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

12th World AIDS Conference

Abstracts 12407-12411 95

their behavior suggesting that learning one is positive has an impact on risk
reduction and can lead to improvements in health status. The drop-off observed
in the control group by six months may suggest that counseling/home care at this
later point could prevent sexual risk relapse.
12407 Evaluation of the WHO clinical management algorithm for
respiratory tract infection among a cohort of
symptomatic HIV-1 infected adults in Nairobi, Kenya
Christina Mwachari1, L. Nganga2, J. Kimari2, J. Odhiambo2, P. Waiyaki2,
C.R. Cohen3. 1Box 43640, Nairobi; 2Kenya Medical Research Institute, Nairobi,
Kenya, 3University of Washington, Washington, US
Introduction: Respiratory tract infection (RTI) is the most common cause of morbidity among human immunodefeciency virus type-1 (HIV-1) infected adults living
in developing countries. Our aim was to evaluate the diagnostic and therapeutic
efficacy of the World Health Organization (WHO) algorithm for management of
RTI in an urban African setting.
Method: Symptomatic HIV-1 infected adults were recruited from various health
centers in Nairobi. HIV-1 serostatus was confirmed and CD4 and CD8 T-cell
counts enumerated. The WHO 1991 RTI algorithm was used to manage patients
complaining of persistent and/or worsening cough. Patients underwent physical
examination, chest X-ray, sputum microscopy, and sputum and blood cultures.
Ampicillin was given as first line therapy, and trimethoprim-sulfamethoxazole as
second line therapy. Complete clinical response was defined by cessation of
clinical symptoms.
Results: Two hundred and fifty (250) adults, with a female to male ratio of 3:
1, were recruited over a 6 month period. Patients had a mean age of 33 (7.4),
a mean educational level of 8.7 (3.71) years and 47.2% were married. Most
patients were classified B1 to B3 (72.3%) per the 1993 CDC HIV-1 classification
system. Thirty-one percent (31%) of patients had a CD4 count < 200 cell/mm3,
45% 200-499 cell/mm3 and 24% - 500 cells/mm3. The RTI algorithm was used
117 times. Out of 117 RTI episodes, 96 were upper RTI and 21 lower RTI.
Ninety-two (78.6%) patients responded clinically to first line therapy, 16 (13.7%)
to second line therapy, 9 (7.7%) required a non-protocol antibiotic and 4 (3.4%)
were hospitalized for RTI. From 64 sputum specimens, the most common isolates
were Streptoccocus pneumoniae 5 (7.8%) and Branhamella catarrhalis 5 (7.8%)
both of which were sensitive to 1st line therapy and are common causes of RTI.
Mycobacterium tuberculosis was recovered in 8 (12.5%) and organisms resistant
to both therapies were recovered 2 (3.1%) of specimens.
Conclusion: Our preliminary results support the efficacy of the WHO RTI algorithm. The use of this algorithm and similar ones for other common diagnoses may
help reduce morbidity and mortality in HIV-1 infected adults living in developing
countries.
S12408 Modified ACTG-076 protocol and its initial results in the
largest ongoing perinatal HIV study in India
Sachin M. Changedia1, I.S. Gilada2, R.H. Merchart3. 1House Physician, I.H.O.
-Bombay. MH; 2Secretary General, I.H.O. -Bombay MH; 3Pediatriction, Wadia
Hosp., Parel, Bombay, MH, India
Background: With the HIV epidemic in its third phase affecting a large number
of women, India, ridden with poverty (GNP 150$), illiteracy, double standards
and multiple scandals, has some activists for the cause of trees, animals and
human rights. But strangely enough, a child in the womb is not covered under
any of these causes and continues to be neglected. We decided to pursue 'Right
to AIDS-Free Life' for the small creatures in the womb, before they breath in
this morally and socially polluted world. To prevent perinatal transmission cost
effectively by appropriately modifying the ACTG-076 protocol in Indian context,
we initiated this study.
Methods: After sequential, systematised HIV screening of the antenatal clinic
attendees at a large Women's Hospital, seropositive women were counselled on
preventing perinatal transmission through modified ACTG-076 to suit the cost
and convenience in the 'IHO-Wadia' model. It has four wings: Locally produced
AZT to mother for 8 weeks 400 mg/day; elective Ceasarean section for delivering
the baby, no breast feeding or modified breast-feeding and AZT to the infant for
first 40 days. Children are followed quarterly till 15 months and tested for HIV by
ELISA at 9 and 15 months, the latest they can be certified infected or otherwise.
Sero-negative babies are discharged from the study at the earliest revelation.
Result: Of the 81 babies born following our protocol, 26 have failed to follow-up,
35 are below 9 months. All the 20 babies who have completed 9 months have
come 'HIV negative' (Zero prevalence, but small sample size). It is a cost-effective
study.
Pool ELISA test per woman: Rs.15/- ($0.40), Cost of detection of one infection: Rs 1500/ ($40/-) (prevalence in women is 1%), Cost of prevention of one
perinatal transmission: Rs 5000/- (130$) vis a vis cost of managing one HIV
infected child with 'cocktail': Rs. 100,000/- (2800$)
Conclusion: AZT given to seropositive mothers in proportionately smaller
doses (due to low average weight), for a shorter duration of 4 to 6 weeks has

been equally efficient in preventing perinatal transmission. Such a cost-effective
and user-friendly model needs to be replicated elsewhere. UNAIDS guidelines
of 'no-breast feeding' for rich countries and 'breast-feeding' in poorer countries
needs to be modified with indigenous solution of modified breast-feeding (heating
breast milk).

71*/ 124091 Clinical profileof 1800 HIV/AIDS patientsat theonly
comprehensive AIDS clinic in Bombay, India
Satish C. Bodhare1, I.S. Gilada2, N. Shrigoppikar3. IPhysician, Unison
Medicare, Grant Road, Bombay MH; 2Secretary General, I.H.O. Bombay, Mh;
3Gynaecologist Unison Medicare Grantford, Bombay, India
Background: Bombay, the AIDS capital of India has reported the highest number
of HIV/AIDS cases. With an estimated 250,000 HIV infections, the city has only
one private comprehensive AIDS Care clinic. However, this caters to the patients
from all over the country. With the objective of caring for patients commensurate
to their stage of progression, we have drawn up clinical profile of 1800 cases.
Methods: A group of 1800 patients-male, female and children with HIV infection
were recruited in last 3 years. Patients are provided counseling, clinical examinations, laboratory and radiology investigations, cost-effectively under one roof.
Results are tabulated on single, but individual case sheets. Spectrum of care:
Outpatient, day-care, home care and inpatient are provided. Patients are broadly
categorised as Asymptomatic-with or without PGL and Symptomatic-Early or Late
and subsequent follow-ups are decided on that basis.
Results: Of the 1180 asymptomatic, 880 (74.5%) had PGL. Of the 620 symptomatic, 356 (57%) were in early and 264 (43%) were in late stage, of which 106
(40%) succumbed and 42 (15%) lost to follow-up.

Early Symptomatic
Tuberculosis (TB)
Herpes Zoster
Weight Loss
PUO
Oral Hairy Leucoplakia
Fungus infection (mild)

(n = 356)
160
92
289
112
98
91

(57%)
(44%)
(26%)
(81%)
(31%)
(28%)
(26%)

Late Symptomatic
Tuberculosis
Extra-Pulmonary TB
Oropharyng. Thrush
Cryptosporidia Dia.
Cryptococ. Meningitis
Toxoplasmosis

(n = 264)
113
81
134
105
35
48

(43%)
(43%)
(31%)
(51%)
(40%)
(13%)
(18%)

Conclusion: HIV is widespread, as patients from all over India seek treatment
in our centre. TB, Candida and cryptosporidia are most common Opportunistic
Infections. Though most are still in early phase of HIV disease spectrum, the
future scenario appears grim. Male:Female:Children ratio is 58:40:2. Mean survival rate is not as low as was thought earlier. Not a single patient committed
suicide.;Average annual spending worked out to US$400/- for Late Symptomatic
and 30$ for rest. Cost-effective, comprehensive and quality centre for HIV care
emerged.
73*/12410 Care in resource limited settings
Vikramjit Singh Nepram. Continuum of Care Project, EPI Complex Lamphelpat
Imphal Manipur, India
Issue: To avail comprehensive care for PLWHAs in Imphal, Kakching and Churachandpur in Manipur which is having the highest sero-positive rate in India.
Project: Continuum of Care programme (COCP) has been evolved out of
series of discussions and workshops with the Government of Manipur, Oxfam,
WHO, British Council, NACO and NGOs with the main objective of availing care
and support to PLWHAs and their families. This project was launched to bring
about a concerted and integrated effort by the Government, NGOs and relevant
sectors of society and rally their support and services to PLWHAs. The strategy
also includes bringing the Government, NGOs, CBOs and community on a same
platform to strengthen the referral system between community, NGOs and hospitals and capacity building training for nurses, volunteers and care providers.
Further, Service Cells are established in the major hospitals to provide medical,
psychological and social supports to PLWHAs and families.
Results: In the initial phase of the project only 5 cases of HIV+ persons
were referred by community and families for further referrals to health institutions
whereas after 3 years of our work the number of referrals has increased to
350. The strengthening of our network with the hospitals, NGOs and community
based organisations has helped us to circumvent the social stigmatisation and
provide them with care due to which a major network of PLWHAs called Manipur
network of positive people (MNP+) has been formed. This group is emerging as
a voice that strives to lobby for social acceptance and improved health services
for PLWHAs. Today the services support towards PLWHAs has improved substantially and more and more of them have become willing to disclose their HIV
status and join the mainstream of society as change agents and facilitators in the
area of HIV/AIDS intervention.
Lessons Learned: The past three years of experience has taught us that a
concerted and collaborative effort of the community, government and non-government organisations in managing the epidemic has created a positive impact
in a resource constrained setting like Manipur, India.
S70* /12411 Comprehensive care across a continuum: Uganda
experience
Nathan Bakyaita1, E. Madraa2, P. Waubale2, E. van Praag3. PO. Box 8
Entebbe Uganda c/o ST/AIDS Control Programme, Ministry of Health;
2STD/AIDS Control Program Ministry of Health Entebbe, Uganda; 30ffice of
HIV/AIDS WHO Geneva, Switzerland
Issue: The high prevalence of people with HIV (PLHA) in need of care in Uganda
has over-stretched the health care delivery system. Hospitals have been overburdened, with more than 50% of beds occupied due to HIV-related illnesses in most
districts in Uganda. In the meantime, the peripheral or primary health care units
due to lack of trained personnel in clinical management and counseling, lack of