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

98 Abstracts 12422-12426

12th World AIDS Conference

12422 Success of comprehensive HIV counseling, testing and
care clinics in India
Kumudesh Bhandaril, I.S. Gilada2. 1HOPES, Sumangal, B.G. Kher Marg,
Bombay-400006; 2lndian Health Organisation Bombay MS, India
Background: Stigma attached to extra-marital sex is squarely extended to
HIV/AIDS. There is poor acceptance of PLWHAs. Being fatal disease, misconceptions are a common phenomena. Patients at risk are scared of breach in
confidentiality and find anonymitous, integrated and comprehensive set up as the
most acceptable option. A chain of Anonymous, Comprehensive clinics within
reach of common person are initiated at strategic locations in India.
Method: After the success of IHO and UNISON models in Bombay on lines of
Washington's "Whitman Walker" clinic, we started a similar clinic, but integrated
in a Goa hospital run by NGOs. BLUE (Better Living with Understanding & Education) is run by team of clinician, counseller, nurse, technician and support
staff, supervised by a Technical Team. It is popularised through AIDS Cell, training programs, handouts and media coverage. Services are extended to cover
screening in Antinatal Clinic. Awareness programs & training sessions are also
conducted.
Results: In one year a total of 772 patients who considered themselves at risk
attended the centre of which 170 (110 male and 60 female) were subjected to HIV
Test giving them option of Anonymity, assumed name and real name. A total of
78 (76%) males and 66 (94%) females preferred to reveal identity. Demographic
profile was:
Males (n = 522) (%) Females (n = 250) (%)

Method: (1) PLWA, were interviewed on their health and psychosocial needs,
their emotional concerns and how they cope with their environment. 2. Families
of PLWAS were interviewed to assess knowledge and attitude to care, coping
and acceptance to care for PLWA at home. (3) In situ assessment at home, of
level of home care and obsanvance of universal precaution and hygiene were
made. 4. Support and care programme was set up.
Results: Frequently encountered health needs/problems of PLWA were coping
with and controlling diarrhoea (92%), weakness (70%) and irritating cough 64%.
86% of PLWA were concerned with lack of love and understanding from immediate
family members and community 94% of PLWA will rather not disclose HIV status
to family members. Majority of family members of PLWA lacked basic knowledge
on HIV, universal precaution and caring. Similarly, 94% were not aware that their
relatives are PLWA. If known they demonstrated unwillingness to care for their
relatives. Concerns with finance, coping with caring and hostile environment was
common to all.80% of households lacked basic hygienic environment to care for
PLWA.
Conclusion: Home based care can be ideal for uncomplicated health problems of PLWA, however a responsive environment is essential. Emphasis on
educating and counselling of family members is a prerequisite to successful
home based care. Community acceptance can be motivated though involvement
of communities in social projects beneficial to all. Training of counsellors and regular home visit by care providers encourages relatives and community to accept
PLWA. Sustenance of care programme is possible through community and family
acceptance of PLWA in their environment.
S12425 Reduction in refusal to admit HIV +ve patients by private
nursing homes: A help based programme in suburbs of
Mumbai
Rashmikant Shah1, R. Trikamani2. 'KMA AIDS Cell, Jobanputra Clinic 59,
Balasinor, S. V Road, Kandivli (W) Mumbai; 2Rotry-Arcon Anno Centre,
Mumbai, MH, India
Issue: Inadequate beds in Municipal Hospitals, High cost of care in big pvt.
institutions & fear of identification, the indoor care of +ve pts. depends on samll
pvt nursing homes (NH). This NH requires encouragement to admit the +ve pts
when needed since symptomatic pts are increasing in suburbs of Mumbai.
Project: A Project was prepared to reduce refusal rate to admit HIV +ve pt by
pvt NH after analysing reasons. Following help was given to NH: (1) Education
to Doctors & Paramedics on low cost management, recent advances & universal
safety measures. (2) Counselling services. (3) Low cost test. (4) Education to
local resident who discriminated
Results: 35 Nursing homes were selected for project. Results analysed as
before and after the project.
Refore After

Mean age yrs.
Single
Skilled workers
Past STD
HIV reactive

28
328 (62.8)
284 (86.6)
176 (33.7)
46 (8.8)

25
96 (38.4)
99 (39.6)
41 (32.4)
20 (8)

5 CSWs
Conclusion: The success of Comprehensive HIV Counselling, Testing and
Care centre depends on atmosphere of confidentiality, sensitivity towards people in difficult situation, quality of counseling and other back-up services. Such
centres are most suited for developing countries like India. Looking at the initial
success of BLUE Clinic, the National AIDS Control Organisation has decided to
expand its scope to cover counseling and care in its second phase of World Bank
supported project.
12423 The impact of HIV/AIDS on an urban hospital in Tanzania
during 1994-1996
Samuel E. Kaluvyal, T.J. Boerma2, E.N. Mkumbo3, A. Klokke3. 1Bugando
Medical Centre PO. Box 1370 Mwanza; 2Royal Tropical Institute Amsterdam
Mwanza, Tanzania
Background: Studies from hospitals in Africa have suggested that, even with
moderate HIV prevalence, HIV/AIDS increases the patient load dramatically, adds
more strain to the meagre health budgets, which may affect the quality of care for
all patients.
Objective: To assess the impact of AIDS on an urban hospital while the epidemic matures in a population where HIV prevalence has been fairly stable since
1989.
Methods: During Aug-Dec 1994 and again during Aug-Dec 1996 all new admissions 15-44 years to the medical (including tuberculosis wards) of Bugando
Medical Centre, Mwanza, Tanzania, were requested to participate in the study
including a standardized interview, physical examination and laboratory examinations.
Results: The number of admissions to the medical wards during the five-month
study period declined from 1641 in 1994 to 1309 in 1996. Also the number of
admissions in the age group 15-44 years declined from 1231 to 931 patients.
Both in 1994 and in 1996 45% of admissions 15-44 years were HIV infected, while
the case fatality rate increased from 14 to 18 per 100 HIV positive admissions (p
=.178), and from 4 to 8 per 100 HIV negative admissions (p =.010). The mean
duration of stay among HIV+ patients declined from 19.5 to 12.7 days (mainly
due to earlier discharge of TB patients), and the proportion of beds occupied by
HIV positives declined from 48 to 38%.
Conclusion: In this population we had expected an increasing burden due to
HIV/AIDS for the hospital, as the epidemic matures and morbidity and mortality
presumably increase. No such increase was observed. The effects of the AIDS
epidemic on hospitals should be considered in the light of changes in hospital
care seeking behaviour of AIDS patients (including home-based care), hospital
policies with regard to admission and discharge, and health system changes in
general.
12424 Needs assessment and care programme for people living
with HIV/AIDS (PLWA), in resource constrained and
hostile environment
Femi Soyinka. Dept. of Dermatology-Ven. College of Health Sciences, Obafemi
Awolowo University, ILE-IFE, Nigeria
Objective: (1) To determine health and psychosocial needs of PLWA in Nigeria.
(2) To structure a self-sustaining, family and community participatory programme.
Design: Qualitative and quantitative interview. Pilot intervention programme.

1. No. of NH admitted +ve pts
2. Patients benefited per month
3. Reason for not admitting (By NH)
- Fear of getting HIV
- Inadequate knowledge
- Objection from Paramedic
- Objection by local residents
- High cost of management
- High mortality in +ve pts
- Fear of discrimination of NH
- Lack of counselling facilities

6-17% 22-62%
- 30
25 7
14 3
19 5
19 5
10 1
11 4
10 4
12 3

Lessons Learned: Regular counselling facilities, education to doctors &
paramedics, involvement of local residents along with various other help, the
refusal rate to admit HIV +ve pts by NH reduces considerably. This model project
will be very useful to other resourse limited areas which are highly affected by
HIV epidemic. Symptomatic pts will benifited with low cost indoor care (in patients
care).
12426 Total lymphocyte counts as an alternative to CD4 counts
in resource poor countries
Sanjay Pujari1, N. Gupte2, R. Wadia3. Dir Ector HIV Unit Ruby Hall Clinic, 1730
Sa Dashiv Peth 19 Ram Sham Apt S, Pune 411 030; 2Statistician University of
Poona Pune; 3Nuerologist Ruby Hall Clinic, India
Objectives: To determine correlation of CD4 counts with Total Lymphocyte counts
(TLC) in HIV infected subjects and to develop a model to predict CD4 counts from
TLC.
Design: Prospective cohort study from Oct. 96 to Nov. 97
Methods: Adult subjects with confirmed HIV infection, irrespective of clinical
status were recruited into the study. However, subjects on antiretroviral therapy were excluded. Lymphocyte phenotyping and TLC were determined by flow
cytometry and hematological methods respectively. Spearman's correlation coefficient was determined and chi square test for assessing independence was
applied. A regression equation was determined (the least square equation was
solved by Newton-Raphson method). Finally cut off points for TLC with CD4 <
500 and CD4 < 200 was determined.
Results: A total of 214 subjects were recruited. High degree of correlation (r =
0.688) and dependence (x2 = 65.26, p < 0.001) was observed between the two
variables. The regression equation determined was y = 1.72E-06 X2.5
The prediction table is as displayed below: