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

12th World AIDS Conference

Abstracts 12458-13103 105

S12458 Developing appropriate quality of life monitoring tool -
An issue for PHA empowerment
Lesley Ann Sinclair', Kit Yee Wong', Yuet Ming Lee1, Wai Kaan Wong2. 1The
Society for AIDS Care, Unit 18A Winning Centre, 46-48 Wyndham Street
Central, 2AIDS Concern, Hong Kong (China)
Issue: The Development of a Quality of life monitoring tool from client focused
parameters, incorporating a holistic, longitudinal perspective.
Project: Given the changing management of client care, through pharmacological intervention and disease understanding, an intervention aimed at quality
of life for people living with HIV or AIDS (PHA). To enhance the empowerment
of PHA's, the project will return knowledge to clients from a retrospective point
of view, monitoring the course of their perceptions and coping. Current Quality
of Life (QOL) tools can focus on clinical outcomes or medically related issues of
importance rather than client perceived issues of importance. This tool therefore
hopes to accommodate personal outcome. This is achieved through case history and recording understanding of health, insight into wellbeing, recovery and
medication commencement/alteration. QOL tools such as AIDS Time Orientated
Health Outcome/Multidimensional Index of Life Quality for HIV are reviewed to
develop the proposed Individualized QOL monitoring tool.
With the proposed QOL assessment tool, PHA's will be able to monitor their
own well being. From the point of view of Health care workers, they will be able
to increase partnership of care and assist in delivery of appropriate and timely
interventions.
Lessons Learnt: Self monitoring QOL by PHA's themselves is an empowering
process.
12459 "Hide and seek" games in the experienced of people
living with HIV/AIDS
Pranned Songwathana. Faculty of Nursing, Prince of Songkla Uni., Hatyai
Songkla 90112, Thailand
Objective: To explore the health seeking behaviours of people living with
HIV/AIDS in southern Thailand
Design: Ethnographic study
Methods: 15 patients and 20 primary caregivers recruited from hospital and
villages of Hatyai District, Songkla Province were participated in in-depth interviews and participant obervation including several visits at home, clinic, temple
and other places which patients went for treatment.
Results: Three important stages of health seeking behaviour are described. Patients have several thoughts about the cause of illness which affect help-seeking
behaviour and treatment. Self-treatment and seeking information occur during the
assessment stage in an attempt to improve their health. At the diagnostic stage,
people's response to diagnosis vary depending upon their illness experiences,
doctor-patient communication, and their decision to disclose HIV status to others.
Knowing the diagnosis at the same time can help both patients and families to
cope with better understanding of illness and accepting care. Because they fear
the social condition they have to bear if illness is disclosed, the responses to the
diagnosis and several models of health seeking are experienced within a "hide
and seek" game throughout the trajectory of illness. The most important aspect
of the sick-role experience is that the wide range of healing options, both Thai
tradition and biomedical, were employed with regardless of cost.
S13101 International program for quality assurance and
standardization for immunological measures relevant to
HIV/AIDS: QASI program for CD4 testing
John L. Fahey1, F.F. Mandy2, J. Bradley3. Cirid at UCLA, Microbiology &
Immunology, Box 951747, Los Angeles, CA, USA; 2Bureau of HIV/AIDS, Health
Canada, Ottawa, Canada; 3Flinders Medical Center, Adelaide, Australia
Issue: Inexpensive CD4 T cell proficiency testing programs are needed to assure
reproducible and comparable measurements. Measurements of CD4 T cell levels
are essential to assessment of disease course because most of the course of HIV
infection is asymptomatic. Quantitative CD4 T cell testing has proved essential for
clinical staging, for epidemiologic studies and for decisions regarding prophylactic
therapies for opportunistic infections. Quality assurance and proficiency testing
programs of national or regional scope are important means to assure the reliability and value of CD4 T cell measurements. Satisfactory performance in CD4
T cell proficiency testing programs is required or recommended for HIV research
and care programs in North America, Australia and many parts of Europe.
Project: The QASI program was established in 1997 to meet proficiency testing
needs in countries where this service is not available. It is supported by agencies
in Canada, Australia, and the USA and several international organizations. Stabilized blood samples are sent on a regular basis to participating laboratories. Flow
cytometric results on CD4, CD8 and CD3 levels are reported to the Reference
Center which collates the data and reports to all laboratories on the pooled values.
Data from individual laboratories are confidential. These test samples are made
available at no cost to the recipient laboratory.

Results: Shipments of samples were made in May and in September 1997
to 50 laboratories in the Asia-Pacific region, Latin America and Africa. Some
laboratories differed substantially from the larger median group. This experience
and issues that arise during conduct of proficiency programs will be discussed.
Conclusions: The QASI program for quality assurance and proficiency testing
of CD4 (as well as CD8 and CD3) T cell measurements by flow cytometry is
available for all countries needing this assistance. Ministries, institutions and

laboratories concerned with evaluation of HIV disease in patients are invited
to participate. Contact John L. Fahey, M.D., Dept. Microbiology & Immunology,
UCLA School of Medicine, Los Angeles, CA 90095-1747, Fax: [phone],
E-mail: [email protected]
S13102 Relentless rises and discrete declines of the world HIV
epidemics
Daniel Tarantola1, B. Schwartlander2, P. Lamptey3. 1Harvard School of Public
Health FXB Center 651 Huntington Avenue Boston MA 02115; 3lmpact-Family
Health International Arlington VA, USA; 2UNAIDS Geneva, Switzerland
Objectives: To analyze global trends of HIV epidemics and highlight factors
that influence their relentless rises, their sudden explosive nature and, in some
populations, their discrete declines.
Method: HIV epidemics around the world have become increasingly diverse
and fragmented. Created in 1996 by the AIDSCAP Project of Family Health
International, the Franqois-Xavier Bagnoud Center for Health and Human Rights
of the Harvard School of Public Health and UNAIDS, the Monitoring the AIDS
Pandemic (MAP) Network has produced widely disseminated analytical reports
on the regional and global status and trends of HIV epidemics. Issues currently
studied by MAP include the differentiation of HIV epidemics over time and across
populations, factors influencing the dynamics of HIV spread, the magnitude of
current epidemics and their impact, and the forecast of future trends.
Results: UNAIDS and WHO estimated that, by the end of 1997, over 30 million
adults and children were living with HIV around the world, more than 90 percent
of whom were in developing countries. While estimates for several countries in
Africa have been significantly raised in 1997, they remain conservative. In several
countries in this region, declines in HIV incidence and prevalence among young
people, correlated with behavior change, continue to be documented. Asia and
the Pacific projects a picture of great disparity. While countries such as India,
Thailand, Myanmar and Cambodia are severely affected, the sudden occurrence
of extensive, large-scale HIV epidemics is less likely in others. If the great diversity
of HIV epidemics within Latin America and the Caribbean is suggested by the
analysis of reported AIDS cases, the lack of information on HIV seroprevalence or
incidence limits severely the understanding of current dynamics of HIV, and even
more their forecast. Eastern Europe experiences sharp rises in HIV prevalence in
IDUs and their sexual partners. In Western Europe and North America, epidemics
are clustering in populations with inadequate access to health and social services.
Population mobility, economic disparity, gender, the prevalence and patterns of
sex work and health practices strongly influence the potential for HIV spread.
Conclusion: The dynamics and differentiation of the HIV epidemics around
the world must be monitored more efficiently through combined epidemiological
and behavioral surveillance required to guide and monitor the world response
to HIV/AIDS. A synthesis of the conclusions of the MAP symposium, to be
held immediately prior to the conference, will underscore the key features and
determinants of current and projected HIV epidemics.
S13103 Surveillance for group 0 HIV-1 infections among
African-born HIV infected persons in the United States,
1995-1997
Patrick Sullivan1, A.N. Do2, R. Lal2, C. Tetteh2. 1Centers for Disease
Control/Prevention, Atlanta, GA; 2CDC, Atlanta, GA, USA
Background: Different subtypes of HIV-1 predominate in different areas of the
world. Most HIV infections in the United States are caused by group M, subtype
B HIV-1. Non-B HIV-1 subtypes may present problems in the diagnosis of HIV
infection by enzyme immunoassay (e.g., group 0 HIV-1), in quantification of HIV
RNA concentration by polymerase chain reaction (e.g., subtypes A, E, F, and G),
and in detection of recent HIV infections (subtypes A, E, and G).
Methods: Persons in the United States who had been reported to the national
HIV/AIDS Reporting System (HARS) with HIV infection or AIDS through 1 Jan
1997, and who were born in an African country where group O infection had
been reported or in countries bordering Cameroon (where the highest prevalence
of group O has been reported) were considered at increased risk for group O
infection, were contacted by state and local health departments, and were asked
to give blood for analysis of HIV subtype by peptide specific serology and genetic
sequence analysis.
Results: Nationally, 156 patients were identified in HARS as at increased risk
for HIV-1 group O infection. As of 31 Dec 1997, 52 have died, 43 were lost to
followup, 8 refused participation, 17 are still being investigated, and 36 patients
have given samples. Of these 36, 2 patients were infected with group O HIV-1,
14 patients were infected with subtype A, 6 with subtype B, 9 with subtype C, 1
with subtype D, 1 with subtype G, and 3 with nontypable, non-group-O strains.
Conclusions: Even in areas of the world where subtype B HIV-1 is highly
prevalent, persons may have HIV strains typical of their country of birth. Among
persons at high risk for HIV-1 group O infection in the US, over 80% are infected with non-B subtypes of HIV-1. Subtype A was most common. Health care
providers should consider the possibility of infection with non-B strains of HIV

when interpreting the results of screening tests for HIV infection and viral load
determinations in HIV-seropositive persons who may have been infected abroad.