背景：由於抗愛滋病毒藥物的效果，使得HIV感染者的平均壽命延長、疾病的慢性化，而隨著HIV感染者的存活人數持續增加，照顧議題日趨複雜及醫療成本逐漸攀升。HIV個案管理為台灣目前針對HIV感染者推展之照護模式，而HIV感染者於診斷後仍有危險性行為，其中梅毒為最常見之性病。
目的：調查成大醫院HIV感染者及接受HIV個案管理者在初診時之梅毒盛行率，HIV感染者在接受個案管理期間之梅毒發生率。比較HIV感染者在接受個案管理服務前、後一年可避免多少件梅毒新感染發生，及每減少一件梅毒感染所增加之成本效果比。
方法：採回溯性描述性研究，以次級資料庫分析及病歷資料回顧進行梅毒盛行率及發生率之評估。並以經濟評估(economic evaluation)之成本效果分析，估算HIV感染者於研究期間接受個案管理照顧、梅毒檢驗及治療實際花費之成本，及計算個案管理前、後一年間新感染或再度感染梅毒之減少人次。
結果：1985年7月至2009年10月間曾至成大醫院就診之HIV感染者及接受HIV個案管理之HIV感染者，在初診時之梅毒感染盛行率分別為20.2%及29.0%，接受HIV個案管理者在個案管理期間之梅毒感染發生率為5.5百人年(100 person-year)。符合進行成本效果分析之52位中，僅有30位(57.7%)於接受個案管理前、後一年有完整之梅毒檢驗等資料。在接受個案管理前一年梅毒新感染人數有5位(17%)，個案管理後一年則減少為2位(7%)，共避免3件梅毒新感染發生(P=0.18)。比較個案管理前、後一年，每避免一件梅毒新感染發生，可節省2,883元的梅毒檢驗及治療成本，但需額外花費10,709元之個案管理照顧成本，整體而言，為避免一件梅毒新感染的發生其實質醫療照護成本為7,826元。然而，透過個案管理照顧避免梅毒及HIV新感染發生所需醫療成本為6,489元。
結論：HIV感染者在初診時合併感染梅毒之盛行率高，需透過個案管理師持續評估危險行為及提供降低危險之措施，以減少梅毒新感染的個案發生，並可節省梅毒檢驗及治療成本，進而避免性病及HIV之散播。然而，雖然個案管理照顧成本較高，但透過避免梅毒新感染發生，進而減少HIV新感染發生所需之醫療成本是較低的。
關鍵詞：HIV個案管理; 梅毒; 成本效果

Background: Since the introduction of Highly Active Anti-Retroviral Therapy (HAART), the life expectancy of HIV-infected persons gradually increased and care for people with HIV become more complicated. HIV case management program is the promoting HIV care model in Taiwan. Syphilis is one of the most common sexually transmitted infections among HIV-infected persons with unprotected sex.
Objectives: This study purposes were to understand the prevalence of syphilis and the incidence of syphilis among HIV-infected persons who enrolled in the HIV case management (CM) program at National Cheng Kung University Hospital (NCKUH). Furthermore, this study estimated the incremental cost effectiveness ratio (ICER) that successfully averted one case of syphilis infection by the HIV CM program.
Methods: The study was a retrospectively descriptive study with economic evaluation. The study paticipants were HIV-infected persons who have ever visited to our hospital since 1985 to 2009 and patients who received HIV CM. Econimic evaluation with chart review was applied to estimate the cost of care and treatment for syiphilis among 30 HIV-infected patients who had received case management over one year.
Results: From July 1985 to October 2009, the prevalence rate of syphilis infections among HIV-infected persons in NCKUH and cases who received the HIV CM program at NCKUH is 20.2% and 29%, respectively. The incidence of syphilis infections among HIV-infected persons during the HIV CM program enrollment is 5.5 per 100 person-year. The number of cases who acquired syphilis were decreased from 5 (16.7%) to 2(6.7%) (P=0.18) after enrolled in the HIV CM program. The cost of syphilis-related treatment that successfully averting one case of syphilis could saved 2,883 N.T. dollars. However, we need to spend additional N.T. 7,826 dollars to avert one case of syphilis by the HIV CM program.
Conclusion: Concurrent syphilis infection is common among HIV-infected persons. Risk reduction counseling and interventions conducted by the HIV case manager might be able to decrease risky behaviors and the incidence of syphilis and other STIs. However, the high cost of HIV CM would also increase the cost of the HIV health care.

Keywords: HIV case management; syphilis; cost effectiveness

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