Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

998 Abstracts 44314-44317

12th World AIDS Conference

informing improved design of projects and to accumulate these for sharing them
with other NGOs.
Response: PHANSuP, a linking organization associated with the International
HIV/AIDS Alliance, supports local partner NGOs to develop and strengthen their
activities in HIV/AIDS a number of different ways, including through capacity
building workshops, one-to-one technical support visits, and NGO exchange visits. Furthermore, the conduct of project reviews, half-way through and at the end
of the projects, forms an integral part of this technical support. Prior to a review
visit, PHANSuP assesses the project's general status and consults with the concerned organization to identify the relevant qualifications of the person preferred
to conduct the review. PHANSuP then selects an expert either internally or from
its pool of national consultants. Pre-and post-review consultations are held with
the evaluator, when all relevant materials and issues are provided and discussed.
The partner organization is also oriented by PHANSuP on the progress of the
upcoming visit.
Results: Partner organizations feel that the pre-review consultation lessens
their anxieties in their preparation for the review. The interactive and participatory nature of review/evaluation activities facilitated by the evaluator raises the
self-esteem and builds the confidence of project staff. According to feedback
from partners, the well-prepared evaluator plays a multiple role, including that of
a facilitator. Partner organizations learn new strategies for improving the implementation of the remainder of the projects and in developing new plans for the
future.
Conclusion: In PHANSuP's experience, an interactive and responsive approach to review and evaluation greatly enhances the usefulness of the exercise
to the partner organization and it helps substantially in bridging differences at
individual and organizational levels.
44314 Evaluating the economic consequences of substance
abuse treatment on demand can be accomplished using
existing data sources
James G. Khan1, Alice Gleghorn2, J. Guydish3, J.L. Sorensen4. 1Center AIDS
Prevention Studies/IHPS, UCSF, Box 0936, San Francisco, CA 94143;
2Commun. Subs. Abuse Serv., Dept. Pub. Health, San Francisco, CA; 3lnstitute
for Health Policy Stud., UCSF San Francisco, CA; 4 TRTMT Resrch. Str; Dept.
Psychiatry, UCSF, USA
Background: San Francisco recently initiated an effort to provide substance
abuse treatment on demand, a key component of HIV prevention. Since we had
limited limited resources for evaluation, our objective was to develop methods to
assess the economic consequences of this initiative using existing data.
Design/Methods: We evaluated data in the public treatment system billing
and contracting databases and in an existing cohort study of IDUs. We reviewed
research on the economic effects of drug treatment via changes in crime rates,
employment and income, medical services use, and spread of HIV and hepatitis.
Results: The treatment system database contains records of each treatment
program admission and discharge, and it is possible to link individuals' records to
define treatment episodes that include several contiguous treatment admissions
(e.g., transferred from detoxification to methadone). Total treatment costs can
be calculated by program- and modality-specific contract records. The cost of
treatment is total costs divided by treatment episodes or by treatment admissions.
Past studies found consistent reductions in crime, medical service use, and risk
factors for HIV/hepatitis, but variable effects on employment and income. The IDU
behavioral cohort can also evaluate the link between treatment status and these
outcomes. It is possible to calculate economic effects as the following product:
[number of treatment episodes] x [number of outcomes (e.g., crimes) averted per
episode] x [cost per outcome]. Costs can be classified as to society, taxpayers,
and/or crime victims. One limitation of this method is its partial reliance on studies
conducted elsewhere, which may not apply exactly to conditions in San Francisco.
Another limitation is treating all drug treatment episodes as having similar effects,
even though treatment on demand may affect treatment effectiveness. Thus, use
of upper and lower bounds of effects is important to avoid false precision.
Conclusion: Substance abuse treatment on demand initiatives can be evaluated efficiently using existing information from public databases, research studies,
and published literature. This method is less desirable but more feasible than a
large prospective evaluation requiring extensive primary data collection.
44315 Developing indicators for assessing AIDS program
effectiveness in developing countries: Conceptual and
methodological issues
Joe Thomas. Community Research Program on AIDS, The Chinese University of
Hong Kong CCTER B7B, The Prince of Wales Hospital, Shatin, N.T, Hong Kong
Background: Lack of comprehensive indicators to assess AIDS program effectiveness in developing countries has practical and theoretical implications.
Developing, a provincial, and district level, AIDS program effectiveness indicators
(APEI) present both familiar and unique challenges. Consistent with the program
evaluation research in general, the APEIs must meet a set of standard parameters

and respond to a complex set of social, behavioral causative and consequential
variables of HIV/AIDS infection. In this, paper a model APEIs to be applied across
various conditions, with a discussion on essential conceptual and methodological
issues in selecting a set of APEIs are presented.
Methods: Judicious mix of review of major theoretical frameworks which are
able to bring several causative and consequential variables of HIV/AIDS infec
tion, existing data, field visits, in-depth interviews and focus group discussions to
develop six set of indicators for assessing the provincial and district level APEIs.
Results: Based on the concept of Health promotion for AIDS prevention and
care, six set of indicators consist of General prevention indicators (GPI), Care and
support indicators (CSI) Services and community Participation Indicators (SCPI),
Social determinants Indicators (SDI), Social and economic consequences indicators (SECI) and Research and Education indicators. Overall 35 APEIs, which
could be used in a provincial and district level context, is presented.
Conclusion: The maturity of AIDS program evaluation demands comprehensive indicators to assess the effectiveness of National AIDS Programs (NAPs).
The APEIs presented in this paper will provide minimum essential indicators to
assess the provincial and district level effectiveness of AIDS programs in developing countries like India and China and small and medium size territories like
Hong Kong.
44316 Results of a pilot intervention among girl-attendants at
road-side restaurants in Hainan Province, China
Susu Liao1, Q.Y. He2, M. Liu3, J.F. Liao4, Meng4, Y. Li5, X.C.H. Wang4.
1Department of Epidemiology, PUMC 5 Dong Dan San Tiao, Beijing 100005;
2Provincial Anti-Epidemic Station, Haikou, Hainan; 3Peking Union Medical
College, Beijing; 4Anti-Epidemic Station of Chengmai County, Chengmai,
Hainan; 5Anti-Epidemic Station, Hainan Province, Haikou, Hana, PR. China
Objectives: To compare awareness and risk perception of STD/HIV, and condom
use among girl-attendants providing sexual service in roadside restaurants prior
to and following a pilot intervention.
Methods: Two cross-sectional, questionnaire-based surveys were conducted
among girl-attendants at roadside restaurants at F town in Hainan province
in March and July 1997, prior to and after a comprehensive pilot intervention
combining reproductive health and STD/HIV education with condom distribution
through outreach methods and a drop-in center.
Results: 221 girls were surveyed at baseline and 201 at evaluation with approximately 33% overlap in these two convenience samples. Mean age of the
girls was about 18. More than 90% of them were unmarried. The majority were
from rural areas of southern China and most had limited education. Ethnic minority girls accounted for 22% at baseline, and 12% at evaluation. About 10% of
respondents reported having experienced at least one STD infection. Awareness
of STD/HIV improved somewhat after intervention, but there was no increase
in the proportion of the girls who realized they were at risk of STDs. A rise in
the frequency of condom use was found only in those girls who remained in
the project long enough to participate in both baseline and evaluation surveys,
indicating that longer exposure to the intervention can motivate risk prevention
behavior.
Conclusion: Improvement of awareness of STD/HIV and increase of condom
use can be achieved to some extent through a short-term intervention using
multiple methods, but further promotion of condom use, especially consistently
using condoms, remained a challenge in reducing sex-related risks of the girls.
44317 Evaluation of national AIDS control programme using
prevention indicators: A case study in India
Hemanta Kumar Kar1, S.K. Satpathy2, P. van Padmana3, D.K. Taneja4
L.A.L. Sunder5, A.B. Biswas6, S.T. Gandhi7, K. Banergee8, C.C. Mohan Ram9,
D.R. Dashatwaro1. 1Head, Dept of Dermatology & STD & AIDS Dr. RML
Hospital, DIIA71 South Motibagh New Delhi 110021; 2National AIDS Control
Org. Ministry of Health, India Got T New Delhi; 3Public Health Preventive
Medicine, Tamil Nadu, Govt. Chen Al; 4PSM Dept, M.A. Medical College New
Delhi; SPSM Dept., PGIMS Rohtak, Haryana; 6PSM Dept R. G. KAR Medical
College Calcutta Westbegal; 7PSM Dept. Grant Medical College Mumbai
Maharashtra; "Medicine Dept., Calcutta Medical College, Calcutta (WB); 9STD
Dept., Kilpauk Medical College, Chennait (TN.); 10STD & AIDS Cell, DHS,
Ministry of Health, Mumbai, Maharashtra, India
Issue: A decade old National AIDS Control Programme of India was evaluated
during the period March to September 1996 using eight out of ten prevention
indicators (PIs) developed by WHO, in five States of India (Delhi/Haryana, West
Bengal, Maharashtra and Tamil Nadu).
Project: This study included population survey conducted both in rural and urban belts and STD healthy facility survey conducted in urban domain only. Survey
was carried out by conducting interviews and observations using questionnaire
and methods developed by WHO-GPA.
Results: 54.4% to 77.9% of the population of age groups 15 to 49 years from
four cities and 13.4% to 63.8% of same age group population from four rural belts
had the knowledge of prevention practices. The high risk sexual behavior varied
from city to city (0.9% to 3.2%) and from one rural population to another (0.7%
to 4.2%). Reported condom use with irregular sex partners varied from 19.4%
to 77.8% in different cities, whereas in rural domain this figure was much lower
(8.6% to 25%). Availability of condom at central level appeared to be adequate
except in the rural area of West Bengal. Every adult person in cities had a access

to condom (100%) but not so in rural belts (53% to 100%). In case of STD Case
management in cities, the quality of history taking and patient examination by
health care providers (HCPs) was satisfactory, but only 12.5% to 80%. HCPs
could diagnose and treat the patient as per the National guidelines. 34.9% to
81.7% of patients received advice on condom use and 22.8% to 88.5% on partner
notification in different cities.