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

354 Abstracts 22450-22454

12th World AIDS Conference

patients with advanced disease. As to vertical transmission prevention, mothers
and their newborn babies were followed at home during the 1st 6 weeks after
childbirth to ensure correct administration of zidovudine suspension and adequate
bottlefeeding.
Results: as to advanced-stage disease patients, results were excellent, with
several discharges from home care, confirming the importance of home care
teams in adherence to HAART. As to mothers and newborn babies social and
family problems hampered effectiveness of home care approach: many women
feared their families and neighbours learned about their seropositive status. We
then switched them to an outpatient modality.
Lessons Learned: Home care can be effective in ensuring adherence to
HAART in patients with advanced disease. Discharge from home care is one of
the new features brought by HAART. HIV-infected women have family and social
peculiarities that have to be considered when planning specific strategies and
follow-up for the prevention of vertical transmission.
122450 Home based care: The partnership
Lorna Scheepers. 14 Texas Ave Colorado Park Mitchellsplain Capetown South
Africa, South Africa
Objective: To deliver effective, equitable home based care to the frail and infirm
living in the Metropole Region of the Western Cape.
Background: Home based care has never been a function of the Health Department and was traditionally delivered by non governmental (N.G.O.'S). These
organisations' service delivery was however often needs driven from an N.G.O'S
perspective and not necessarily needs driven from the community's perspective.
This resulted in some areas being over serviced, and other areas lacking services.
N.G.O'S were also struggling financially and fighting for survival and therefore
there was hardly any co-ordination between these N.G.O'S. This resulted in
overlapping and ineffectiveness.
Method: Workshops and plenery sessions were held with relevant N.G.O's.
Issues under discussion were: The co-ordination of services, the geographical
layout of N.G.O'S, implementing a data base, sustainability of the organisations,
viability of the project, the role of the department and subsidization of N.G.O'S.
An operational plan with fixed time frames were also drawn up.
Result: By forming partnerships with N.G.O'S to deliver home based care on
behalf of the department and supporting them financially, the department could,
in a cost effective way reach their objective.
22451 Infective complications in AIDS patients with tunneled
Groshong catheter
M.G. Pravettoni, P. Marinoni, R. Capra, F. Maggiolo, F. Suter. General Hospital,
Busto Arsizio, Italy
In the last stage of HIV infection a permanent intravenous access is often required
for long-term therapy of HIV-related opportunistic manifestations such as HCMV
or Candida infections, malignant tumors or for parenteral nutrition. Groshong
catheters are permanent, tunneled, central catheters that allow a simple use also
by home-care nurse teams, without causing any distress to the patient. We report
our experience with 39 patients (22 males and 17 females; mean age 34.8 years),
CDC stage IV with CD4 T-cell mean count of 18 cells/mcl that required positioning
of the catheter for HCMV end organ disease (36 patients), neoplasm, candidosis
and nutrition (1 patient each). Catheters were in place for an average of 177 ~ 163
days, for a total of 6933 days of catheter use. Five patients (12.8%) developed a
systemic infection (infection rate of 0.072 per 100 catheter/days). Infections were
due to S. aureus (3 cases) and to P maltophilia and E. cloacae (1 each). Gram
positive infections required antibiotic treatment and catheter removal, while Gram
negative infections were cured with antibiotic treatment alone. All infections but
one occurred at least 6 months after catheter insertion. Three patients presented
cutaneous infections at the exit site that responded to local medications.
infection
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60o --

Project: SHALOM (Society for HIV/AIDS and Lifeline Operation in Manipur)
is a community based health organization whose overall goal is to reduce HIV
transmission and the impact of AIDS in an already high HIV prevalent community.
Services provided by SHALOM include community education, confidential HIV
testing, home-based care, advocacy, harm reducation and research. With the
outbreak of ethnic war between the two major communities in Churachandpur
from June 1997, SHALOM staff have had to adopt new strategies such as opening
drop-in-centres in sensitive areas, recruiting new staff from neutral (uninvolved)
ethnic groups, stationing some staff in safe zones and developing a new policy of
vehicle use including transportation of clients.
Results: During the last 6 months (July-December 1997), with extra efforts
and precautionary measures, SHALOM have treated 564 patients mostly IDUs
suffering from various HIV related and drug related illnesses, overcoming the
barriers of well demarcated boundaries between the warring groups. During the
above period 27 clients died of HIV diseases including AIDS.
Lessons Learned: HIV spread is accelerated by war which also eclipses the
gravity of the problem. In short HIV issue can no longer be a priority for both
the government and the common people. More tact, patience, courtesy and
commitment is required on the part of SHALOM staff especially care providers in
HIV/AIDS prevention and care services in war condition.
22453 Oral health in the home care for HIV/AIDS patients:
A pioneer work in Brazil
Regina Celia Rissi1'2, A.C. Rissi2, J.N. Lima2, M.C. Ilario2. Rua Dona Libinia
1941 AP14 Campinas - SP ZC 13.015-090; 2Prefeitura Municipal de Campinas,
Campinas SP, Brazil
Issue: Patients with HIV/AIDS in Brazil find difficulty in obtaining odontological
treatment during the evolution of their pathology once there are few services
wich count on an Oral Health clinic. In the case of home patients, the problem is
aggravated by their clinic and physical limitations. Those patients lack: 1) Information on Oral Hygienics and Physiotherapy and diet, with consequent increase
of the incidence of caries and periodontal diseases; 2)lnformation on STD/AIDS
and their relation with Odontology; 3)Maintenance of Oral Health. It is important
to value the diagnosis and the precocious treatment of oral manifestation.
Project: Odontology develops a preventive and curative approach, together
with a multiprofessinal team, with the following activities: 1)Non-specific activities:
support to patients, education and health, team meetings. 2)Specific activities:
a)Anemnesis; b)Detailed Oral Examination aiming the precocious diagnosis and
the treatment of the oral pathologies; c)Prevention: instruction on brushing, fluorine and diet; motivation for Oral Hygienics and Physiotherapy; guidance on oral
health extended to the family and community of the patient; production of specific
educational material: leaflets, booklets on brushing, movies on brushing technics
and motivation of the patient; d)Curative Treatment: home care: periodontics,
dentistics, minor oral surgery; and fowarding to clinic care. The patient is offered
whole care and periodical maintenance.
Results: We have observed that in the course of one year, 35 patients were
examined and observed in their respective homes and that they presented 100%
of gum diseases and 80% of teeth caries. At the end of the period, those rates
decreased to 40% and 20%, respectively. 8 biopsies were made in the oral tissues
of those patients. The most common pathologies were: oral candidiasis (90%),
hairy leukoplakia (50%), inespecific athous ulcer (40%) and KS (5%). There was
a great improvement of the family and community in the patient treatment. The
improvement of the Oral Health and its maintenance are now goals of the patient
him/herself.
Conclusion: Brazil has invested a lot in the implantation of the Home Care
services, but our team is the only one which includes a Surgeon-Dentist, which
has turned us into national reference for this matter. At the patients home we have
the advantage of evaluating and monitoring the adopted prevention technics, of
providing them information on STD/AIDS, of providing education on health, of
offering curative treatment to patients wich contributes to the improvement of
the life quality and consequent increase of the self-esteem of the patient, thus
reinforcing the importance of the Odontologist in the team of Home Care.
S22454 The Rio Buddy Project: Making a difference for gay PWAs
Ezio T. Santos-Filho1, R.M. De Lima1, A.V. Menezes1, R.S. Ramos1, W. Den
Uijl2, H.I.F. De Albuquerque1, C.N. Silva2. 1Grupo Pela Vidda/RJ; 2Grupo
Arco-iris, Rio De Janiero, RJ; Sad-Schorerstchting, Amsterdam, The
Netherlands
Problem: People living with AIDS in Brazil did not count with any help care
service focusing gay issues. To settle a project in this field, two basic problems
were identified: 1) the difficulty to organize a long term community help care
service on a volunteer basis in Brazil; 2) the challenge to organize a service that
would not only help people to die, but mostly could help people living with AIDS
to reassume their normal lives.
Project: Since gay men represent 31.5% of the AIDS' accumulated cases in
the State of Rio de Janeiro until September 1997, the project targeted 60 gay

individuals (clients) in its pilot phase. Partnerships (both technical and practical)
in this sense were made to reach the necessary skills to implement the service.
A committed professional coordination was settled. The training was organized
to focus gay life specificities, to respect to the client's choices and standards and
to help him to recover and reassume his life with the perspective of normality,
considering the natural limitations of the disease.

40i
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days

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Implanted tunneled catheters are a safe device in patients with AIDS.
S22452 Strategies for providing HIV/AIDS prevention and care
services in armed conflict situation
Vanlalmuana Pachuau1, J.L. Tusing2, C. Tungnung3, S.B. Gangte4. 1Eden
Street Churachandpur, Manipur; 2Comunity Educator Shalom, Churachandpur,
Manipur; 3Clinician Shalom, Churachandpur, Manipur; 4Programme Coordinator
Shalom, Churachandpur, Manipur, India
Issue: A community torn apart by ongoing ethnic war requires modified strategies
in HIV prevention and care services.