16% 31% 8% 13% 19% 6% 0.8% 3.2% 3% 9% 1% 0.8% WHO 2001 Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates - 55 -
1989 1981 1988 124.31% 1989 1997 10 25% 1998 1999 1998 632 949 1997 36.87% 1999 837 357 1998 32.29% 2000 859 040 1999 2.59% 2001 795 612 2000 7.38% 1979 1993 1999 80 406 1993 40 1979 1987 1000 1988 1992 2000 1990 1993 1999 85% 2000 2001 5 10 2000 NGU NGU NGU 2001-56 -
29.48% NGU 31.81% 24.11% 9.71% 4.43% 0.45% NGU - 57 -
- 58 -
- 59 -
STDHIV HIV STD HIV STD STD HIV HIV STD STD HIV HIV STD STD HIV STD HIV Torian 1990 1997 481/10 194/10 HIV 10 11 STD HIV 8% 5% HIV 11 12% 25 HIV 14 16% HIV HIV HIV Koumans 29 HIV 1984 1994 HIV 0 1258/ 0 81/10 HIV HIV HIV Gray HIV Rakai STD HIV 8089 HIV 16% HIV HIV HIV STD STD STD STD HIV HIV STD STD HIV 370 Chaplinskas 1998 HIV HIV AIDS STD STD 101.4/10-60 -
Dowe 339 NGU 5.2% HIV Tabrizi 7 291 STD 6% 17 16% 47 1% 2 8% 24 HIV 1% 2 75 26% 16 STD STD STD HIV HIV 1983 1997 STD 80 1808 HIV 58 3% HIV 11.3% HIV 88% 31% 4% STD AIDS Roy HIV 909 25.9% 31% 36.4% HIV 1.9% 20 HIV Feldman 599 HIV 2.0% 1.6% 18.8% 75% HIV 14.2 HIV Pitche STD 33 13 12 ( ) 1 10 HIV HIV HIV STD - 61 -
Severson HIV HIV HIV HIV HIV HIV HIV HIV Bordan 13 HIV 13 4 5 4 5 RPR 8 RPR VDRL DNA Erbelding HIV STD 1997 6 1998 4 691 HIV 58% 90 7.4% 1 34.6% 691 HIV 46% 1 637 2.4% 1.6% STD HIV STD STD HIV - 62 -
- 63 -
- 64 -
STDs 1999 31 8 HIV(+) 837,357 1998 32.29% HIV 1999 10 12 2 1. 15 49 Fox Pro 5.0 SPSS 9.0 2 Fisher 2. 2.1 21 12 11 1 9 3 6 33 7 2.2 2.3 1 4 1 2 1.1 58% 7/12 22% 2/9 12 2 1-65 -
9 7 50% 6/12 PCR MDI 1 1. / (%) 11 (92) 1 12 8 (89) 1 9 9 (75) 3 12 8 (89) 1 9 9 (75) 3 12 8 (89) 1 9 11 (92) 1 12 8 (89) 1 9 12 (100) 0 12 9 (100) 0 9 2 (17) 10 12 0 ( 0) 9 9 7 (58) 5 12 2 (22) 7 9 6 (50) 6 12 7 (78) 2 9 9 (75) 3 12 8 (89) 1 9 6 (50) 6 12 8 (89) 1 9 2 (17) 10 12 5 (56) 4 9 8 (67) 4 12 9 (100) 0 9 6 (50) 6 12 8 (89) 1 9 5 (42) 7 12 8 (89) 1 9 5 (42) 7 12 8 (89) 1 9 HIV 3 (25) 9 12-66 -
6 (67) 3 9 8 (67) 4 12 9 (100) 0 9 8 (67) 4 12 9 (100) 0 9 MDI/PCR 8 (67) 4 12 3 (33) 6 9 MDI = PCR = 2.3 40 12 30% NGU 46 4 9% NGU P = 0.01 23 8 35% NGU 25 1 4% NGU P = 0.01 2 2. NGU GH CA / 9 1 12 2 10 0 6 40 6 3 4 5 16 0 12 46 0 0 8 1 6 8 0 23 0 0 1 0 14 10 0 25 NGU = GH = CA = 2.4 3 NGU 89% 83% 44% 50% 40% 23% Fisher NGU 300 161 434 603 3000 4000-67 -
3. (%) P 1 8 (89) 9 0.23 434 (294 697) > 3000* 3 3 (50) 6 300 (140 555) 252** NGU 3 15 (83) 18 0.09 603 (309 6034) > 3000* 3 2 (40) 5 161 (66.2 225) 190** CA 9 7 (44) 16 0.18 660 (114 1192.8) > 4000* 23 7 (23) 30 428 (63 1163.2) 359** NGU = CA = *. **. 3. 2.3 7 1.1 33 MDI PCR 40 23 12 30% 8 35% NGU 46 25 4 9% 1 4% NGU MDI PCR 3000-68 -
1. 2. MDI 3. 4. - 69 -
- 70 -
- 71 -
- 72 -
- 73 -
4-74 -
41-75 -