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

Monday, July 8, 1996

Mo.B.553 - Mo.C.123

dressing on a patient with AIDS and shaving a patient with AIDS for surgery Sixty five percent of the nurses stated that they would be very uncomfortable administering blood products to a hemophiliac patient with AIDS and 74% of the nurses stated they would be very
uncomfortable starting an IV on a patient with AIDS.
Lessons Learned: A more indepth study of nurses' fears about caring for patients with HIV
infection is necessary. This study should include a comparison with the nurse's level of com-rn
ort in providing the same care to a patient without known HIV infection. In addition, the
reasons for the fears should be explored and described.
Patricia Correll. 46 Michael Drive, Westfield, New Jersey, 07090, USA;
Telephone: [phone]; Fax: [phone]
Mo.B.553
HIV INFECTION IN CHILDREN IN SCHOOL: EDUCATING SCHOOL NURSES AND
PUBLIC HEALTH NURSES IN THE U.S. USING A TRAIN-THE-TRAINER MODEL
Gross, Elaine, Burr C, Boland M. National Pediatric and Family HIV Resource Center
(NPHRC), UMD-New Jersey Medical School, Newark, NJ, USA
Issue: HIV infected children attend day care and school throughout the US. Many of these
children have multiple health and educational problems. School is a normal part of childhood providing growth, development, and socialization that the chronically ill HIVinfected
child needs.The knowledgeable school nurse can help make school a positive and as normal ais possible experience for the infected child Providing educational programs on pediatric HIV infection for school nurses is difficult because of their community base and their
ndividual practice.
Project: Usingr an interactive, adult education based program created specifically for school
nurses by NPHRC, a 2-day train-the- trainer model was developed to prepare school nurses/public health nurses to educate their peers (SNTOT). Content included: the spectrum of
pediatric HIV; treatment and medications; infection control; nursing care; legal issues, psychosocial issues for children, families and schools, HIV prevention messages for students and
school staff, and teaching strategies for all content. Each participant received a curriculum
and materials. After training, access to NPHRC trainer was available via an 800 phone line.
Participants completed a 6 month follow-up evaluation of training activities.
Results: Since 1993, 235 school nurses from I16 states have completed the training. Offered
in both high and low incidence states, the SNTOT has fostered collaboration between
NPHRC, Pediatric HIV projects, state departments of education/health, AIDS Education and
Training Centers and state/national school nurse associations. Using a self report 6 month
evaluation (return rate 48%), nurse trainers have provided more than 40 programs for
234 I school and public health nurses.The nurses have educated numerous teachers and
other school staff as well as students.
Lessons Learned: This model successfully trains school nurses to educate their peers,
extending the reach of information about HIV infection in children to nurses who need the
information. Educated school nurses and public health nurses serving schools can have a great
impact on the quality of life for HIV infected children and their families.They can serve as
resources and as advocates for health and HIV prevention for their schools and communities.
I. Gross,2 NPHRC, I 5 South 9th St., Newark, NJ 07107 USA Tel: [phone] I1
Fax: [phone], emrail: gross(daiid.umdnj.edu
Mo.C.120
ASSESSMENT OF HIV TESTING IN BLOOD DONATIONS: COST ANALYSIS OF
ROUTINE SCREENING WITH HIV-ANTIBODY AND HIV ANTIGEN TEST IN THAILAND.
Kongsin S*, Rerks-Ngum S**. "Faculty of Public Health, Mahidol University Thailand; +
Department of CDC, Ministry of Public Health,Thailand
Objectives: I) To analyze the cost component of routine screening of Thai blood donors
by using FIIVAb (the 2nd and 3rd Generation ELISA) and HIVAg. 2)To determine the
cost for the detection of the window period. 3) To analyze the effectiveness of donor's self
selection methods.
Methods: The study design was a cross sectional retrospective study using economic tools
in quantitative method including epidemiological aspects. The available data from 14 regional/general hospitals in Thailand with high HIV prevalence rates at the provincial level were
collected over 30 months The cost was calculated to present its present value using a yearly interest rate of I 1.5%.
Results: The unit cost of HIV-Ab (2nd Gen) was Baht 52, of HIVAb (3rd Gen) Baht 58, and
of HIVAg Baht 81.The incremental cost of the HIV testing to detect the window period
was Baht 7,004 for HIVAb (3rd Gen) and Baht 1,030,740 for HIVAg when HIVAb test
was negative. The positive rate of HIVAb (2nd Gen) was 0.39% and HIVAb (3rd Gen)
0.48% for II 4,877 blood units.The HIV Ab positive rate among self declared safe donor
group (SDS) was 0.5 1%, while the self declared non safe group was in contrast 0.93% HIVAb positive. In term of impact to the socety was Baht 1,923,780 per unit of transfused
blood caused by the distribution of neglected positive blood from the SDS.
Conclusion: To ensure the safety of all blood and blood products, selection of safe blood
donors by Donor Self Selection Method (DSS) should be considered as the first step in
ceducing the risk of transmission of HItV through blood. However we emphasized that
screenng the SDS with 3rd Generation ELISA is essential and cannot be substituted for by
DSS.The study will assist the Thai government in estimating the resources needed for routine
IV screening of Thai blood donaions.The use of HIVAg in screening donated blood was
highly costly even after DSS and I41V Ab screening. Frther evaluation is about the appropriate conditions in detai for usirig HIV-Ag screening if policy makers want to use this method.
Kacngsa S.f Fcrly If Puic cHItolth, Mahidol University, Rsjvthee Rd. Bangkok 10400
Thai Icrd.Tclcphone0(662. 235.l2ff 3 ext 2304,2301 Fix (662) 6448833.2467765
Mo.C.121
EVALUATION OF HIV TESTING OF THE BLOOD SUPPLY IN KENYA
Lackritz Eve*, Moore Ar, Nyanmongo J', Herrera G*, Granade T*, Phillips 5*, Nahlen B,
Janssen R.'. *Centers Ior Disease Control and Prevention, Atlanta, GA, USA **National
Public f-ealth Laboratory Services, M inistry of Health, Nairobi, Kenya
Objective:To identily ways to prevent transmission of HIV by blood transfusion in Kenya.
Methods: Fom April through September 1994, we collected demographic and laboratory
data on all blood donors in S government hospitals in western Kenya and I in Nairob.

Donations were tested for HIV I antibody by routine hospital screening, and results were
later compared with reference laboratory test results.The study team supplied HIV test kits
to the hospitals if they were unavailable.
Results: Of the 1883 blood donations made in the 6 hospitals during the study period, 123
(6.5%) were HIV positive. Seroprevalence varied among hospitals, ranging from 2.0% to
20.6%. Seroprevalence was significantly higher among persons making a directed donation
for a family member (9.7%) than among volunteer donors recruited by campaigns (1.7%,
odds ratio - 6.3, 95% confidence interval = 3.3, 12.3). Because of a national shortage of
test kits during the study period, 29% of donations were screened by kits supplied by the
study team. Overall, 2% of all blood transfusions were seropositive but not removed by
hospital screening. Ninety-six percent of donations were screened by the hospitals, but one
hospital screened only 56% of donations. Among units screened, hospitals accurately identified 8 I % of seropositive donations.
Conclusions: The Kenya Ministry of Health conducted this collaborative study and subse
quently developed the following initiatives to reduce the high risk of HIV transmission: (I)
recruiting low risk donors, (2) improving procurement and distribution of test kits, (3) promoting universal screening of donors, and (4) retraining personnel in laboratory techniques
and record keeping.
Eve M. Lackritz, CDC, MS E-46, I 600 Clifton Road, Atlanta, GA 30333 USA.
Tel: [phone] Fax:[phone]; Email: eal3@cidhiv I.enr.cdc.gov
Mo.C.122
WHY ARE AIDS CASES IN PERSONS WITH HEMOPHILIA AND THEIR HETEROSEXUAL
PARTNERS IN THE UNITED STATES NOT DECREASING?
Sullivan Patrick 5, Fleming R Evatt BL,Ward JW. Centers for Disease Control and
Prevention, Atlanta, GA.
Objective: Although ten years have passed since the introduction of heat treatment of plasma derivatives and laboratory screening of donated blood, cases of AIDS among persons
with hemophilia (PWH) continue to be reported to CDC.This report examines trends in
AIDS diagnoses among PWH and their heterosexual partners.
Methods: Adults (> 13 years) with AIDS (from all states, the District of Columbia and
Puerto Rico) diagnosed from 1990 1994, and reported to CDC through September 1995,
were evaluated using reported or estimated dates of diagnosis of the first AIDS defining
opportunistic illness (AIDS-Ol). PWH whose only known risk for HIV infection was receipt
of blood products, and persons whose only known risk was heterosexual contact with a
PWH were included.
Results: From 1990-1994, 2,474 PWH were diagnosed with AIDS. PWH reported with
AIDS were more likely to be diagnosed with AIDS based on a CD4+ count less than
200/pl than were AIDS cases reported other groups: for example, in 1994, 69% of 337
PWH, 50% of 26,173 men who have sex with men (MSM), 55% of 16,869 injecting drug
users (IDU), and 53% of 7,078 patients whose only risk was heterosexual contact were
diagnosed with AIDS because of severe immunosuppression. PWH were also younger than
persons diagnosed with AIDS in other risk groups: median age at AIDS diagnosis was 31 for
PWH, 36 for MSM, 37 for IDU, and 35 for patients with oheterosexual r isk. Median age at
AIDS diagnosis among PWH decreased from 35 in 1984 to 29 in 1994. Using date of first
AIDS-OI diagnosis to analyze trends in AIDS diagnosis, annual clinical AIDS incidence
increased from 350 cases in 1990 to 469 cases in 1992, and was stable from 1992- 1994. In
contrast, clinical AIDS inc dence among persons whose risk was heterosexual contact with a
PWH rose from 28 cases in 1990 to 48 cases in 1994.
Conclusions: AIDS incidence among PWH is not declining ten years after the dramatic
reduction in risk of HIV infection due to infusion of contaminated blood products.The persistent AIDS incidence among PWH may be due to long incubation period, particularly for
those who were young when they were infected (as evidenced by younger age at diagno
sis), or because they receive frequent medical care and monitoring (as evidenced by a
greater proportion of diagnoses based upon CD4+ counts). PWH who are HIV infected
represent a young group whose sexual partners are also at risk for HIV infection.
Patrick Sullivan.
Mo.C.123
WINDOW PERIOD DONATIONS IN AN HIV EPIDEMIC AREA IN THAILAND
Sawanpanyalert, Pathom*,Yanai -H**, Kitsuwannakul S*, Nelson K***. *Ministry of Public
Health,Thailand; **Research Institute ofTuberculosis, Tokyo Japan:; ***Johns Hopkins School
of Hygiene and Public Health, Maryland USA
Objective: To estimate the risk of donation during the window period of HIV infection in an
HIV epidemic area
Methods: Six years (1I989-1994) of blood donation registry data of a hospital blood bank in
the HIV/AIDS epicenter in northern Thailand were doubly-entered in a computer file with
names and other identifying information deleted. After validation, verification and correction
of errors, repeat donations were identified and seroincidence rates, based on uniform distribution of seroconversion, by year: sex, age group, type of donorship, and ABO blood groups
were calculated.
Results: There were 75,980 donations from 41,419 donors during the period. After 132
autologous donors were excluded, 30,055 were one time donors and 14,232 repeat
donors. Among the repeat donors, 273 (2.43%) seroconverted during the study period
with a total of 9,518,863 person-days of HIV negative observation (equivalent to 1047.54
seroconversions per 100,000 person years of observation [PYO]). Based on the assumption
that the time period from HIV infectien to the eraset of detectible an tibody wais 45 3dmys,the
risk of donation during tbe window, periad wus 129.06 per- 100,000 3donitierrs or I in 7/S
doncatons.The seroncdence rites donraed S ccc 1760.3.5 or 1989 to 49319 per 100,000
PYO in 1994.The rate in males was higher than in females (1246.96 vs 949.65 per I00,000
PYO).The age group of 21 30 years had the highest rae (1906.60 per 100,000 PYO).
Replacement donors had a higher rate than volunteer donors (I 576.42 vs 917.51 per I00,000
PYO).There were no differences in seroincidence rates among different blood groups.
Conclusions: The estimate of window period donations in this populatior, although conservative, is much higher than the one found in Bangkok (I in 5,000 units), in San Francisco ( in
61,171) and Montreal (I in 198,000).This prompted the blood bank to consider other supplernental methods to ensure safer blood supply e.g. donation deferral, HIV antigen testing.
Pathom Sawanpanyalert, 30/3 Nakornkheunkhan Road, Talad Phrapradaeng Samutprakarn

10 130 Thailand. Fax: 662-8 I 818-406 1. email: [email protected]

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