Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Tu.B.2140 - Tu.B.2145

Tuesday July 9, 1996

Tu.B.2140
FUNDING AND RENUMUNERATION FOR HIV/AIDS PRIMARY AND COMPREHENSIVE CARE IN AREAS OF LOWER SEROPREVALENCE IN CANADA
GIBSON, Sandy J*,Williams, KE**. Saskatoon District Health Board, Royal tI.,it'
Hospital,**, University of Saskatchewan, Saskatoon, Saskatchewan, Canda
Issue: HIV-infected people require a broad spectrum of rnedical and social "vies and
expertise. We wished to examine funding for and availability of, relevant services in areas of
lower HIV seroprevalence.
Project: Data was collected through telephone interviews followed by quct vo if.ries with
9 identified HIV clinics in the Prairie and Atlantic provinces. the nunber of regular clinic
attendees was compared with the personnel and physical infrastructure available Source,
extent and nature (salary fee for-service or hourly) of funding were determined.
Results: Clinics reported between 40 and 400 regular attendees over the last yea in all
stages of disease. Physician to patient ratios varied from 1:1 5- I:80.The fir-gest clinic!d a
1:40 physician patient ratio, a salaried director; clinic physicians paid by the hour a complete
multidisciplinary team for support services, a dedicated facility and office support staff.
Resources for other clinics varied independently from the number of clinic attendees. Only
one had a salaried physician with nursing and office staff. All others (7/9) had fee for-service
billing with variable nursing support. All had HIV clinic nursing coordinators but duties
(patient care vs. primarily administration) and nurse: patient ratios (1:40 1:200) varied widely Other personnel were available by referral with only 3/9 clinics having dedicated social
workers, psychologists and nutritionists.
Lessons learned:There is significant disparity in the level of funding for primary ani ccmprehensive care of HIV/AIDS patients in areas of low seroprevalence.
Sandy J. Gibson, Royal University Hospital, 103 H-ospital Drive, Saskatoon, Saskatchewar,
S7N OW8, Canada Telephone: [phone] Fax: [phone]
Tu.B.214 I1
HOSPITALIZATION IN ONTARIO WITH A SIGNIFICANT DIAGNOSIS OF HIV/AIDS
Robinson G A, Millson M E, Rachlis A R. HIV Ontario Observational Database, Sunnybrook
Health Science Centre
Objective: This study will describe patterns and the distribution of acute in patient care for
all patients discharged for significant conditions related to HIV infection/AIDS in Ontario
during the fiscal years 1987-88 to 1992 93.
Methods:This study examined 8,457 AIDS/HIV-related discharges (5,232 individuals) fior
all Ontario acute care hospitals over the fiscal years April I, I1987 to March 31, 1993.
Discharges were examined by Ontario region, age and gender, number of diagrnoses on discharge, and specific AIDS-related diagnoses on discharge.The hospital parameters examined
include the mean and median length of stay percentiles for the length of stay and the number of alternative level of care (ALC) cases over the study period.
Results: A constant increase in the hospital discharge rate for AIDS/f IIV infection per
10,000 population was noted in Ontario during the period 1987-88 to 1992 93. Generally,
the number of discharges tended to increase across all regions of Ontario. During the study
period the mean and median length of stay decreased steadily fiorn a mean of 20.6 days
(median 15 days) in 1987-88 to 14 days (9 days) in 1992 93.1 he number of alternative
level of care cases increased over the period 1989 90 to 1992-93 Across most age groups
the total number of discharges and corresponding age specific rates have increased over
time.The number of discharges with greater than four diagnoses per t00 discharges in
female and male patients has increased. Declining number of diagnoses per I00 discharges
was noted for some diseases such as PCP cryptococcosis, and more recently skin malignancy however many other chronic AIDS-related conditions have increased over tine.
Conclusions: Hospital discharge rates in Ontario continue to increase for AIDS/HIV infection. While the length of stay in hospital has decreased the number of ALC patients continues to increase.There is an increasing complexity of AIDS cases seen in hospital.This study
has implications for restructuring health care and identifies questions that require further
research on the delivery of health services to persons with HIV.
Dr Gregory A. Robinson HIV Ontario Observational Database, Sunnybrook -Lealth
Science Centre, 2075 Bayview Avenue, Room 3 I4A, North York, Ontario,
M4N 3M5,Tel: [phone] Fax: [phone]
Tu.B.2142
ACTION FOR CARE, QUALITY OF LIFE, RESEARCH AND ETHICS IN AFRICA:THE
EXAMPLE OF THE CTA IN BRAZZAVILLE, CONGO
Chieze F, Bonnaud C,Van Den Noort P Javanni J, de Gagne D, M'Pele R Organisation
PanAfricaine de Lutte contre le Sida (OPALS)
Issue: Opals has established the first "Center for anmbulant care and day care" (( TA), in
Brazzaville, Congo, in 1994. Its objective is to give Africans with HIV/AIDS access to the care
they require and to allow them to benefit from treatment and medicin that are actually
available. Cohort studies (quality of life, natural history of the virus) are in process in the
CTA, as are income generating, recreational and nutrition projects.This plot has to establish
the feasibility of such centers for PWA s in Africa.
Project: The CTA, located near the University Hospital of Brazzaville, executes: consultation,
testing, day care, home care, the pharmacy renutrition and laboratory examinations. The
staff I medical docto I trainee medical doctor 2 nurses, 17 social workers and I0 support
staff Social assistants are active in two areas: psycho-social care of the patients (at the center and at home) and pry and post counseling.
Results: The start of the CTA has effectively shown active involvement and iinproved quality of life of PWAs participating in it. After I year 226 HIV C people, aware of their seo -status, wish to participate in the structure on a regular bases. 543 people have presented
themselves voluntarily, asking for a test; 21.7% were found to be HI-V positive (44.8% ren,
55.2% women). 50% of these people have expressed the wish to participate.
Lessons learned: The CTA improves the quality of life of PWA's who have the means (trael and fee) to participate.The open structure of the centre has not decreased the willing..
ness of PWAs to participate. It has contributed to the de-dramatization of HIV/AIDS and
hran beers integrated in societyThe model as des-eloping further with respect to: the co-heat
studies (quality of life and the natasral history of the virus, the inclusion of NGO s/CBO's of
PWAs, income generating projects, recreational projects and nutrition projects.The

important o: cf the ocil workers in home care needs further attention.The model of
the CIA is do-able and c be implemented in other Afi-ican countries.
OPALS - IM rue de i'Ecie de decine, 75006 Paris
Tph: 33 I 43 26 0 86- Tcp: 33 I 43 25 66 16 - Email: opals(hivnet.fr
Tu.B.2143
SATISFACTION LEVEL OF ADVANCED AIDS' PRIMARY CAREGIVERS WITH A NEW
PROGRAMME OF HOME CARE ASSISTANCE
Perez-Elias MJ, Aguujetas I_ Castillo G*, Antela A, Hermida JM, Montilla R Casado JL, Moreno
A, Buzon L, Enfermedades Infecciosas, Hospital Ramon y Cajal. Madrid. (SPAIN).* Marketing
Analyst.
Objective:To evaiuate the level of satisfaction experienced by the primary care giver (PCG)
of advanced AIDS patients after receiving home care assistance (HCA).
Methods: A specific questionnaire was designed and sent to 167/191I (87%) PCG; we can
confirm the address of 14 1/167 (84%).Ten questions were made to asses the programme,
and two to ascertain family problems with regard to patients care. HCA was created at our
institution in 1990 as an alternative to hospital care.
Results: Data were obtained after one week and a half of fieldwork. We analysed
83/1 67(50%) answers. Patients received HCA after family/patient request (23%), or (73.8%)
after being offered the assistance; 3% of patients were compulsory sent to home.

raLOBAL
PROGRAMMI
ASSESMEN f

NUlRSE CARE

PHYSICIAN CARE PCG WORK
OVERLOAD

Patient benefit Whole patient problem solved Frecuency of visits yes (45.9%)
very hight (85.2%) always (91.8%) always (85.2%) no (29.5%)
hight (9.8/) most times (5%) most rtimes (8.2%)
HCA coordinated Time to contact nurse less than Knowledge of disease
with hospital 24h
-always (90.2%) always (83.6%) / most times (5%) very high (95%)/ high (5.3%)
Global score Psychological support Whole patient problem
solved
excellent (73.8%) always (83%) always (83.6%)
good (23.0%) moist trimes (8.2%) most times (3.1%)
Conclusions: HCA created as a tertiary hospital initiative, with voluntarily admitted patients,
high degree hospital integration, and well trained and motivated personnel results in a very
high satisfaction level.
Margarita Agujetas. Infectious Diseases Unit. Hospital Ramntarily admitted patients, high
degree hospital integration, and well trained
Tu.B.2144
CHANGES IN THE CHARACTERISTICS OF PATIENTS WITH AIDS IN THE LATTER
YEARS
Iribarren JA, Merino JL, Arrizabalaga J, Rodriguez-Arrondo FJ,Von Wichmann MA. Unidad de
Enfermnedades Infecciosas. Hospital Aranzazu. San Sebastian. Spain
Objectives: To assess the changes in the clinical characteristics in patients with AIDS (PWA)
through the years.
Methods: In a ward of Infectious Diseases (22 beds) almost rnonographically caring patients
with -IIV infection, we compared the characteristics of the patients admitted in 1988 and
1995.We eualusated rifs practice, previous to admission diagnosis of AIDS, AIDS diagnosis
on discharge, CD4 lynphocytes, diseases related to drug addiction, numbers and sorts of
disease diagnosedn discharge, and survival on discharge.The differences were assessed
rasing chi-square with Yates correction (qualitative parameters) and Student's t with IC=95%
(quantitative parameters).
Results: The following parameters reached statistically significant differences (first number
for 1988 and second for 1995): previous to admission diagnosis of AIDS (28 vs 81%); AIDS
diagnosis on discharge (47.8 vs 90%); number of patients with <50 CD4 lymphocytes per
mm3 (23.8 vs 809%), number of diseases diagnosed on discharge per patient (I. 19 vs
2.14).There were also differences in the sort of diseases related to AIDS, happening more
frequently in 1995: MAI, cryptosporidiasis, HIV encephalopathy oesophagic ulcers, bacterial
infections and FUO episodes.
Conclusions: Now, patients with AIDS are more severely immunosupressed, having more
complexity in their management, with a higher rate of readmissions and a higher seriousness in these readmissions. Probably there is a need for changes in the care models to
adapt to the changing clinical characteristics of the patients.
Jose A. Iribarren. Unidad de Enfermedades Infecciosas. Hospital Aranzazu. Paseo del Dr.
Begiristain s/n 20080 San Sebastian-Spain. Fax:[phone]
Tu.B.2145
ROUTINE STD SCREENING OF HIV POSITIVE ADULTS IN PRIMARY CARE
SETTINGS
Harris, A. Gibson, Leone P Mclaughlin J. Wake County Department of Health,
Raleigh NC UISA
Objective: To evaluate the efficacy of routine screening of HIV + adults for gonorrhea and
chlarnydia during initial and follow-up visits in the primary care setting.
Methods: All adult patients seen at the Wake County Department of Health HIV Clinic
were screened for chlamydia and gonorrhea at initial visits and biannually at follow-up.The
CIVA microtrack EIA system was used for chlamydia detection. Gonorrhea swabs were
plated on GC-Lect and incubated in CO2 incubator for 48 hours. Plates were then
screened macroscopically and colonies had gram staining and oxidase tests performed.
Results: 205 male patients were followed over a 3 year period (1993-1995). 10.7% and
these patients were found to have gonorrhea and/or chlamydia. Of those found to be positive, 40% presented with no symptoms.

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