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

12th World AIDS Conference

Abstracts 12438-12443 101

12438 Method to decrease of the AZT-treatment cost
Oleg Yurin1, A. Kravchenko1, E. Gorbachova2, V.V. Pokrovsky1. 'Russian AIDS
Centre, B2 D15 8-Ya Ulitsa Sokolinoy Gory, Moscow 105275; 2Municipal
Infectious Hospital N2, Moscow, Russia
Objectives: As both combination therapy and monotherapy by AZT is inaccessible for the many of HIV+ patients it still remaines essential to work out a cheaper
treatment for those patients.
Design: Prospective, controlled study.
Methodology: The clinical and immunological observation during 48 weeks
for 3 groups of HIV+ adults. 116 patients of groups 1 and 2 received AZT in
the daily doze of 0.6g. 69 patients (group 1) were treated by interrupted course
(treatment within every 12 weeks at 12 weeks intervals) and 47 patients (group 2)
by continuous course. 52 patients (group 3) refused to receive any antyretroviral
therapy. All of 168 patients were in clinical categoria A2 by CDC classification.
Results: The conversion to clinical categories B during the period of observation was found in 6 (8.6%) patients of group I and in 5 (10.4%) of group 2, 5
(15/6%) (p > 0.05).
The mean number of CD4+ cells (bin/I)
Weeks of therapy 0 13 25 37 49
Group 1 0.310 0.369 0.330 0.354 0.301
Group 2 0.294 0.372 0.340 0.318 0.296
Group 3 0.316 - - - 0.253
Increase of the number of CD4+ cells in 13 weeks of treatment in groups 1 and
2 and decrease of this number in group 3 was statisticaly reliable. The difference
in the number of CD4+ cells between patients of groups I and 2 was statisticaly
reliable on the 36 weeks of observation only.
Conclusion: The effectivity (delay in clinical progression and CD4-lymphocytes
level decrease) of more cheap interrupted and standard continuous courses of
AZT therapy in patients with asymptomatic HIV-infection is practicaly the same.
Thus, the use of interrupted AZT therapy course gives a possibility of treatment
of larger quantity of patients for same price.
12439 1Role of hospice care with spiritual intervention in the
AIDS management
Nabin Bhuyan. Shyam Kutir, New Sarania Guwahati-781003, India
Issues: The special needs of AIDS patients in the Third World country like India
can be effectively met through the introduction of hospice care system on a wider
scale as part of the cost-effective home and community care programme.
Observation: In Assam, situated in North-Eastern part of India, where the first
AIDS case was diagnosed in Sept.1990, the response to hospice care in the
early stage of AIDS epidemic, as provided by 'Santidan' which is run by Mother
Teresa's "Missioneries of Charity", has been found quite encouraging. Since its
begining "Santidan" accommodated 5 AIDS cases, of which 3 were referred from
hospitals; only 1 patient expired in the hospice, while others returned to their
respective homes as their families accepted them after adequate counselling and
spiritual intervention resolved their initial psychological reactions.
Lessons Learned: AIDS epidemic is a new phenomenon in the state of Assam
where the negative responses like isolation, discrimination etc. still persist as in
the other parts of the world. Here, hospice care system can act as an intermediate
palliative support system between the hospitals and the Home and Community
Care system.
i 12440 Role model of non-discriminatory, supportive therapeutic
community approach for PLWHAs with chemical
dependency
Rajiv N. Jerajani1, J. Pareira2. 1Psychiatrist, Kripa Foundation, Bombay, 34B-1
Panchavati Apts. Juhu Lane Andheri (W) Bombay-400058 MH; 2Kripa
Foundation, Bombay-400050, MH, India
Issues: Support services in group. One can give an opportunity to learn and the
possibility of living a risk free life to the people, but to bring about the relatively
permanent change of attitudes in the life it takes the motivation time and the
persistent efforts on part of clients. More often then not on their own they find it
difficult to cope with this reality. And therefore it became essential to develop a
self help, self sufficient program suitable to the Indian ethos where the clients can
stay and learn the process.
Project: Kripa foundation is an in-residence facility provided to PWHA with
chemical dependency. A charitable trust having five major in-residence programs
for clients in various cities of India.. Clients stays with the organization for period
varying between 6 weeks to six months to learn to live with HIV disease.
Results: It possible to provide a reasonable degree understanding about relatively permanent change of thoughts, emotions, attitudes, behavior, sensations,
postures and limitations.. It is possible to improve on the sensitivity of the client
on the relationships with the significant others. The holistic approach of interac
tions includes the methods like prayers, meditation, yoga, Tai - Chi etc. on one
hand from orient, and psychotherapy, psychometric, biomedical, advises based
on Occident.
Lessons Learned: It is preferred that in absence of curative medicines and
preventive vaccine the option of change of life-style is the only answer. Not
many people are willing to offer the kind of help, without experiencing the fear,
resulting in discrimination to the client. Group approach with metaphysical, mul
tidisciplinary, multidimentional approach to the issue is far more beneficial to the
client in learning the skills to cope with reality of being HIV infected.
S12441 | Care in resource - Limited setting
Adriana A. Machinjili. 1Regional Health, PO. Box 3, Blantyre, Malawi
Issue: Malawi is faced with many persons living with HIV/AIDS so much so that
there were 1850 people who were confirmed positive HIV from January to June,
1997. But the patients who met the clinical requirements for suspecting AIDS the
same period were 2,203.
Project: With the high numbers of HIV infected people and those with AIDS, the
hospital care is very difficult because of inadequate space and manpower, hence
hospital care in the medical wards is a nightmare. Chronically ill people are discharged to be cared for at home. As a result peole with HIV/AIDS have organized
themselves in most parts of the country to do Home Care for these people. The
groups also act as support groups whereby they share experiences, problems
and and what activities to render to one another or other people; i.e. bringing
awareness to the general public. Some communities too have formed groups
which also do Home care on voluntary basis. Due to very limited resources, both
groups render such services using locally available resources.
Lesson Learnt: Accepting HIV/AIDS cases in the community will help reduce
the pressure on these health facilities while affording those affected a sense of
belonging to society.
12442 Sources of dissatisfaction with health care among HIV+
women in the Women's Interagency HIV Study (WIHS)
Chicago Consortium
Jane Burke1, M. Cohen1, J. Cook2, K. Weber1, P. Garcia3, B. Sha4
R. Hershow2. 1Cook County Hospital; 1900 W. Polk St., CCSN, Chicago;
2University of Illinois Medical Center, Chicago; 3Northwestern Medical Center,
Chicago; 4RUSH Medical Center, Chicago IL, USA
Objective: To identify sources of dissatisfaction with care among HIV + WIHS
participants in Chicago, Illinois.
Methods: The WIHS is a multi-center longitudinal study of HIV disease progression in women in the US The Chicago consortium comprises four urban
medical centers including one public hospital. Data from HIV+ participants' one
year follow-up visit (n = 215) are included in the analysis. Content and factor
analysis identified three principal components to patient satisfaction.
Results: The first component measures patient perceptions of financial barriers
to care and access to appointments, emergency care, prescriptions, and medical
specialists. Fifty-three percent (n = 112) of respondents were satisfied with their
access to care and 47% (n = 101) were dissatisfied. The second component measures patient perceptions of the quality of care received, and respondents were
72% (n = 153) satisfied and 28% (n = 60) dissatisfied. The third component rates
the quality of provider-patient interactions, including doubts about providers' ability
and accuracy, and perceptions that providers hurry too much, ignore patients, are
impersonal, make moral judgements, and dislike the patient. Respondents were
only 41% (n = 87) satisfied and were 59% (n = 126) dissatisfied with interaction
quality. Patient satisfaction on these three scales differs significantly (chi-square
= 19.77 (d.f. = 2), p <.001). Multivariate analysis controlling for CD4 found that
care site (public hospital vs. not public hospital) was significantly associated with
dissatisfaction with access to care (p =.04, O.R. = 2.02): however care site
was not associated with dissatisfaction with quality of care or provider-patient
interaction. Dissatisfaction with quality of care was significantly associated with
the patient being employed (p =.05, O.R. = 2.39), and being depressed (p =.04.
O.R. = 2.32). Depression was also significantly associated with dissatisfaction
with the provider-patient interaction (p =.02, O.R. = 2.52).
Conclusion: Results affirm the multidimensional nature of patient satisfaction
with HIV care and suggest that different factors influence different dimensions of
care. In addition to access and quality of care, the quality of the provider-patient
interaction is an important component of patient satisfaction in this cohort, and
may be the least effective. Identifying the sources of dissatisfaction, and patient
and provider characteristics associated with it, could help to improve care for
women with HIV/AIDS.
1180*/ 12443 Discontinuation (D/C) of protease inhibitor (PI)
therapy: Reasons and risk factors
Lisa R. Hirschhorn1, Valerie E. Stone2, S.L. Boswell3. 1 Dimmock Community
Health Center, Boston, MA; 2Memorial Hospital of Rhode Island, Pawtucket, RI
02860; 3Fenway Community Health Center, Boston, MA, USA
Objective: To describe reasons, and risk factors for PI discontinuation in clinical
practice.
Methods: Multi-center study of 248 patients (pts) with HIV/AIDS receiving care
at five urban sites. Structured interviews were performed between 5/97 and 12/97
with chart review of visits between 7/96 and 12/97. Only interview data was

available at the time of abstract submission.
Results: Of the 248 pts, 151 pts reported ever taking at least one PI. Of these
pts, 32.6% were minorities, 19.9% women, and 25.2% reported IDU as their HIV
risk. Pts reported ever taking from 1 to 4 PIs (mean = 1.58) representing 239
PI exposures. 22.5% pts took ritonavir (n = 34), 62.9% indinavir (n = 95), 43%
nelfinavir (n = 65), 29.8% saquinavir (n = 45). 62 of 151 (41%) patients D/Ced
at least one PI. 28 (45.1%) received a second PI, of whom 14 (50%) D/Ced that