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

816 Abstracts 42215-42218

12th World AIDS Conference

mean years of education was 11.97. 84% of the women reported a history of
drug abuse, of these 54% reported currently being in recovery and abstinent.
Two primary subscales were determined on the POC with eigenvalues >1.00:
Provider Attention accounted for 58.2% of the variance, Ease of Interaction accounted for 16.2% of the variance. African-Americans (mean = 2.50) reported
lower levels of satisfaction with HIV medical care than Caucasians (mean = 2.90)
(p < 0.01). Examination of the subscales also revealed lower scores among
African Americans on both the Provider Attention (p < 0.01) and the Ease of
Interaction subscales (p < 0.01). Women who reported fewer HIV symptoms
reported decreased satisfaction on the full POC (p < 0.05) and on the Provider
Attention subscale (p < 0.05). Women who reported that they were in recovery
from substance abuse reported decreased satisfaction on the Ease of Interaction
subscale only (p < 0.05). No other demographic or psychosocial variables were
associated with satisfaction with care.
Conclusions: Current HIV medical care may not meet some of the perceived
needs of African-American women, women in early disease and women who are
in recovery from substance abuse. Reasons for these outcomes may be cultural
differences between providers and patients, adverse feelings about the frequency
of care among those who are asymptomatic, and higher expectations regarding
care among those in recovery. HIV care delivery may need to be modified to
accommodate these concerns.
42215 Race, age, gender, and risk-group difference in rates of
suspicion for HIV-related tuberculosis
Charles Bennett1, Mondira Bhattacharya2, D.R.L. Lane2, R.A.W. Weinstein3,
J. Phair2, P. Yarnuld2, D. Schuwartz3, C.L.B. Bennett2. 1400 East Ontario Street,
Chicago Illinois; 2Northwestern University Medical School, Chicago;
3Rush/Presbyterian/St. Luke's Medical Ctr., Chicago, USA
Background: With the re-emergence of tuberculosis (TB) as a public health
threat, suspicion and isolation have become an important first line of defense
against nosocomial outbreaks. In many HIV-related disorders, risk factors and
sociodemographic characteristics have been shown to have an impact on quality
of care.
Methods: 106 culture-confirmed inpatient records for HIV-related TB from
seven Chicago hospitals from 1994 to 1996 were reviewed. Hospitals sampled
included a large public facility, VA hospital and several private hospitals with
significant HIV populations. TB was suspected if noted in the differential diagnosis, or if a sputum smear lab test was ordered. Hospitals were grouped into
high-experience (N = 4 inner city hospitals) and low-experience (N = 3 urban
hospitals) based on ratio of cumulative TB to PCP caseloads from 1994-1996
(0.7 versus 0.2, respectively).

Results:
Hospital Affiliated
charac- with
teristic University

Inner-city
n =69
patients
Urban
n =37
patients

Private
VA
Country
Private
For Profit
Private
Private

HIV-TB
suspicion
rate
100%
100%
94%
100%
83%
80%
70%

TB/PCP HIV-PCP
ratio cases
1994-1996
1.7 26
0.7 105
0.7 505
0.4 138
0.4 135
0.13 287
0.13 315

TB
cases
1994-1996
44
71
373
60
55
36
41

AIDS
cases
1992-1995
237
1,050
5,203
1,370
848
2,398
2,396

Patient characteristic
IDU
Gay
Black
White
Hispanic
Male
50
50
Medicaid
Private Insurance
Overall

High/low experience
(n = 69, n = 37)
98/63%
100/67%
95/80%
100/78%
100/67
98/73%
95/79%
100/67%
94/80%
100/81%
99/78%

Factor
1.55
1.49
1.18
1.28
1.49
1.34
1.20
1.49
1.17
1.23
1.30

Conclusions: While overall experience with AIDS, PUP or TB can not independently predict the difference in suspicion of TB and isolation rates, the ratio of
TB to PCP cases serves as an effective predictor for quality of care for all of the
nonprofit hospitals. The for profit hospital, despite having an experience similar
to the non profit hospitals, had a low TB suspicion rate (83%). Nonprofit hospitals
in Chicago with a high ratio of TB to PCP provide good quality of TB care.
42217 Cost and quality indicators for the analysis of a program
for the HIV/AIDS care
Rodolfo E. Quiros, W. Belloso, A. Monticelli, M. Marchetti, H. Jauregui Rueda,
H. Laolume, M. Cassini. Honorio Pueytteddon 825 6P 25 1405 Buenos Aires,
SPM Sistema de Proteccion Medica Buenos Aires, Argentina
Background: In the last two years, significant strides have been made in the
care and treatment of patients with HIV that have meant longer life spans and
a better quality of life. With the introduction of new complex combination drug
therapies, consensus has been emerging that HIV and AIDS are better treated
by the specialist. The aim of this study is to present the results of a disease
management program implemented by a Managed-Care Organization (MCO).
Methods: Since April 1997, we implemented a program to care for HIV/AIDS
patients, members of our MCO, based on a team of infectious disease specialists.
Clinical guidelines containing diagnosis algorithms, prophylactic and therapeutic
regimens were developed by consensus. Periodically rounds were performed
with the program coordinator to keep the physicians up to date. Several cost
and quality indicators were chosen in order to evaluate the program. Most of
them were adjusted for the time of follow-up, and expressed as 100 patient-days
(pd). The quality of life was assessed by an adapted and validated version of
the Brief Health Status Questionnaire (scale: 0-100). We used the Defined Daily
Dose (DDD) (Guidelines for DDD, WHO Collaborating Center for Drug Statistics
Methodology, Oslo) as a unit of measurement of antiretroviral drug utilization. The
costs are expressed as US dollars.
Results: During the study period (Apr-Dec 97), 113 patients were initially
included (3 patients died), with 20,106 days of follow-up (range 13-274 days).
Ninety-one patients (80.5%) received antiretroviral drugs with 153.96 DDD per
100 pd. The main outcome was to maintain the treated patients with undetectable
viral load and this was obtained by 31.0 days per 100 pd. Nevertheless, when the
status of all patients (treated or not) were considered, the viral load was <4 log
by 60.1 days per 100 pd. The total medical care costs were $4,169.03 per 100
pd. While, the median of quality of life score was 77.5, all patients considered
that the program satisfied their needs in more than 90%.
Conclusions: The progressive increase in the costs and complexity of the
HIV/AIDS care, require the implementation of innovative programs with the monitoring of appropriate indicators for the principal outcomes. As for other chronic
diseases, the use of adjusted rates by the time of follow-up seems necessary for
comparisons and control of quality of care in HIV infection and AIDS.
42218 "Quality of care" - its effect on the experience and
outcome of HIV positive women during pregnancy and
childbirth
Lisa O'Connor. Walden House 815 Buena Vista West San Francisco, California,
United States
Issue: In the age of major advances in technology, research and medicine, their
is not a standard of care for HIV positive pregnancy and delivery. While BAPAC
(Bay Area Perinatal AIDS Center) boasts zero seroconversion in two years (56
deliveries), many local and national clinics have been unsuccessful in stopping
mother to infant transmission even while following 076 medication guidelines.
Project: I interviewed 15 HIV Positive women who gave birth, while knowing
their HIV status, to 20 infants. The women are from four US states, diverse
ethnicities and range ages 25-41. The survey looked at the women's experience
of her providers level of judgement, support and knowledge around HIV and
asked them to rate the quality of prenatal care. It looked at several issues during
delivery, medications taken during pregnancy, labor and postpartum and then at
the infants HIV status by 6 wk/6 mo PCR. Finnaly, it asked what was most, and
least helpful about their care.
Results: 39% of the women surved received care at BAPAC. None of these
women felt judged by their providers. 100% of them felt BAPAC was knowledgable
about HIV/pregnancy and there was 0 seroconversion of infants in this group. Of
the "Non-BAPAC" patients, 40% felt judged by their providers and 41% felt their
providers were not knowledgable around HIV/Pregnancy although of this group
20% consulted doctors who were. 17% of all surveyed women transmitted HIV
to their infant. It is important to note they were all from "Non BAPAC" group and,
disturbingly, all 17% of the women took AZT as well as giving it to their infants.

Results: For 10 of the 11 patient subgroups, the ratio of suspicion of and early
isolation for TB were at least 20% better at the high-experience hospitals. For all
but 1 subgroup, less than 80% of each subgroup of TB patients were suspected
of TB and less than 85% were isolated at low-experience hospitals.
Conclusions: At high-experience hospitals, rates of suspicion of TB among
high-risk individuals have improved dramatically from 1990 rates (74%) for all
subgroups of patients based on age, race, gender, sex, and insurance, while poor
rates persist for almost all subgroups at low-experience hospitals.
S42216 1 The relation between in-hospital TB and PBP experience
and quality of HIV-related tuberculosis care
Charles Bennett 3, David Schwartz2, D.R.L. Lane3, E.A.C. Calhoun3, J. Phair3,
P. Yarnold3, M. Bhattacharya3. 1400 East Ontario Street, Chicago Illinois;
2Rush/Presbyterian/St. Luke's Medical Center, Chicago; 3Northwestern
University Medical School, Chicago, USA
Background: As tuberculosis (TB) rose to the forefront of national public health
concerns during the early years of the HIV crisis, physicians began to consider
TB more frequently as a potential diagnosis. From 1987 to 1990, suspicion of TB
in HIV patients with pulmonary disease in Chicago hospitals rose from 61% to
74%. More recent data have not been reported.
Methods: 106 culture-confirmed inpatient records for HIV-related TB from
seven Chicago hospitals from 1994 to 1996 were reviewed. Hospitals sampled
included a large public facility, VA hospital and several private hospitals with
significant HIV populations. TB was suspected if noted in the differential diagnosis, or if a sputum smear lab test was ordered. Hospitals were grouped into
high-experience (N = 4 inner city hospitals) and low-experience (N = 3 urban
hospitals) based on ratio of cumulative TB to PCP caseloads from 1994-1996
(0.7 versus 0.2, respectively).