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

96 Abstracts 12412-12416

12th World AIDS Conference

supplies (essential drugs and HIV test kits) and assumed lack of confidentiality
are often bypassed by PLHA.
Results: The STD/AIDS control programme has developed operational, policy
and training guidelines on provision of comprehensive care across a continuum.
Over 600 operational level health workers, 120 counsellors and numerous resource people at community level have been trained in comprehensive care for
(PLHA) by both government and NGOs. Networking by all care providers through
regular meetings, exchange of reports and zoning areas of operation has been
done in about 10 districts in Uganda. Various models of care have evolved in
different settings like Kitovu Hospital, Nsambya Hospital, TASO, IDAC in Iganga,
World Vision Bbale AIDS care project etc that have decongested some hospitals
by setting up services in the community. These care models combine clinical care
with counseling, home care. and community mobilisation for care and education.
All of them are a collaboration between government and NGOs, with government
providing drugs and patial funding.
Lessons Learned: Care of PLHA at the community and operational (Primary)
level is feasible if the necessary facilitation in terms of drugs, close supervision
and staff motivation is done thus releaving hospital burden. Its important to integrate care servicesinto the health care delivery system if the services are to be
susustained.
74*/12412 The impact of family support on outcome of
hospitalization for symptomatic HIV infection
Irene K. Bruinsma-Adams1, R.R.S. Ferreira2, S.M. Figueiredo2,
R. Nogueira-Duarte2, M.R. Vargas2. 1Rua Alem Paraiba 181, Bairro Lagoinha;
2Clinica Nossa Senora da Conceicao, Belo Horizonte MG, Brazil
Issue: Disadvantaged patients with HIV/AIDS attended in a philantropic hospital
with limited financial resources, were greatly improved at discharge only to be
readmitted, frequently in a state as bad as the previous admission.
Project: An intensive intervention in the families of patients during and after
hospitalization was initiated in July, 1997 by a multiprofessional team (Social
Worker, Psychologist, Nutritionist, Community Health Agent [CHA]). The CHA
visited the homes, and adapted the discharge medical, nutricional and hygiene
recommendations to the reality of the family/home situation. She identified community resources in the absence of, or in addition to, family support.
Results: Results of 132 admissions of 97 patients between January and December, 1997, comparing results before and after the intervention, and in those
who did and didn't have family support are presented. In 86% of cases, there
was family support. Unsatisfactory family relationships (often pre-dating the HIV
diagnosis) were identified in 75% of cases. In 64% of cases re-integration into
the family was achieved. Needs identified and resolved included; entitlement
to government financial benefits, erroneous ideas about posssible HIV transmission, adherence to medication, low self-esteem, family and social abandon,
inadequate and inappropriate diet, inadequate hygiene. In 11% of cases, failure to
achieve family support occurred. These were cases where family indiference and
abandon preceded HIV diagnosis and resulted from self destructive behaviour of
the patient. The duration of hospitalizations, cost of care and diet, weight gain
at discharge, and frequency of re-hospitalization were greatly improved by the
intervention.
Lessons Learned: The human and financial resources invested in hospitalization of socioeconomically deprived people with HIV/AIDS were achieving only
transitory improvements until multiprofessional intervention with the families during and after hospitalization. This approach can achieve a prolonged improvement
in quality of life, reduction in duration, frequency, and cost of hospitalization.
S12413 Drug detoxification amongst IDUs and heroin users from
the slums
Keith Kanga. Sharan G-46 Green Park (Main) New Delhi, India
Issue: The rapidly growing number of IDUs and Heroin users with very high risk
behavior, the increasing percentage of HIV/AIDS and the high incidence of T.B.
in the Slums of New Delhi urgently need Detoxification encompassing a holistic
approach involving HIV awareness, support systems and rehabilitation.
Project: The detoxification unit provides medicated detoxification keeping in
focus IDUs and Heroin users with high risk behaviour. The Project in its staffing
include a medical doctor, a psychologist, a nurse, rehabilitated ex-drug users as
key staff members and a social worker. The Detox period is for 15 days. After
the initial Detoxifation process, interactive sessions on HIV/AIDS awareness,
counselling, T.B. intervention, accent on nutrition, the risks of IDU and monitoring
of health are the key components. Self reflection, how to lead a drug free life and
specific problems a client may be facing are discussed and help given through
direct intervention. One N.A. meeting is held in each batch. The clients are
then referred to Rehabilitation Centres, Day Care and support group systems on
completion of their detoxification.
Results: The Detoxification Unit has been very well received by its clients.
Within six months the total number of clients detoxified were 118. Of this 17
Clients have been referred to Residential Care Centres and 40 are substance

free through the support group systems.
Lessons Learned: It is important to involve the Client in the needs assessment
in any Harm Minimisation Process. Respite in chaotic drug usage has indicated a
major success. Low cost treatment and follow up is important in the treatment for
HIV Positive and IDUs. Ex-drug users working in the project is advantageous as
there is a strong understanding and qualitative delivery of care towards the client.

I12414 Conventional health workers' views and attitudes
towards improving traditional health practices
Clare Nsubuga1'2, D. Kabatesi2, F.X. Mubiru2, S.N. Kasolo2, C.K. Tusaba2. 1PO
Box 21175; 2 Theta Kamdala, Uganda
Objectives: 1. To assess the attitudes of conventional health workers (CHW)
about traditional health practices in relation to STD/HIV/AIDS 2. To get CHW's
views about training of traditional healers in basic clinical diagnostic skills.
Methods: 79 CHW including doctors, nurses and midwives were randomly
selected and interviewed in hospitals and private clinics around Kampala using
a structured questionnaire. Questions included roles of traditional healers in the
community. Shortcomings of the traditional healing practice and what can be done
to improve quality of care provided by traditional healers.
Results: 95% of respondents reported that traditional healers are the first
line care providers in the community especially in rural areas. Several potential
problems were mentioned that could relate to traditional healing practice including overdosing of patients with herbal mixtures (71%), poor hygiene at working
places (43%), misdiagnosis of patients (39%), delay in referral of complicated
cases (35%). Working together with traditional healers (80%), was suggested as
one of the ways to solve the problems. The majority of CHW (96%) supported the
idea of training traditional healers in various skills of patient care as this would
enable them to improve patient management and encourage cross-referral in
STD/HIV/AIDS patients.
Conclusion: CHW recognize the importance of traditional healers in the health
care delivery system. Improved quality of care and mutual respect and trust can
be strengthened by training and collaboration by CHW and TH. A training program
in basic clinical methods for TH, the first of it's kind, has since started in Kampala,
Uganda.
12415 1 Chinyadza villages: Community home based care
programme for the terminally ill
Dorothy Mtemeli. Ministry of Health, PMD Manicaland Box 323 Mutare,
Zimbabwe
Issue: AIDS cases continue to escalate in the province. Rural areas are experiencing the same devastation as the urban areas. The majority of the people
live in the rural area and those in urban areas go home (to the rural area) to
die. Medical services are experiencing a growing demand because of AIDS.
The Chinyadza Home Based Care programme was initiated in response to the
problem of increased numbers of terminally ill patients within the community.
Objectives: To develop and implement community HBC activities to meet
physical psychosocial, spiritual and social needs of terminally ill AIDS patients
and their families.
Project: Training of influential leaders on HIV/AIDS and home based care
(HBC). Formation of village committees to carryout home visits patients at home.
They meet fortnightly to review progress and problems. Each committee keeps
records of activities in their own village. Activities involve home visits, training
counselling and support of family care givers by committee members.
Result: A self sustainable home care programme which is community owned.
Role of health workers is training and support. With land set aside by the chief
community has embarked on project to produce food communally to supplement
food for the terminally ill
Lessons Learnt: Village based program which is sustainable; has little or no
transport costs. Villagers organised themselves to visit the sick in turns and as a
result, less problems of burn out.
S12416 Care of HIV-infected children in developing countries:
An agenda for clinical research
Philippe Lepage1, R. Spira2, K. Pillay3, C. Giaquinto4, S. Kalibala5, F. Dabis1.
1 Centre Interuniversitaire A. Pard, 2 Boulevard Kennedy, 7000 Mons, Belgium;
21NSERM U330, Bordeaux, France; 3University of Natal, Congella, South Africa;
4Univ. Degli Studi Di Padova, Padova, Italy; 5UNAIDS, Geneva, Switzerland
Issues: (1) To review the available natural history data on pediatric HIV infection
in developping countries;
(2) To discuss the current experience in management of HIV-infected children;
(3) To identify the key areas where clinical research should be conducted.
Methods: (1) Review of the literature;
(2) Questionnaires on mortality, incidence of AIDS, case management and
research priorities to 14 selected teams;
(3) A summary Workshop held in Paris, September 26-27, 1997, to formulate
recommendations.
Results: Rates of mortality and morbidity were very different from one study to
another.
High incidence of death and AIDS were often observed in the first 2 years of life
with lower rates between 2 and 5 years. Heterogenous clinical case definitions
of AIDS were used. The following issues were reviewed: laboratory and clinical
diagnostic criteria, prevention and treatment of opportunistic infection (01), nutri
tional management; childhood immunization and antiretroviral therapy. Half of the
participating teams had a specific protocol for HIV-infected children with persistent
diarrhea and 40% for children with severe malnutrition; 36% reported antimicrobial prophylaxis after an episode of interstitial pneumonia, 43% after recurrent
infections and 50% used primary prophylaxis of 01, generally in intermediate
countries like Thailand and Brazil but not in Africa.