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

12th World AIDS Conference

Abstracts 12417-12421 97

Lessons Learned: Prophylaxis of 01 was considered the top research priority
by this pannel. Supplementation with vitamin A, immunization schedule and case
management of persistant diarrhea are other clinical research areas to consider.
From a public health stand point, HIV infant feeding policies on morbidity and
mortality deserve attention.
12417 Improving the quality of community based AIDS health
care in Uganda
Joseph Konde-Lule1, C. Somoka2, G. Nabisubi2, F. Sengooba1. 'Institute of
Public Health, PO. Box 7072, Makerere University, Kampala; 2AIDS Control
Program, Kampala; 3 Uganda AIDS Control Program, Kampala, Uganda
Issue: In many parts of Uganda the demand for AIDS health care and counselling
is greater than the conventional health sector can provide. Community based
AIDS prevention and care groups have been organized to fill the gap. These
consist of volunteers who receive minimal training. The quality of service they
provide is often poor and strategies to improve it are needed.
The task: was to devise simple inexpensive measures to improve the quality
of health care provided by health volunteers who do not have formal medical
training.
The project: The Institute of Public Health and the Uganda National AIDS
Control Program developed "monitoring tools" for use by volunteers. A joint team
evaluated the effect of the tools on the volunteers' quality of work. Tools consisted
of simple formats for (a) recording all activities carried out and (b) for making
reports to supervisors. A baseline survey was conducted in the communities
served to assess the performance of the volunteers who were then divided into 2
groups. One group was provided with the tools and trained to use them while the
other group continued to work without tools. After 6 months of supervised work the
performance of the volunteers in both groups was assessed in a follow up survey.
Results: We found that the performance of volunteers who used tools was
greatly improved and public rating of the volunteers who had the tools was much
higher than for those without tools.
Lessons learned: While community volunteers with limited skills take up a
large load of work in health education, patient care and counselling, their performance and quality of work can be substantially improved by simple innovations
such as enabling them to record all their activities and assisting them to make
regular reports to their supervisors.
12418 Care and management of people living with HIV/AIDS -
A scenario in Calcutta, West Bengal
Kingsuk Misra1, K. Verma2. 1MIVA Foundations 20/4 Onkarmal Jetia Rd
Howrah-711103, West Bengal; 2 West Bengal Sexual Health Project, India
Objective: To review services existing in Calcutta, West Bengal for care and
support of people living with HIV/AIDS, to accumulate information regarding monitoring of HIV positive and AIDS patients and to find out availability of antiretrovirals
in Calcutta.
Methodology: Face to face and telephonic interviews were taken from physicians involved with ASOs, general practitioners, West Bengal health services,
Gov.t and private hospitals, NGOs, laboratories, ambulance services, hearse
services and pharmacies. Secondary search was also done of NGOs working on
care and support issues.
Results: The interviews revealed that about 30.6% of the genenal practitioners
interviewed do not know what to do with an HIV positive or AIDS patient. About
38.9% prefer to refer such patients. HIV positive and AIDS patients can access
hospitalisation services at the Calcutta Medical College in Calcutta. Private hospitals are unwilling to provide hospitalisation services to HIV/AIDS patients. ELISA
testing is available only in 17 laboratories in Calcutta, 3 Govt and 14 private. Pre
and post test counselling facilities are not available in most of these laboratories.
Western Blot is available only in the 3 Govt run laboratories.. Regarding monitoring not a single centre in Calcutta offers CD4 or HIVRNA counting. Patients are
monitored only clinically or by total leucocyte count, a baseline routine examination. The only retroviral available in Calcutta is zidovudine. Ostensibly there is a
marked difference in the prices of the same AZT marketed by 2 companies. One
sells at Rs. 18.53/- per tablet while the other is sold for RS. 52/- per tablet. Only
2 NGOs offer outdoor, services, 4 ASOs provide psycho social and legal support
and 2 NGOs provide hotline services to PLWHAs.
Conclusion: A wide gap exists between the developed world and the 3rd world
countries specially Calcutta in India in the care, support and treatment available to
HIV/AIDS patients. Gap also exists in Calcutta between the rich and the poor as
far as accessing treatment is concerned. Communication/Knowledge regarding
the existence of certain services for people living with HIV/AIDS is very poor in
Calcutta.
12419 How to survive till the gaps are bridged
Lynde Francis. The Centre, 14 Harvey Brown Avenue, Harare, Zimbabwe

Issue: The reality of HIV infection in developing countries is that access to even
the most basic medications for opportunistic infections (o.i.s) (antibiotics, antifungals etc.) let alone anti-retrovirals, is an impossible dream for the forseable future.
Therefore, totally different strategies for survival must be urgently sought.
Project: Since 1992, The Centre has adopted an intensvie counselling and education strategy based on preventive and complementary medicine, that teaches
patients how to recognise and respond to the symptoms of o.i.s early; how to

prevent or avoid many o.i.s through such methods as hygeine management,
nutrition and supplementary vitimins, avoidance of harmful substances etc. They
work closely with traditional healers whose herbal preparations are often both
more affordable and more acceptable to patients. Clients and their families/carers
are taught simple first-line treatment strategies utlizing readily available remedies
(teatreeoil, salt). They are also taught stress management techniques together
with visualisation and affirmation models as well as given social support and,
when required, home-based care and alternative therapies (massage, reflexology, homeopathy, chiropracty).
Results: The empowerment of patients through the combination of education and psycho-social support enables them to regain control of their lives and
health. Hundreds who, according to popular African research models, would otherwise have deteriorated rapidly without treatment, have, in fact, remained totally
asymptomatic and others have regained health and recovered from serious o.i.s
including super-infected herpes, tuberculosis and pneumonia. (p.c.p.)
Lesson Learned: The developing world has centuries of practice in holistic
medicine to draw upon and the capacity to support H.I.V. patients immunologically,
even without allopathic intervention. Since poverty is not solely the domain of the
"third world" - viz. inner-city poor etc. - there are lessons to be learned by the
developed nations from our survival techniques.
12420 Mapping resources available to families affected by
HIV/AIDS in northern Thailand
Pornpin Boonkeaw, Udom Likitwonnawut, Promboon Panitchpakdi, Intaphad
Caroensin. 185-187 Phaho Lyothin Road SOI 11, Bangkok 10400, Thailand
About 40 percent of the reported AIDS cases have been reported from northern
Thailand. The incidence of AIDS related morbidity and mortality is high in rural
villages. The Integrated Community-Based Care for People with HIV/AIDS and
their families (ICBC) project, funded by the European Union, aims to stimulate
community involvement and support for affected families. The project has trained
200 village volunteers from 50 villages. The volunteers provide advice to affected
families on the provision of nutrition, home-based care, financial and occupational
support. They also assist in contacting internal and external sources of support
for the infected person and other family members.
A common problem at the village level is that villagers lack access to services
provided by external agencies. In addition they have not yet mobilize their local resources. Thus a key activity of the project is linking families affected by HIV/AIDS
with sources of support both at the community and district levels. The project uses
Participatory Rural Assessments (PRA) techniques to prepare "village resource
maps". The process involves various village groups in a discussion on what are
the various needs of affected families and how can these needs be met by the
community or by organizations external to the community. The discussions lead
to the drawing of a map or preparing of a table showing support from various
sources. Factors hindering the affected HIV family from securing support and
ways to reduce such hindrances are also discussed.
Conclusions: PRA sessions enables both village local leaders and persons
with HIV/AIDS to recognize and openly discuss the broad range of resources that
could be made available to support AIDS affected families. In many instances,
these resources are not utilized due to lack of information on external sources.
In other cases the source agency may not be organized. It is important the
community develops action plans to increase the utilization of such resources.
12421 Do sputum smear-negative TB suspects in a community
with high HIV seroprevalence really have TB?
S. Bertel Squire1, Nicola J. Hargreaves2, F.M.L. Salaniponi3, D.S. Nyangulu3,
O. Kadzakumanja2, S. Phiri2. 1Liverpool School of Tropical Medicine Pembroke
Plae, Liverpool, L3 5QA, UK; 2Lilongwe Central Hospital;3 National TB Control
Programme, Lilongwe, Malawi
Objectives: To estimate, within the context of a donor-supported National Tuberculosis Control Programme (NTBCP), the proportion of patients registered as
sputum smear-negative pulmonary tuberculosis (TB) cases who have TB that can
be confirmed on micriobiological criteria.
Design: Prospective assessment of randomly selected smear-negative TB
cases who would, under programme conditions, have been registered for
chemotherapy in Lilongwe, the capital of Malawi. Mycobacterial culture is not
routinely available to inform diagnostic decision-making under NTBCP conditions.
Methods: Patients recruited to the study undergo rigorous clinical re-evaluation and investigation including repeat sputum submission, bronchoscopy and
broncho-alveolar lavage (if repeat sputum smears are negative), and sputum submission post-bronchoscopy. All specimens proceed to routine smear microscopy
and mycobacterial culture.
Results: Of 82 cases assessed, 23 (28%) were sputum smear-positive on retesting and 12 (15%) had another non-tuberculous diagnosis established. Of the
remaining 43 true smear negative TB suspects, 32 underwent bronchoalveolar
lavage, and TB was confirmed in 13 (46%). Overall, therefore, 39 (48%) of the
82 patients who would have started TB treatment had unequivocal tuberculosis.

Seventy five (92%) of the 82 cases were HIV positive on serological testing.
As many as half of the patients currently registered for treatment for smear
negative pulmonary TB in communities with high HIV seroprevalence may have
causes other than TB for their respiratory symptoms. At this stage it is not clear
whether the high rate of sputum smear-positivity detected on re-submission of
sputum is because patients have become sputum positive in the intervening time
or because they were falsely categorised when sputa were originally examined.