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

12th World AIDS Conference

Abstracts 60635-60640 1117

60635 HIV-associated diarrhea: The changing spectrum and
diagnoses
Johannes Koch, J. Maimares Schmidt, L. Baidoo, M. Keiserman, L. Kim.
University of California San Francisco, 1001 Potrero Avenue 3D, San Francisco,
CA 94110, USA
Background: The majority of patients infected with HIV report diarrhea during
the course of their illness. We conducted a retrospective study to determine if
the advent of antiretroviral therapy changed the outcome of gastroenterology (GI)
referrals for chronic diarrhea.
Methods: All patients who had endoscopic procedure(s) for HIV-associated
chronic diarrhea were identified from the endoscopic and GI clinic databases at our
large county hospital. Pathology reports were reviewed for enteric opportunistic
infection (01) diagnoses.
Results: From January 1, 1994 to December 31, 1997, 293 procedures were
performed in 179 patients. These included 153 upper endoscopies, 88 colonoscopies, and 52 flexible sigmoidoscopies. The mean (~SD) age of 171 men and
8 women was 37.0 years (16.8 SD) and median CD4 count was 72 cells/mm3.

New patients
Patients with procedure
% with AIDS
Enteric 01 on biopsy

1994 1995
171 193
79 88
94% 73%
38% (41/107) 14% (11/79)

1996 1997
219 130
71 55
78% 51%
p - 0.001

p =0.09

The proportion of patients with an AIDS defining diagnosis and chronic diarrhea
declined from 1994 to 1997, this trend approached statistical significance (p = 0.09)
Conclusion: Over the past four years, the number of patients infected with
chronic diarrhea undergoing endoscopic evaluations has declined. The proportion of patients diagnosed with an enteric opportunistic infection has fallen
precipitously. In the age of highly effective antiretroviral therapy, the nature of
HIV-associated diarrhea has changed dramatically.
S60636 A circle of care: Beyond HIV counseling and testing
Catherine O'Connor1, P. Taveiral, C.A. Patsdaughter2, C.G. Grindel2. 1East
Boston Neighborhood Health Center, 10 Gove Street, East Boston, MA 02128;
2Northeastern University, Boston MA, USA
Issue: Many HIV counseling and testing programs do not link seropositive and
seronegative individuals with comprehensive health services after testing.
Project: East Boston Neighborhood Health Center implements HIV counseling
and testing in four programs: 1. a confidential program for existing health center clients, 2. an anonymous test site serving inner city residents in the health
center catchment area, 3. a mobile unit serving six sites including district courts,
methadone maintenance clinics, and residential and outpatient substance abuse
treatment programs, 4. a health screening clinic for new immigrants. A wide range
of health and social service referrals are offered at the time of counseling and
testing by a registered nurse and senior HIV counselors.
Results: Between October 1, 1996 and September 31, 1997, 1,051 persons
were counseled, and 504 elected to test in all four programs. Nineteen (3.8%)
tested HIV positive, and all were referred to comprehensive HIV services. An
additional 102 referrals were made for 48 seronegative individuals. Referrals for
both groups were made to the following services: 27% to primary care, 20% to
mental health services, 40% to specialty medical care (i.e., gynecology, opthamology), 5% to dental services, 2% to substance abuse treatment, and 6% health
insurance enrollment.
Lessons Learned: A referral system must extend beyond mere information
provision to include case management and advocacy. Personalized referrals
ensure that newly seropositive individuals are immediately engaged in comprehensive HIV specialty care. Referrals to primary care and mental health services
for individuals at risk may help maintain their HIV negative status as well as
promote early detection and intervention in the future.
60637 Estimating program impact on HIV transmission: a
validation of the AVERT computer model
Thomas Rehle1, T. Saidel2, D. Sokol3. 1 c/o Mary O'Grady, Impact/FHI, 2101
Wilson Blvd, #700, Arlington, VA 22201; 2FHI, Arlington, VA; 3FHI, Durham, NC,
USA
Objectives: To validate the accuracy of quantitative estimates of the annual incidence of HIV infection generated by the novel AVERT model against observed
seroconversion data from a large cohort study.
Design: Deterministic spreadsheet-type model based on per sex act HIV-1
transmission probabilities.
Methods: In order to validate the AVERT model's estimates against the number of infections observed in a real life situation, we used data from a recently
completed randomized controlled trial carried out in Cameroon between March
'95 and December '96 to assess the effect of a commonly used spermicide on
HIV transmission among female sex workers in Douala and Yaounde. This study
provided detailed data on the number of sexual acts per year with clients and nonclients, corresponding levels of condom use, and estimates on the prevalence of
STDs during the study period. The HIV seroprevalence among the partners of
female sex workers was estimated from 1994 data on male blood donors from
the towns of Douala, Yaounde and Ebolowa (n = 7,148) and from 1996 data on
male military collected from 11 army bases (n = 1,052).

Results: The analysis showed that AVERT estimates of the total number of
HIV infections (73 new infections) and the annual incidence rate (6.24%) have
matched quite well the actual results observed in the trial (78 new infections and
6.67% incidence rate, respectively). In addition, separate runs with the model for
the different types of partners with whom the study subjects had sexual intercourse
during the year of observation revealed that almost 60% of the total infections in
the female sex workers were the result of sexual activity with non-clients.
Conclusion: Our comparison with actual seroincidence data from the
Cameroon trial not only confirmed the validity of the model's estimates but
also illustrated its potential to provide additional options in data analysis. The
AVERT model is a helpful tool for estimating the impact of prevention programs
and/or analyzing the effectiveness of different intervention combinations.
160638 Upgrading behavior change intervention skills on the job
Donna Flanagant, E. Serima2, N. Jamieson3, A. Pohtong4, J. Hayman5,
H. Gunadi6. 'c/o Mary O'Grady, Impact/FHI, 2101 Wilson BLvd, #700, Arlington,
VA 22201, USA; 2FHI, Harare, Zimbabwe; 3FHI, Jakarta, Indonesia; 4FHI,
Bangkok, Thailand; 5FHI, Nairobi, Kenya; 6HAPP, Manado, Indonesia
Issue: Designing and implementing behavior change interventions in HIV/STI
care and prevention projects requires communication and planning skills that are
new to many implementors.
Project: Family Health International, through its past (AIDSCAP) and current
(IMPACT) prevention projects work with more than 500 interventions, many of
which could benefit from 1) improved skills in design and implementation (e.g.,
peer education projects, care and support projects, STD management projects);
2) improved communication skills (e.g., using mass communication, pre-testing
materials, creating partnerships with the media) and 3) improved skills for policy and advocacy, and monitoring and evaluation. Lacking resources to provide
workshops, AIDSCAP developed 9 self-learning handbooks designed to increase
specific skills.
Results: The handbooks' focus on only the "need to know" made them adaptable and meaningful in a variety of cultures and situations. More than 10,000
copies of 9 small handbooks were distributed in 37 countries. In some cases, an
IEC officer introduced the handbook to the recipient who then used the handbook
as a self-learning material. In others the handbooks were simply distributed and
the user was expected to refer to them if and as necessary. In still other cases,
the handbooks were used as curriculum for more formal training or as explicit
guidelines for project development.
Lessons Learned: Handbooks that outline clear steps to take and include
things to think about and options to consider can guide the reader through a
learning-by-doing experience. Skills can be taught and/or improved through self
learning materials that are written in an easy to comprehend language and format.
However, busy implementors may not take the time to read a handbook and learn
a new skill unless encouraged to do so by project managers.
60639 Effects of the maternal HIV infection in the child
Juncal Echeverria12, J. Landa Maya2, L. Paisan Grisola3, J. Arena Ansotegui2,
V. Collado Espiga2, A. Rey Otero2, J.A. Iribarren Loyarte3. 1Hospital Aranzazu,
2Medico Adjunto, 3Jefe Seccion, San Sebastian, Spain
Objective: To know the perinatal transmission and orphanhood risk at the offspring from HIV infected mothers.
Methods: Retrospective study of the offspring of HIV infected mothers. Data
were recollected during 13 years (1984-1997) of infection evolution, before viral
load studies started. We study: vertical transmission (VT), maternal mortality (MM)
and child's age (months) at the maternal exitus time in two groups: 1). -Intravenous drug use (IVDU) infected mothers group and 2). -Heterosexual (HTS)
infected mothers group.
Results: 150 children born from 143 mothers (2 twins and 5 multiparity).
IVDU mother's group: n = 111 (77%); HTS: n = 32 (23%). Overall VT 19%; VT
from IVDU group 15.9%; VT from HTS group 33%. Overall MM 39/143 (27%);
from IVDU 28/111 (25%) and from HTS 11/32 (33%).
Child's age at the maternal exitus time from IVDU group: 53.3 ~ 41 months vs.
41 ~ 20 months in HTS group.
Conclusions: 1. - Premature maternal orphanhood increased risk in children
from HIV seropositive mothers. 2. - Maternal mortality was higher in HTS mother's
group. 3. - Age of children at mother's dead time was lower in HTS group. 4.Vertical Transmission was higher in HTS infected mother's group.
S60640 Inconsistencies in insurance coverage for HIV treatment
in New York City
Randall Harris, G. Ilaria, J. Jacobs. Center for Special Studies N. Y.
Hosp.-C.U.M.C., 140 Seventh Ave. Apt. 6-P New York, New York 10011-1840,
USA
Issue: Healthcare in New York City is funded by a patchwork of public and private

insurance plans which do not fully cover services required for the treatment of
HIV.
Project: In an urban HIV primary care clinic serving 1,100 patients, a subset
of 80 records was reviewed to determine types, adequacy and consistency of
insurance coverage and the resultant effects on patients.
Results: 34% of patients had medicaid only, 14% had ADAP HIV outpatient
coverage only, 10% had medicare and medicaid, 6% had commercial managed