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

Track B: Clinical Science
care and community settings.The new role for OT offers security t irdividuals living with
HIV/AIDS knowing that the same therapist will provide service no matter the setting.
Occupational therapy services for 109 patients during crucial transitions in their disease
were allocated as follows: 53% in the hospital. 18% in the health centre, 13% across all three
settings, 7% from hospital to home setting, 4% health centre to hom etting, and 1% at
home.
There is anecdotal support for the broader service parameters o1 _) [ hy the patients and
the interdisciplinary team.The resulting role fosters greater rappoi with patients and complements the interdisciplinary team in the areas of case coordination and discharge planning, while acting as a primary advocate for patient care.
Results: This nontraditional OT role links patients to the same thc' rapis from primary care
to hospital to home setting, during crucial transitional stages of the disease.
Lessons Learned: The nontraditional OT role facilitates a seamless continuum for patients
across the spectrum of community and institutional care, and facilitates timely anrid consistent links to the team as the patient's disease progresses.
S Thomas, The Wellesley Health Centre, 4 10 Sherbourne Street, Toronto, Ontario, M4X I K2
CANADATelephone: 4 I 6-926-5053x 4 II I, Fax 4 I 6-926-491 I
Mo.B.1 158
COMPLIANCE TO THE MEDICAL SERVICE ON HIV-POSITIVE PATIENTS IN JAPAN
Ajisawa, Atsushi, Negishi M, Masuda G. Department of Infectious Diseases, Tokyo
Metropohlitan Komagome Hospital, Japan
Objective: To investigate compliance to the medical service on HIV positive patients and
describe factors related to the compliance.
Methods: Four hundred and thirty four HIV+ persons had visited to tokyo Metropolitan
Komagome Hospital by the end of 1994.We reviewed the records of the 434 HIV+ persons and took age, sex, race, address, source of introduction, route of transmission, motive
from that the patients come to the hospital, use of counseling system, CDC staging (1986),
and CD4 count as parameters of the compliance.The factors were obtained using CHAID
(Chi-squared Automatic Interaction Detector) analysis.
Results: Fifty four patients could not be followed up for more than one years without any
reason. CDC staging (1986) was first predictor of the patients' compliance. In the Stage 2
HIV-positive people, 272 (83.69%) patients had been visiting to the hospital or referred to
another medical services. In the stage 3 or stage 4 people, 109 (99.89%) patients had been
coming or introduced to the other services(p<0.00005 ). Second predictor for stage 2 people was use of counseling system. The compliance of the patients with no use of counseling
system was 79.44% (I197/248).That of the patients utilizing the system was 97.4% (77/79,
p<0.00019).Third predictor for asymptomatic people with no use counseling system was
route of transmission. One hundred ninety four (75.77%) sexual transmitted patients continued to visit to the hospital.The other 54 (92.59%) patients had been coming (p<0.027).
Conclusions: The compliance to the medical service on asymptomatic HIV positive patients
was worse than symptomatic patients. For asymptomatic people, introduction of counseling
system was useful to continue to contact with the medical service.
Atsushi Aiisawa, Department of Infectious Diseases, Tokyo Metropcolitan Komagome
Hospital,Tokyo, Japan-Tel: (8 I)-03-3823-2101 Fax:(8 I)-03-3824 1552
Mo.B. I 159
EPIDEMIOLOGICAL, CLINICAL, PSYCHOLOGICAL AND SOCIAL FEATURES OF THE
FIRST HOSPICE CREATED IN THE WEST PART OF MEXICO FOR PEOPLE LIVING
WITH HIV/AIDS.
M.A. Aguiniga-Sinchez*, A. Hernandez-Chavez, J.M. Ramirez-Rodriguez, G. Amaya-Tapia, A. De
Luna-L6pez, A.Valadez-Casillas, P L6pez-Guillen. Ser Humano A. C. Guadalajara, Jalisco, Mexico.
Introduction: AIDS is a disease that is distributed all around the world. In Mexico, AIDS has
the sixth place of death rate.There are 24,843 reported cases until October I st 1995. In
Jalisco, there are 2,913 reported cases.
Objetive: To value the epidemiological, clinical, psychological and social characteristics of
people who lives with HIV/AIDS and ask to Ser Humano A.C. for help.
Methods: A retrospective analysis of the patients admitted at the hospice was made by a
record's review. All patients' HIV infections were documented by ELISA and confirmed by
western blot analysis.
Results: From February to December 1995, 58 patients were analyzed at Ser Humano's
hospice. 30 of them (52%) were admitted at the hospice and 28 were outpatients.The
median age was 35~13 years. 49 (84%) were males. HIV risk factors were homosexuality in
25, heterosexuality in 17, Bisexuality in I I, blood transfusion in 4 and I without known risk
factors. Oral candidosis, diarrhea, herpes zoster, community-acquired pneumonia,
Pneumocystis crinii pneumonia, toxoplasma encephalitis and Kapossi's sarcoma were the
most frequent pathologies seen. CD4 count was less than 199 in 21 (52%) patients, 13
(32%) had between 200-499 CD4 cells and 6 had more than 500 (I 5%). In psychological
features, the most common behavior was depression (100%) follow by isolation (80%) and
fear (60%). In the social features, 95% hadn't economical resources and a 50 % were abandoned, or their families didn't want to support them. At the monuent of this report, 4 I
(71%) patients are still alive.
Conclusions: Hospices are an alternative for care and integral treatrent of people who live
with HIV/AIDS.They decrease health costs, help people who haven't economical resources
and they improve their quality of life.
M.A. Aguiniga Sanchez. Nicolas Romero No 117, Sector Hidalgo C.R 44200, Cuadalajara,
Jalisco, Mexico.Telephone [phone], Fax [phone]
Mo.B. I 160
HIV CARE STANDARDS EQUIVALENT REGARDLESS OF TYPE OF OUTPATIENT
PRACTIoNER
van den Berg Wolf, MG, Moyer DTedaldi E*, Shah S**,Yim R Galloni T**. *Temple
Ijniveitsity. erPhladelphia FIGHT Philadelphia, Pennsylvania, USA
Objective: To determine practiener adherence to CDC guidelirs'. for comprehensive and
appropriate care of HIV infected outpatients in an urban acadrmc mc'diral centn

Methods: The encounters of all HIV infected outpatients (17 fem dles, 53 males) who presented to HIV clinic, between July 1, 1994 and July 1,1995 were reviewed retrospectively.
68 of 70 patients were members of an ethnic minority.The types of care provided were

Mo.B.1 158 - Mo.B.1 162
from primarily residents (res care n=28), primarily attendings (att. care, n -25) and primarily
nurse practioners (NP care, n= 17).The adherence of these types of providers to CDC
guidelines in treating HIV infected patients was examined.
Results: All patients had CD4 cell testing. RPR testing was performed in 82% of patients in
res care, 82% in NP care and 84% in att. care. Six-monthly GYN exams were performed in
71 % of patients in res care, 75% in NP care and 100% in att. care. Pneumococcal vaccine
was adnministered to 57% of patients in res care, 82% in NP care and 68% in att. care. PCP
and MAC prophylaxis were offered or given to 100% and 77% respectively of patients in
res care, 100% and 100% in NP care and 95% and 73% in att. care. PPD testing and if
appropriate MTB prophylaxis were done in 75% and 71% respectively of patients in res
care, 73% and 69% in NP care and 85% and 56% in att. care. Antiretrovirals were offered to
100% of patients in res care, 100% in NP care and 88% in att. care.
Conclusion: There was no difference in adherence to recommended CDC guidelines for
care depending on care provider of HIV infected outpatients in an academic medical center
MG van den Berg-Wolf, 3401 North Broad Street, Philadelphia, PA 19 I 40, USA,
Telephone: [phone] I Fax: 2 I15-707-3644
Mo.B. 161
AIDS DRUG ASSISTANCE PROGRAMS IN 42 U.S. STATES: CHARACTERISTICS OF
CLIENTS SERVED, DRUGS DISPENSED,AND THE ROLE OF FEDERAL FUNDING.
Eichler Anita, Baitty, Robert. Health Resources and Services Administration, Department of
Health and Human Services, USA.
Objectives: To describe the numbers and characteristics of clients served, drugs dispensed,
and annual funding levels of AIDS drug assistance programs in the USA.
Methods: Data were collected from 45 States including the Commonwealth of Puerto
Rico, and the District of Columbia on clients served and drugs dispensed for a 6 month
period from July - December 1994 through AIDS drug assistance programs that utilize
funds provided under the Ryan White CARE Act.
Results: Forty five States used a portion or all of their Ryan White CARE ActTitle II funds
for AIDS drug assistance programs.Twenty-one percent (2 I %) of Title II funds ($4 I1.4 million) were used to provide HIV drug therapies to 52,641 people with HIV/AIDS.Title II
funds provided approximately one-half of the resources for these programs, with Title I providing an additional 20 percent ($16.7 million), and State or local entities providing 22.4
percent ($18.6 million).
Eighty two percent of the clients served were male and I 8 percent female. Of the clients
served, 41I percent were White, 26 percent were Black, 27 percent were Hispanic. I per
cent were Asian-Pacific Islander, and 0.3 percent were Native American Indian. Ninety eight
percent of the clients served were 20 years of age or greater.
Eligibility criteria and drugs provided under the State programs varied widely across the
United States. Eligibility criteria were locally determined and included CD4f/T-cell count
(20% of the programs), HIV-related symptoms (3 I %), CD4/T-cell count and HIV related
symptoms (I 3%), and an AIDS diagnosis (4%). Among the drugs dispensed, 15 drugs
accounted for eighty eight percent (88%) of program expenditures. Over one third of the
funds (37.2%) were expended for AZT, which was dispensed to 51.5 percent of program
clients. Other drugs received by more than 10% of clients nation-wide included: acyclovir
ddC, ddl. fluconazole, and trimethoprim/sulfamethoxazole.
Conclusions: States' choice to use funds for this program area indicates clear unmet need
to promote access to therapeutic drugs. Federal support has been essential to assist States
and localities meet the need. Lack of consistent formulary and consensus on appropriate
therapeutics across States may reflect:
(i) financial resources available;
(ii) non-uniform practice patterns; and
(iii) variable coverage of drugs by existing reimbursement systems
Mrs. Anita G. Eichler Director, Division of HIV Services, Rm: 7A-55 Parklawn Bldg.,
5600 Fishers Lane., Rockville, Maryland 20857 USA
Mo.B.I 162
LONG-TERM CARE FOR PEOPLE WITH HIV/AIDS IN A DEDICATED SKILLED
NURSING FACILITY
Selwyn PA-, Molde S, Constantino J, Demarinis J, Lesnick N, Costello G, Wetherill P*,
Kennedy C., Leeway Inc. New Haven, CT *AIDS Program,Yale School of Medicine, New
Haven, CT
Background and Rationale: As AIDS becomes more of a chronic disease, and with the
changing dynamics of managed care and health care delivery a growing need has arisen for
long term, non- hospital-based care. In October, 1995, in response to this need. Leeway, a
freestanding, 30 bed skilled nursing facility for people with HIV/AIDS, was opened in New
Haven, Cl, a small city (pop. I130,000) with a high annual per capita incidence of AIDS
(36/100,000). Care is provided by an integrated, multi-disciplinary treatment team.
Objectives: To examine the feasibility patient characteristics, and community impact of this
new facility
Results: After I 6 weeks, the facility had filled to 80% capacity, with projected 100% occu
pancy by 20 weeks.There have been 36 admissions (and 3 re-admissions); referrals have
come from New Haven's two hospitals (64%), other CT hospitals (3%), other CT chronic
care facilities (I 9%), and outpatient care sites (14%). Reasons for admission have included
completion of acute medical treatment (17%), need for skilled nursing care (44%), unstable/unsafe home environment (19%), and terminal/comfort care (20%). 5 (14%) patients
have been discharged home; 10 (28%) have died (median length of stay for those who died
I 1 days) 26/36 (72%) were male, 28% female: 50% Black, 17% Latino, 33% White: median
age 4 I yrs; 47% were current or former injection drug users, 31% heterosexual contact
cayes 227/v men who had sex with men. Median Karnofsky score was 40 median CD4
count 14!rum3; 89% had CDC defined AIDS. Median score on smom mental status exam was
20:e 836 h50v) had clinically significant neurologc disease, including HIV dementia,
m/elopath neuropashy, PML, other CNS infections, or stroke.
Conclusions: A dedicated, freestanding skilled nursing facility can provide a humane and
cost-effective alternative to lengthy hospitalizations for people with AIDS. Clinical services in

such settings must address the high prevalence of neurologic disease, drug abuse, and the
need for bereavement counseling for patients and families. Data on financing and the impact
of this G fcility on local hospitals' length-of stay will also be presented.
Peter A. Selwyn, M.D,Yale AIDS Program. 135 College Street, New Haven, CT 06510
Tel: [phone], Fax: [phone] I

TO
as
>)
O
0
u
c
0
me
rn
c
0
C>
c0
ru
c
0
arS
c
x
82