Objective To analyze the characteristics and influencing factors of high-risk sexual behaviors before infection confirmation among middle-aged and elderly people living with human immunodeficiency virus (PLHIV) transmitted via different routes. Methods We recruited 449 PLHIV in Wuhan city of Hubei province and aged 50 years and older at the diagnosis during the period from 2017 to June 30, 2019. A face-to-face anonymous survey was conducted among the PLHIV using a self-designed questionnaire to collect information on high-risk sexual behaviors and HIV-related knowledge before the confirmation of HIV infection. Chi-square test and multivariate analysis were used to explore influencing factors for high-risk sexual behaviors. Results Complete information were collected from 419 participants (353 males and 66 females with a mean age of 59.67 ± 7.48 years). The reported HIV transmission routes included extramarital heterosexual behaviors for 215 (51.3%) of the participants, heterosexual behaviors between HIV-discordant couples for 40 (9.5%) of the participants and homosexual behaviors for 164 (39.1%) of the participants. Multivariate analysis showed that for the participants being infected via extramarital heterosexual behaviors, ever working in places other than hometown (odds ratio [OR] = 4.55), being capable of making annual balance between income and expenditure (OR = 4.22), and history of commercial heterosexual behavior (OR = 11.20) were risk factors for multiple sexual partners before HIV infection confirmation; while for the participants being infected via homosexual behaviors, ever working in places other than hometown (odds ratio [OR] = 10.04), being capable of making annual balance between income and expenditure (OR = 26.29), and history of non-commercial temporary homosexual behavior (OR = 35.37) were risk factors for multiple sexual partners before HIV infection confirmation, but with a common knowledge/without knowledge about AIDS prevention (OR = 0.04/0.07) was a protective factor against multiple sexual partner. Conclusion Ever working in places other than hometown and being capable of making annual balance between income and expenditure are risk factors for multiple sexual partners before infection confirmation among middle-aged and elderly people living with human immunodeficiency virus.

目的 了解武汉市性病门诊男性就诊者艾滋病监测情况,分析目标人群高危行为以及HIV、HCV和梅毒感染状况,为制定科学的防艾措施提供依据.方法 按照《全国艾滋病哨点监测实施方案》,用连续采样方法,对2014—2018年监测期内所有符合条件的对象进行问卷调查并采集血样进行检测,每年监测400人,共完成样本量2000例.采用卡方检验比较各年度艾滋病知识知晓情况、行为学监测结果等的差异.结果 性病门诊男性就诊者年龄以19～56岁为主,占91.20％,平均年龄(35.80±12.55)岁.各年度对"一个感染了艾滋病病毒的人能从外表上看出来吗""蚊虫叮咬会传播艾滋病吗"两个问题回答的正确率均较低(<80.00％),艾滋病相关知识知晓率平均为75.10％,2015年后知识知晓率呈逐年上升趋势,5年间知晓率的差异有统计学意义(χ2=25.32,P<0.01).最近3个月与暗娼发生性行为的比例平均为37.70％;最近3个月与临时性伴发生性行为的比例平均为49.70％.近5年HIV、梅毒和HCV的阳性率平均值分别为2.80％、19.50％、1.45％.结论 性病门诊男性就诊者近年来艾滋病知识知晓率有所提升,但某些知识点的知晓率仍较低,该人群的高危性行为比例和HIV、梅毒阳性率仍较高,需加强对该类人群的宣传教育和预防干预,以减少性病艾滋病的传播.

目的:研究社会支持对新确证的HIV感染者/AIDS患者(people living with human immunodeficiency virus/acquired immunodeficiency syndrome，PLWHA)抑郁合并创伤后应激障碍(posttraumatic stress disorder，PTSD)的影响。方法:对2016年10月至2019年2月在武汉市金银潭医院艾滋病治疗门诊就诊的新确证PLWHA进行一对一的问卷调查，调查内容包括一般人口学特征及确证前HIV高危行为史，社会支持、抑郁和PTSD情况。抑郁合并PTSD的患者为P＋D组，无抑郁无PTSD的患者为N组，采用SPSS 21.0进行统计分析，卡方检验、 t检验和秩和检验比较两组变量之间的差异，多因素Logistic回归分析抑郁合并PTSD的影响因素。 结果:调查的320例PLWHA中，抑郁合并PTSD的患者(P＋D组)72例(22.50%)，无抑郁无PTSD的患者(N组)161例(50.31%)，两组的性别(χ 2＝9.84)、感染途径(χ 2＝11.16)、是否使用过毒品(χ 2＝30.00)构成比差异有统计学意义(均 P<0.05)，社会支持总分[(30.64±10.90)分，(25.51±8.55)分]、客观社会支持[(7.20±3.08)分，(5.76±2.24)分]、主观社会支持[(16.70±6.87)分，(14.04±5.61)分]、社会支持利用度[(6.74±2.59)分，(5.71±2.60)分]的评分均差异有统计学意义( t＝3.56，3.57，2.88，2.81，均 P<0.05)。Logistic回归分析显示，男性( β＝-1.48， OR＝ 0.23, 95% CI＝0.09～0.61)是PLWHA抑郁合并PTSD的保护因素，低水平社会支持( β＝1.40， OR＝4.05，95% CI＝1.36～12.10)是PLWHA抑郁合并PTSD的危险因素。 结论:PLWHA人群抑郁合并PTSD的患病率较高，应当注重性别和社会支持对PLWHA抑郁合并PTSD的影响。

目的:了解餐饮服务人员丙型肝炎防治知识知晓率、相关行为及影响因素,为防治丙型肝炎提供参考依据.方法:采用分层随机整群抽样的方法,对武汉市中心城区和郊区2家体检机构1195名接受体检服务的餐饮服务人员进行问卷调查,并进行χ2检验和logistic回归分析.结果:餐饮服务人员的丙型肝炎防治知识的知晓率为16.6％.有16.4％接受过纹身(包括纹唇、纹眉)、打耳洞等,3.8％有多个性伴侣;1.2％曾与他人共用注射器、针头,24.7％检测过丙型肝炎.受教育程度影响丙型肝炎防治知识的知晓率,高中或中专及以下较中专及以上的从业人员知晓率低.结论:餐饮服务人员丙型肝炎防治知晓率较低,存在一定程度的高危行为,接受过丙型肝炎检测的比例较低,应制定相应的干预策略,加强从业人员的健康教育.

目的 对2017年武汉市艾滋病疫情流行现状进行估计,为艾滋病防控决策提供依据.方法 依据武汉市人口学数据、艾滋病流行病学资料,利用Workbook模型,对武汉市2017年艾滋病疫情流行现状进行估计,并用卡方检验比较疫情估计与病例报告数据中性别及传播途径构成差异.结果 估计2017年武汉市现存活成年艾滋病病毒感染者(HIV)和艾滋病患者(AIDS)人数为6008例,HIV总体感染为0.064％,估计检测发现比例为75.02％.现存活者中,同性途径传播4017(66.86％)例,异性途径传播1803(30.01％)例,注射毒品传播188(3.13％)例,估计上述不同传播途径病例检测发现比例分别为73.89％、78.81％和48.94％.结论 武汉市艾滋病疫情仍处于低流行状态,但仍有近1/4的感染者尚未被发现.传播途径以同性传播为主,异性传播中配偶/固定性伴传播也占有一定比例.在下一步工作中,有必要探索和尝试更有效的艾滋病监测检测实践,特别是高危人群及其性伴的检测覆盖,以最大限度的早发现HIV/AIDS病例,降低二代传播的风险.

目的 应用艾滋病疫情估计和预测软件包(EPP)和Spectrum模型估计和预测武汉市艾滋病疫情特征和发展趋势.方法 收集、核实和整理武汉市各年度病例报告、哨点监测、专题调查、孕产妇筛查、羁押场所报表、抗病毒治疗、高危人群检测等工作数据,运用EPP-Spectrum模型进行曲线拟合和校正,组织专家论证并形成最终结果.结果 模型预测武汉市成人HIV感染率自2003年后明显上升,至2013年左右达到峰值,之后至2019年一直维持在较高水平,2019年成人的HIV感染率约为9.0/万,2020年以后成人感染率将出现下降趋势.各类人群中,感染者配偶/性伴的感染率最高,其次为男男人群.现存活HIV/AIDS人数自2000年开始逐渐上升,2022年估计现存活人数将达到8000人左右(95％CI:5421～9754).从性别年龄构成上来看,HIV感染者的主要年龄分布为青壮年,男性尤其是25～50岁男性是主要的受累人群.结论 武汉市当前仍属于艾滋病低流行地区,男男人群仍然是今后几年的干预重点.

老年艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)报告病例逐渐增多是近几年引起广泛关注的内容[1-3],明确当前老年HIV/AIDS病人的高危行为特征是实施有针对性的艾滋病预防干预措施的重要依据.既往的研究主要以≥50岁HIV/AIDS病人作为整体,未区分不同感染途径的老年HIV/AIDS病人高危行为特征的差异[4-6],本研究对不同感染途径的老年HIV/AIDS病人进行了深入访谈,了解其确证前后发生高危行为特征,以期为制定科学的艾滋病防控策略提供参考.

目的 了解武汉市青年学生艾滋病疫情,为制定针对性的高校艾滋病防控策略提供科学依据.方法 利用武汉市2001—2016年艾滋病综合防治信息系统中的HIV/AIDS病例报告数据,选择其中15～24岁病例1537例建立数据库,其中包括青年学生病例348例,校外青年病例1189例,运用SPSS 22.0软件进行描述性比较分析.结果 武汉市2001年报告首例15岁及以上学生HIV/AIDS病例.截至2016年底,武汉市累计报告15～24岁青年学生HIV/AIDS病例348例,占所有15～24岁病例的22.6％,男女比例为37.7:1,大专及以上文化程度为89.4％,同性途径传播91.1％,主要样本来源为专题调查,其次为自愿咨询检测(VCT).历年新报告青年学生病例数呈增长趋势,特别是19～24岁年龄段.与校外青年病例比较发现,青年学生文化程度、同性传播比例及VCT检测比例均较高.结论 近年来武汉市报告的15～24岁青年学生病例数增长较快,19～24岁是主要的累及年龄段,同性性行为是主要危险行为,应及时加强对青年学生的性健康和预防艾滋病知识的宣传干预工作,进一步提高有高危行为青年学生的H IV主动检测意识.

目的 对2012-2017年武汉市HIV初筛阳性样本的检测结果进行分析,了解武汉市HIV抗体确证情况.方法 依据《全国艾滋病检测技术规范(2009年版、2015年修订版)》对各筛查机构HIV筛查阳性反应的样本进行酶联免疫复核和免疫印迹确证试验.结果 2012-2017年武汉市艾滋病确证实验室共收到11 749份初筛阳性样本,经复核和确证试验,7 433份(63.26％)诊断为HIV-1抗体阳性,3 780份(32.17％)为HIV-1抗体阴性,536份(4.56％)为HIV-1抗体不确定.阳性病例最多的年龄段为16 ～ 30岁.536例不确定样本中有156例(30.41％)进行了随访,120例(76.92％)确证为阳性,13例(8.33％)确证为阴性,23例(14.74％)仍为不确定.结论 2012-2017年武汉市HIV-1抗体阳性数增长趋势明显,应进一步加强急性期和不确定结果病人的管理,做到早发现、早治疗.

目的 了解武汉市社会组织(CBO)参与艾滋病防治工作现状和效果,为进一步推进CBO建设与发展,不断提高艾滋病防治工作能力和质量提供参考.方法 采用定性与定量相结合的调查方法,对参与武汉市艾滋病防治工作的6个社会组织进行问卷调查和访谈收集数据,同时收集同期相关专业机构相关数据并进行统计学分析.结果 6个社会组织中,经民政部门注册的3个;均有固定场所;负责人均为全职,工作人员以志愿者为主(82.28％);参与艾滋病防治服务范围与内容较全面;面临资金短缺、人员不稳定、工作能力和质量不高等突出问题和相关需求.2016-2017年本市通过社会组织进行艾滋病病毒(HIV)检测31 467例,检出阳性357例,检出率1.13％,高于相关专业机构阳性检出率0.73％(x2=48.361,P＜0.001).结论 社会组织在艾滋病防治尤其是在高危人群干预、检测方面具有明显优势和效果,但参与艾滋病防治现状尚未得到根本性改善,资金来源是面临的最大问题和需求.建议多途径加大对社会组织资金支持,进一步提升社会组织参与艾滋病防治能力和可持续性.

目的 分析2009-2016年湖北省武汉市艾滋病监测哨点吸毒人群艾滋病病毒(HIV)、梅毒、丙型肝炎(丙肝)感染状况和变化趋势.方法 2009-2016年每年4-6月,采用国家统一制定的问卷对武汉市哨点中监管场所和社区吸毒者、美沙酮门诊最近1个月吗啡尿检阳性者开展连续横断面调查,并采集调查对象血液标本进行HIV、梅毒和丙肝病毒(HCV)抗体检测.结果 2009-2016年共监测6 408名毒品使用者.HIV抗体阳性率平均为0.73％,维持在较低水平;梅毒为5.07％;HCV为54.35％,维持在较高水平.不同来源及特征的吸毒人群感染情况不同.多元logistic回归分析显示,外省户籍(OR=4.183,95％CI:1.670 ～ 10.476,P=0.002)、其他民族(OR=7.754,95％CI:2.537 ～ 23.703,P=0.000)、曾共用针具(OR=5.908,95％CI:2.906～12.009,P=0.000)、监管场所来源吸毒人员(OR=2.468,95％CI:1.054 ～ 5.783,P=0.038)是感染HIV的危险因素.女性(OR=2.705,95％CI:2.116 ～ 3.457,P=0.000)、有注射毒品史(OR=1.567,95％CI:1.133 ～ 2.165,P=0.007)、社区来源吸毒人员(OR=3.000,95％CI:2.265～3.973,P=0.000)是感染梅毒的危险因素.而女性(OR=1.135,95％CI:1.151～ 1.583,P=0.000)、本省(OR=1.439,95％CI:1.208～1.713,P=0.000)、传统毒品和混合毒品使用者(OR=3.643,95％CI:2.975 ～ 4.462,P=0.000;OR=3.454,95％CI:2.616 ～ 4.561,P=0.000)、有注射毒品史(OR=4.381,95％CI:3.777～5.082,P=0.000)、监管场所来源吸毒人员(OR=2.075,95％CI:I.809～ 2.381,P=0.000)是感染HCV的危险因素.结论 武汉市吸毒人群整体HCV抗体阳性率较高,新型毒品使用者比例呈上升趋势.在继续做好美沙酮维持治疗的同时需进一步调查当前吸毒人群HIV、梅毒和丙肝感染现况并分析影响因素.

目的 比较艾滋病病毒(HIV)扩大检测、扩大治疗措施在男男性行为者(MSM)中实施期间,该人群中HIV感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)早发现与早治疗相关指标的变化趋势,分析扩大检测、扩大治疗措施的实施效果,为制定下一步艾滋病防治措施提供依据.方法 收集武汉市2008-2015年报告的经同性性途径感染的2 036例HIV/AIDS病人的相关信息,比较不同时间阶段报告患者的社会人口学特征、首次CD4+T淋巴细胞(简称CD4细胞)检测时间及结果、晚发现比例、抗病毒治疗(ART)比例及其随时间的变化趋势等指标.结果 2008-2009年至2014-2015年间,≤24岁、大专及以上、已婚、有职业、非本地户籍、郊区及医疗机构来源的病例数,占当年报告总数的比例由22.8％、39.1％、6.5％、39.1％、23.9％、15.2％、19.6％分别上升为34.4％、57.2％、11.6％、54.2％、38.5％、26.9％、45.4％.经趋势x2检验结果,各比例随时间变化的差异均有统计学意义(P＜0.05).按中国疾病预防控制中心2013年的晚发现标准,MSM中AIDS病例的晚发现率由2008-2009年间的51.4％,下降至2014-2015年间的25.3％.确证至首次CD4细胞检测时间间隔中位数分别为12天,6天;确证至ART时间间隔中位数分别为910天,38天;确证后3个月内接受ART的比例由2008-2009年间的7.6％,上升为2014-2015年间的75.1％,差异均有统计学意义(P＜0.05).不同时间段患者确证后首次CD4细胞累积检测率和ART累积率随时间变化,差异有统计学意义(P＜0.05).结论 扩大检测、扩大治疗措施实施对本地区MSM中HIV/AIDS病人早发现、早治疗效果明显,该策略可以推广至其他高危人群,也可为其他地区相关工作开展提供借鉴.

Objective To evaluate dating models and characteristics of newly-diagnosed HIV-positive men who have sex with men (MSM) in Wuhan,Hubei province.Methods A random sampling method was used to recruit the participants from Chinese AIDS control and prevention information system,and a face to face survey was performed by the health professionals to know the dating models,general demographic characteristics and HIV related behaviors of HIV-positive MSM.Results Of the newly-diagnosed HIV-positive MSM,72.76％ found their sex partners based on online dating,8.97 ％ on location dating,and 18.28％ on friend-recommendation.The websites of BlueD and QQ were most frequently used for online dating through mobile phones.Of the HIV-positive MSM based on online dating,42.65 ％ used rush poppers,and 7.11％ used other drugs.Conclusion Online dating through mobile phones is the main dating model for newly-diagnosed HIV-positive MSM in Wuhan.Websites of BlueD and QQ are the most commonly used tools for MSM to seek for sex partners.

Objective To compare the detection of HIV positive ( HIV) patients in different ways,and to explore more economical and proper ways of detection. Methods The HIV detection data of different detection ways in Wuhan from 2013 to 2016 went through comparative analysis. Results A total of 3357 cases of HIV/AIDS positive have been found in the serum of people from different categories in these four years,the top three detection ways for positive samples are:patients from medical institutions (2091 cases,62. 29％) ,MSM mobilization detection ( 555 cases, 16. 53％ mobilization detection ) , counseling for detection ( 500 cases, 14. 89％) . The top three sources of samples of patients from medical institutions are: blood recipient and preoperative examination (978 cases,46.77％),other clinics' patients (912 cases,43.61％),STD patients (187 cases,8.94％,incomplete statistics [ statistics were not made in 2013 and 2014 ] ) . There were significant statistical significance in different sample sources of medical institutions byχ2 test (χ2 =272. 304,P<0. 001). The positive rate of HIV screening increased from 10. 66％ (223/2091) in 2013 to 41. 89％ (876/2091) in 2016 after the implementation of PITC,which shows that PITC increases the efficiency of HIV detection. Conclusion In 2013-2016,most HIV positive patients in Wuhan were found in medical institutions. It is an effective way to improve the efficiency of HIV screening by vigorously carrying out PITC.

Rush poppers是rush或poppers的统称,主要成分是一系列具有挥发性的烷基亚硝酸盐.吸入rush poppers能松弛全身的平滑肌(包括肛门括约肌和阴道括约肌),所以其经常被用于增强性体验[1].国外研究已表明,使用rush poppers与HIV相关高危性行为的发生和HIV的传播均具有相关性[2-4],其滥用者往往具有多种毒品滥用?性活跃和多性伴等特征,易发生无保护性行为[5-6],从而增加HIV传播的可能性.国内关于男男性行为人群(men who have sex with men,MSM)使用rush poppers的专题调查较少,本研究从武汉市新报告的MSM HIV感染者角度出发,探索该人群rush poppers 使用情况,探索阳性MSM HIV 感染者使用rush poppers的相关因素.现将结果阐述如下.

目的 深入了解武汉市艾滋病经性传播感染方式特征变化趋势.方法 分别在不同年份抽样调查武汉市当年新报告男男HIV/AIDS病例,结合病例随访收集分析历年报告传播途径为异性传播的HIV/AIDS信息.结果 接受调查的男男同性HIV/AIDS病例大学及以上文化所占比例由2012年的34.65％升至2016年的64.83％,通过互联网/交友App寻找性伴比例由2012年的25.88％升至2016年的72.76％,差异均有统计学意义(P<0.001).3298例异性性传播病例中非婚异性性行为占91.75％,阳性配偶/固定性伴的仅占8.25％.2015—2017年经非商业性行为感染比例达71.08％,远高于商业异性的18.03％,分层分析结果显示非商业性行为感染HIV/AIDS病例呈逐年增加趋势,在性别、年龄、文化、婚姻、流动性及非婚性行为人数等特征上不同于商业异性性行为病例.结论 互联网/交友软件已经成为武汉市MSM寻找性伴的重要平台/场所,需充分利用互联网资源,针对性宣教干预.同时调整异性性传播防治策略措施,区别对待非商业与商业异性性行为传播.

Objective To analysis HIV/AIDS related knowledge,attitudes,behaviors and influencing factors a mong lower grade college students in Wuhan City,and provide scientific evidence for health education among young students.Methods A self-questionnaire survey was conducted among 908 students who entered college in 2014 and 2015 in 9 colleges by using convenience sampling method.Statistics analysis were performed by chi-square test and logistics regression.Results The HIV/AIDS awareness rate of lower grade college students was 66.1％,66.6％ of them had fear of AIDS,49.1％ of them had lower score of anti-discrimination and compassion,39.1％ of them agreed with premarital sex.The influencing factors of awareness of premarital sex among classmates were gender (OR =1.662),nationality (OR =0.449),love experience (OR =2.224),fear of AIDS (OR =1.707),attitude to premarital sex (OR =3.739).The influencing factors of condom use intention were residence (OR =1.569),HIV/AIDS awareness (OR--0.407),AIDS distance perception (OR =0.630),attitude topremarital sex (OR =0.664).Conclusion The lower grade college students had lower HIV/AIDS awareness rate with a certain degree of discrimination to people living with HIV/AIDS.The students who agreed with premarital sex had lower condom use intentionand more acceptance of existence among classmates,and greater likelihood of AIDS high-risk behavior.It needs to carry out effective interventions integrated sex education and AIDS prevention education for young students.

Objective: Analyzed the Wuhan AAAC program implementation to provide the empirical evidences for the development of AIDS prevention and control.Methods: The comparative analysis was carried with the existing statistical data on the basis of document research.The basic status of the program was analyzed by statistic description, and the data of positive case found, MSM mobilization for HIV testing, epidemio-logical investigation were analyzed by chi-square test using SPSS19.0.Results:From 2008 to 2011 year in program, up to 62012 person-time were intervened, 38706 person were accepted HIV testing, 746 cases were treated, and 915 person-time were accepted the follow-up care pro-vided by CBO.The constituent ratio of positive case found (x2 =33.701,p<0.001), the HIV testing proportion of MSM (x2 =577.386,p<0. 001), the positive detection rate of MSM (x2 =21.178,p<0.001), and the constituent ratio of epidemiological investigation (x2 =97.135,p<0.001) had statistics difference.Conclusion:Through the cooperation of CDCs, CBOs, medical institutions, the program augmented MSM inter-vention and HIV testing, enhanced HIV/AIDS cases management.The suggestion was that improved cooperation mechanism to advance the AIDS prevention and control sustainable.

目的 探讨武汉市人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者生存质量及影响因素.方法 采用世界卫生组织艾滋病生存质量简表(world health organization quality of life questionnaire for HIV brief version,WHOQOL-HIV BREF)对武汉市330例HIV/AIDS患者生存质量进行评价;采用t检验、方差分析和多元线性回归模型分析生存质量的影响因素.结果 HIV/AIDS患者的生存质量在生理领域、心理领域、独立性领域、社会关系领域、总体生存质量得分低于全国常模(均有P ＜0.05),生存质量总分低于全国常模,差异无统计学意义(t=-1.540,P=0.124);而在环境领域和精神/支柱/个人信仰领域得分高于全国常模(t=7.938,P＜0.001).多元线性回归分析结果显示,过去两周HIV相关症状数、所在区域、年龄、职业、文化程度、CD4+T细胞计数是生存质量各维度的主要影响因素.结论 武汉市未治疗HIV/AIDS患者在生理领域、心理领域、独立性领域、社会关系领域、总体生存质量低于一般人群,应重点关注这类人群的生存质量.

Objective: To analyze the economic efficiency on HIV positive detection of AAAC program in Wuhan, and provide the scientific references for program assessment and policy decision. Methods: Health economic analysis, compared with VCT related references, was carried in the basis of measuring the cost, effectiveness, utility and benefit, and sensitivity analysis was adopted to measure the range of indictors. Results: The cost per HIV infection averted was 858.35 yuan, the cost per DALY saved was 39.86yuan, were lower than VCT of Indian, Tanzanian, Kenyan all. The program would recall GDP 1713.26 yuan per input 1 yuan and recall the personal income 595.12 yuan per input 1 yuan. Conclusion: Wuhan AAAC program had certain economic value in cost-effectiveness, cost-utility and cost-benefit.