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

12th World AIDS Conference

Abstracts 12427-12431 99

CD4- 500 CD4- 200
TLC - 2400 <1680
Prediction percentage 88.36 72.22
Conclusion: A remarkable correlation between CD4 counts and TLC demonstrates the suitability of the latter to predict CD4 counts. In resource poor countries,
where facilities for lymphocyte phenotyping are limited and expensive, this simple
model can be used to calculate CD4 counts so that rational clinical management
can be instituted to improve quality of life of HIV infected individuals.
12427 Community-based home-based care for PWA as a policy
option: The experience of a South African NGO initiative
Golda C. Chimere-Dan, G.N. Mnguni2. 1Institute of Urban Primary Health Care
PO. Box 67 Bergvlei, 2Friends for Life, Wynberg Johannesburg, South Africa
Issues: An evaluation of the activities of organizations operating the communitybased home-based model of care for PWA should be a prerequisite for adopting
such a model at the provincial or national level in South Africa.
Project: The activities of Friends for Life, a community-based non-governmental organization (NGO) in the depressed urban black township of Alexandra
was evaluated to establish the likelihood of recommending their methods as a
suitable model of home-based care for resource-poor communities. This paper
presents the problems and prospects of considering a community-based model
of home-based care for PWA and their family members in impoverished black
communities, as a policy option for South Africa.
Results: Despite increasing numbers of HIV+ people and PWA in Alexandra,
community attitudes towards PWA remain visibly negative. The presence of organizations such as Friends for Life (which is at the forefront of home-based
care provision for PWA and their families in resource-poor communities) is not
advertised to minimize negative community attitudes towards them, PWA and
their families who access their services. Although the Alexandra township has
the unenviable record of one of the communities with the highest level of sexual violence against women in South Africa, the staff of Friends for Life have
managed to evade attacks through a policy of non-disclosure of their identity to
non-HIV/AIDS persons even when these people walk into the Drop-In Centre.
This has been a difficult strategy to implement but has contributed to saving many
PWA lives particularly those of women. However, PWA and their family members
seeking counselling and/or care are often referred to Friends for Life by other
community members who may not be HIV+ or have a PWA in their care. The use
of community volunteers who are HIV+ or PWA themselves makes the services
of the organization more cost-effective and sensitive to the needs of PWA in this
community when compared to the care provided by public facilities and other
non-governmental organizations. Assistance with food packages from retailers
and the provision of vehicles in emergency by individuals in surrounding areas
has lightened the burden of this organization in many ways.
Lessons Learned: An 'open-secret' existence of community-based organizations which provide much needed cost effective services for PWA in resource-poor
communities should be a strong indication of the need for sustained community
education campaigns using varying methods. A provincial or national policy
on home-based care which adopts a community-based model should integrate
community-specific education campaign as part of its implementation strategy.
12428 Home care as an alternative to limited medical
resources
Rebecca Joy Batusa. Church of Uganda PO Box 14297 Kampa, Uganda
Issue: The limited hospital resources in developing countries can no longer satisfy
the need created by the increasing number of infections.
Project: A survey conducted in 2 big hospitals in Kampala showed the following
51% of patients in medical wards were infected with HIV.
20% fulfilled the case definition for AIDS
32% had been advised to go back home due to their greatly deteriorated
conditions.
The Diocese arranged sensitisation and Awareness campaigns for religious
leaders to equip them with skills necessary to get communities involved in
HIV/AIDS activities.
Results: 55 Home care teams of 20 volunteers each "Good Samaritans" were
established at the local Church commumity level. Through these teams, more than
213 PLWHIV/AIDS have had their psychological, medical and socio-economic
needs responded to by the Church community.
Lessons Learnt: The development of Home based care as an alternative to
complement the limited Hospital resources is the best alternative for developing
countries where HIV/AIDS cases are high.
S12429 The profile of AIDS inpatient care covered by SUS in
Brazil, 1995-1996

Margareth Portela, J. Campello, Jr., H.N.B. Oliveira, V.M.B. Ferreira. Oswaldo
Cruz Foundation Rua Clovis Salgado 280/104 - Recreio R10 de Janeiro, RJ
22795-230, Brazil
Objective: To describe and compare the profile of the AIDS inpatient care covered
by the Brazilian Unified Health System (SUS) in 1995 and 1996.

Method: We analyzed AIDS discharge data from the Hospitalizations' Information System of SUS that includes demographic, health care resource use and
diagnosis information concerning all hospitalizations covered by SUS in Brazil.
We used the SAS statistical package.
Results: We observed a decrease in the number of AIDS hospitalizations covered by SUS in Brazil from 1995 (28,009 discharges) to 1996 (25,100 discharges),
in spite of the fact that the average length of stay for hospitalizations in 1996
(16.5 days) was slightly larger than in 1995 (13,7 days). AIDS inpatient care paid
by public resources in Brazil was provided, predominantly, by University hospitals
(approximately 43%) and State hospitals (31%). The states of Sao Paulo, Rio de
Janeiro and Rio Grande do Sul aggregated most AIDS hospitalizations (73% in
1995 and 67% in 1996). From SUS perspective, the average cost of an AIDS
hospitalization was approximately 900 US dollars in a University hospital, and a
little less than 480 US dollars in other hospitals, being the variation from 1995 to
1996 insignificant. AIDS diagnosis information was predominantly inaccurate, being most observations associated with the primary diagnosis of immunodeficiency
and with no secondary diagnosis.
The decrease in the number of AIDS hospitalizations covered by SUS in Brazil
from 1995 to 1996 may reflect the trend of providing outpatient care instead of
inpatient care to AIDS patients, and, in some extent, the incorporation/delivering
of new AIDS drugs by the Brazilian Ministry of Health. However, this study is not
conclusive in relation to these points. The data employed is poor with regard to
disease severity control.
12430 Factors affecting accessibility to drugs and care in
Chiringa - a rural community in Malawi
Henry Damison', M. Chimzawa2, A. Kondwani3, A. Reeler4. 'National AIDS
Control Programme, PO Box 30622 Lilongwe; 2Home Based Care Co-ordinator,
Lilongwe; 3STD Officer, Lilongwe, Malawi; 4Researcher, Geneva, Switzerland
Objectives: 1. To identify priority problems related to access to drugs and care
by chronically ill people; 2. To identify positive resources at community level; and
3. To assess collaboration between health systems and communities.
Methodology: Data were collected through focus group discussions, observations, interviews with chronically ill people and their caretakers, traditional
healers and key informants using predesigned structured and semi-structured
instruments. Analysis employed both quantitative and qualitative methods.
Results: A total of 64 data collection instruments were analysed. Food, poverty,
medication, transport and burden of care in that order were identified as priority
problems in this community that impact the accessibility to drugs and care by the
chronically ill people. On the other hand, AIDS and orphan support groups, local
religious groups and drug revolving fund programmes were noted as possible
vehicles of intervention to improve the situation. In addition, traditional healers
were found to be providing first line treatment to a vast majority in the area
compared to bio-medical services. Despite presence of AIDS defining symptoms
(weight loss and chronic diarrhoea) in almost all patients interviewed, there was
no mention of HIV/AIDS. They attributed their illnesses to witchcraft practices.
Conclusion: In an agricultural economy dependent country like Malawi, adverse climatic conditions are bound to have devastating impact on accessibility
to drugs and quality care. In addition, there is need for government to consider
expansion of the community drug revolving fund programmes which make first
line drugs readily available at affordable prices. There is also need for the government to encourage and strengthen collaboration between traditional healers
and health systems in care delivery.
12431 Problems faced during follow up and treatment of
HIV-infected patients in a Turkish University hospital
Serhat Unal, GOlay Sain, 0. Uzun, Y. Qetinkaya, S. Kocagoz, M. Akova.
Hacettepe University Section of Infectious Diseases 06100, Ankara, Turkey
Objectives: To define problems faced during follow up and treatment of HIVinfected patients.
Results: Fifty-three patients were followed between June 1986 and December
1997 in Hacettepe University Hospital, Department of Internal Medicine, Section
of Infectious Diseases with the diagnosis of HIV-1 infection. Since quantitative
measurement of HIV has recently become available in limited centers in Turkey,
the measurement of CD4 lymphocytes was the major determinant for staging the
disease status and follow-up of HIV-1 infected patients.
The most common AIDS-indicator condition was Pneumocystis carinii pneumonia (PCP) in 14 patients followed by pulmonary tuberculosis in 10 patients. Ten of
fourteen PCP cases were treated empirically because of problems encountered
at diagnosis such as limitations for invasive procedures.
Patient compliance was one of the major problems. Twenty-two patients were
lost to follow-up. Forty-two patients were treated with different antiretroviral therapy schedules consisting of zidovudine (AZT), zalcitabine (ddC), Epivir (3TC) or
ritonavir which are available in Turkey, but the high cost of drugs compromises
optimal therapy of HIV infection especially in patients who do not have social
insurance.

Conclusions: Economics is part of the battle against AIDS and physicians of
developing countries try to cope with HIV infection as efficiently as developed
countries yet via inadequate resources.