【摘要】 目的 基于替代效应假设，分析门诊ART效果、住院变量与HIV/AIDS患者发生灾难性卫生支出（CHE）间关系。方法 从W市主要的艾滋病定点防治医疗机构中，收集2019年就诊的患者病案并进行问卷调查。应用广义结构方程模型分析门诊ART效果对CHE发生风险的影响及住院变量（是否住院）的中介效应。结果 共回收有效问卷194份，其中男性占比为80.93%，城镇户籍占比为73.71%，学历为本科及以上占比为44.85%。CD4细胞水平对CHE发生风险影响的总效应显著（OR=0.229,95%CI:0.073～0.717）。加入住院变量后直接效应不显著（OR=0.980,95%CI:0.583～1.650）;CD4细胞水平对住院变量、住院变量对CHE发生风险的影响均显著，故CD4细胞水平对CHE发生风险影响的间接效应显著（OR=0.234,95%CI:0.077～0.708）。间接效应占总效应的比值为98.64%。结论 进行充分且有效的门诊ART是防范CHE风险发生的有效措施，应适当扩大艾滋病门诊治疗相关费用报销范围，提高治疗的可及性、依从性；要重视艾滋病门诊规范管理。更多还原

【Abstract】 Objective Based on the hypothesis of the substitution effect, the relationship between the effect of outpatient ART, the hospitalization variable and the occurrence risk of catastrophic health care expenditure(CHE) for patients with HIV/AIDS was analyzed. Methods Medical records of patients treated in 2019 were collected from primary designated AIDS prevention and treatment medical institutions in City W. A questionnaire survey was conducted. A generalized structural equation model was used to analyze the effect of outpatient ART treatment on the risk of CHE and the mediating effect of hospitalization variables. Results A total of 194 valid questionnaires were issued, of which 80.93%were from males, 73.71% were from urban households and 44.85% were from bachelor’s degrees or above. The total effect of CD4 cell level on the risk of CHE occurrence was significant(OR=0.229, 95%CI: 0.073-0.717). After adding the hospitalization variable, the direct effect became insignificant(OR=0.980, 95%CI: 0.583-1.650). The CD4 cell level’s regression coefficient on the hospitalization variable and the hospitalization variable on the risk of CHE were significant. It suggested that CD4 cell level’s had significant indirect affecting on the risk of CHE(OR=0.234,95%CI:0.077-0.708). The ratio of the indirect effect to the total effect was 98.64%. Conclusions Sufficient and adequate outpatient ART is an effective measure to prevent the risk of CHE. Therefore, outpatient HIV treatment reimbursement should be appropriately expanded to improve the access and compliance of treatment;To focus on AIDS outpatient management.更多还原