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

12th World AIDS Conference

Abstracts 22444-22449 353

use of local beans, soybean, fermented food products with crayfish were used
to increase their protein intake. A minimum of 500 g increase in weight gain was
recorded.
Conclusion: Body weight loss of PLWHA or HIV Positive persons can be
prevented if nutritional and health management care are implemented as soon
as the individual is conformed HIV positive. The use of nutritious locally available
foodstuffs that will restore, maintain and promote optimal nutritional status among
PLWHA in Subsaharan African Region is a challenge on parts health personnel.
It requires commitments, dedication and selfless services to people who need
empathy and not isolation or pity.
F 22444 Neurologic disease's impact in people with AIDS
receiving home health care on Brazil
Ronaldo Hallal, Simone Avila, 1.0. Freitas, D.P. Tremper, D.R. Pilz, M. Lavx,
M.G. Labrea. Secretaria Municipal Saude/Min. Sau, Av Mariland Gouyo, Porto
Alegre, RS, Brazil
Objectives: to present the incidence of neurologic diseases and the manifestations in the home health care (HHC) service and show the importance to have a
multidisciplinar team in the home care.
Methods: a retrospective study of the data registered in the service, in the time
between june 96 and january 98.
Results: in 50 patients receiving home care in the period, 21 (42%) had
neurologic diseases: neurotoxoplasmosis (7), leukoencephalopatya multifocal
progressive (LEP) (4), criptococcosis in the central nervous system (CNS) (7),
dementia complex (3) and others. Some patients had 2 or more concomitant diseases in the CNS. The signals and symptoms more frequents were: hemiparesis
(6), dementia (4), dizziness (2), coma (3), mielopathy (3), comport alteration (2),
neuritis and focal convulsion one case. The media in the Karnofsky's score was
around 40%. The media of the permanence time in the home care service to
neurologic patientes was 95 days (1-309 days), has been 83 days with 8 deaths
until July/97, and 101 days without deaths in the period between August/97 until
January/98.
Conclusions: the high incidence of neurologic patients recevieng home health
care is coincident with the literature data. The important reduction in the deaths
and the higher permanence after july/97 show the cronic characteristics that the
disease has been presented and show that HHC is a important strategy to care
the people with AIDS. Is necessary have a multidisciplinar team taking home care
in AIDS patients and them families.
22445 Impact of the new antiviral therapies in persons with
AIDS and the new roles of home care assistance
Armando Cancelli1, F. Fenianos2, F. Denim2, L. Ceccarini2, A. Salanitro3,
G. Milanese3, G. Rocchi3. 1 Via F Antolisei 25 00173, Rome; 2Cooperativa Osa,
Rome; 3University Tor Vergata, Rome, Italy
Objective: The clinical improvement of Persons with AIDS (PwA) which has been
constant in the 1997 is due to the new antiviral drugs used for the therapy of
AIDS since the late 1996. We conducted a retrospective study to quantify this
improvement on the quality of life of PwA followed in Home Care (HC) and to
determine the impact of these therapies on the type of interventions provided by
a multidisciplinary HC service in the urban area of Rome, Italy.
Materials and Methods: We compared four indices (weight gain, Karnofsky
scale, i.v. therapies, no. of hours/week spent in medical/nursing activities) in a
cohort of 36 PwA (24 males, 12 females; mean age: 40 years;) followed in HC
before and after at least 6 months (median 11 months) of therapy with at least
two new antiviral drugs- non-nucleoside reverse transcriptase inhibitors (NNRTIs)
and Protease inhibitors (PIs)-.
Results: The median weight gain was 14 Kg. The maximum increase was
observed in PwA with Wasting Syndrome while in PwA with cirrhosis this was
markedly reduced (median 2 Kg). Starting from a median baseline of 50 points
on the Karnofsky scale, all our patients reached at least 80 points. 29 PwA (80%)
were on i.v. therapies, among which 14 PwA (48.2%) stopped completely i.v. therapies and were divided as following: 7 on nutritional support, 3 on gancyclovir.
3 on long-term antibiotics suppression, 1 on acyclovir; 3 PwA (10.3%) reduced
by 50% the weekly i.v. drug administration for CMV suppression; 12 PwA (42%)
maintained their i.v. regimen but the no. of hours/week spent for medical/nursing
was reduced by 30%.
Conclusions: After 6 months of therapy with new antiviral drugs we observed
an improvement of the quality of life in a cohort of PwA followed in HC and a
change in their medical/nursing needs. In the future, the role of the HC must be
revised to provide more counselling, prevention, and medical surveillance. HC
is also useful in PwA with neoplastic diseases and neurologic deficencies who
needs long term medical assistance in order to shorten the hospital stays.
22446 Home care a challenge to community nursing
Domitilla Odongo-Aginya. S. T.D./AIDS Control Programme, PO. Box 8, Entebbe,

Uganda
Issue: Adequate community mobilization on AIDS care enhances appropriate
utilization of available resources in the community.
Project: Training of Community AIDS Care Providers (CACPs) was initiated
by STD/AIDS Control Programme-Ministry of Health to strengthen community
capacity in the care of people living with AIDS (PWAs) in the home. The training is

conducted at sub-county level and focuses on equipping Community AIDS Care
Providers (CACPs) with basic Nursing and Counselling skills, Home visiting practices, Nutrition and Management of common AIDS related conditions in home.
The aim of the project is to ensure continuity of comprehensive care for PWAs
and their families who live in rural communities where health infrastructure are
hampered.
Lesson Learned: Potential Care Providers should be selected by Mobilized
Parish Development Committee to ensure availability and accessibility of Home
Care Services for PWAs and their families in the community. This will ensure
sustainability of the Project.
22447 Development of self-care model for persons with
HIV/AIDS
Pikul Nantachaipan1, M.S. Hanucharurnkul Somchit2, M.R. Phongphit Seri3,
Srisuphan Wichit4. 1Faculty of Nursing, Chiangmai University; 2Mahidol
Univeristy, Bangkok; 3UNAIDS: Asia-Pacific Intercountry Team, Bangkok;
4Chiangmai University, Chaingmai, Thailand
Issue: Persons with HIV/AIDS and their families need appropriate intervention to
improve their self-care ability and quality of life.
Project: This action research aimed at developing a model for promoting self-care among 60 persons living with HIV/AIDS in Northern Thailand. To enhance
home-based care, clinical services and home visits were performed by the nurse
investigator 1-6 times a month for 3-6 months consecutively. The intervention
process relied on mutual collaboration between the researcher and HIV infected
persons as well as their families.
Results: The qualitative data revealed six major nursing roles, namely, management of physical and mental illness; monitoring and ensuring the quality of
health care practices; management of changing situations; organizing self-care
system; educating persons on how to live with AIDS; and collaboration with
other significant persons. Although eighteen persons had severe illness and died,
results of the study revealed the favourable effects of the intervention. Both qualitative and quanitative data indicated that after participating in this study program,
subjects had improved ability in self-care practices, had fewer symptoms, and had
better quality of life than before entering into the program. The data obtained from
the questionnaires also indicated that these effects could be seen significantly
after only 1-2 months of the participation and could be sustained for up to 6
months.
Lessons Learned: Home visiting appeared to be an appropriate method in
promoting home-based care for HIV infected persons. The health care service
using a combination of clinical services and home visits can be conducted by
nurse personnel to promote holistic care.
22448 An initiative to strengthen home based care
Prakash Bora1, A.P. Bora2. 1212 Shivam R Narkar Rd, Pantnagar Ghatkopar(E),
Mumbai; 2 HIV/AIDS I & G Centre Pantnagar Mumbai-400075, India
Issue: To explore and utilise potential of the family as care giver and to motivate
them for active participation in home based care.
Project: During the course of his illness a person suffering from AIDS may
move from home to the hospital and back again. It is essential to motivate extended family members to actively participate in care of the patients at home. To
encourage their participation, an innovative step was taken. Home Care Kit was
developed and devised. It consisted of a urine pot, bleaching powder, napkins,
disposable syringes, needles, gloves, dressing material, antiseptic lotions and
cream, nutritional supplements, routine medicines, disposable bags, mouth wash
and literature in the local languages. 100 HIV - positive patients and their family
members were trained and given instructions regarding the use of different items
in the kit. Accompanied literature in local language included practical instructions
regarding diet, lifestyle and precautions.
Results: It was observed that there was improved participation of family with
Home care Kit. It increased willingness to keep the patient at home and there
were lesser visits to hospital in 46% of patients. 62% of families went for refilling
the contents of the kit indicating the acceptance of the kit. It helped in emphasising
the precautions to be taken and empowering them in home care skills.
Lessons Learned: Home Care Kit motivated the family members and encouraged their active participation. There was satisfactory response and acceptance
of Home care kit concept which can be replicated. Initiative of PLWA support
group should be complemented with innovative ideas such as Home Care Kit.
22449 1 Home care in the highly active antiretroviral therapy
(HAART) era
Maria Leticia Cruz1, H.S. Martins2, J.A. Menezes2. iAv. Afranio de Melo Franco,
85/202 Leblon; 2Hospital Dos Servidores Do Estado, Rio de Janeiro, RJ, Brazil
Issues: novel therapeutic approaches for HIV infection led to a change in the
scope of home care in urban centers like Rio de Janeiro. We reassessed the
objectives and possibilities of this modality of assistance in the light of HAART.

Project: our home care service is set in a large non-university hospital in
downtown Rio de Janeiro. In 1997 two important objectives were incorporated to
our program: to reinforce adherence to the new antiretroviral drug combinations
in public health units and to support the vertical transmission prevention program.
In the 1st case, home care staff acted by close supervision and early intervention
whenever clinical and emotional conditions threatened continuity of treatment in