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

12th World AIDS Conference

Abstracts 42219-42223 817

Lessons Learned: Medication alone is not enough in the prevention of mother
to infant transmission. The participants in this survey felt that the quality of care,
or lack of, was a major factor in the outcome of their infants health and HIV status,
as well as the women's experience of pregnancy and childbirth.
42219 Degree of satisfaction of patients with AIDS and
pulmonary diseases at the University Hospital Antwerp,
Belgium
Fan Yi Hu', Robert Colebunders2, V. Willaeys2, N. Debbaut3, R. Koeck3,
K. Depraetere3, E. De Droogh2. 1 Nation Alestra at 155 B-200, Antwerp; 2Institute
of Tropical Medicine, Antwerp; 3University Hospital Antwerp, Edegem, Belgium
Objective: To compare the degree of satisfaction of AIDS patients and patients
with pulmonary diseases in a mixed ward of the University Hospital Anwerp.
Study Site: B2 ward of the University Hospital Antwerp. Patients in this ward
received nursing care from the same nurses but medical care from different
physicians.
Methods: From July 1996 till July 1997 an anonymous self administered questionnaire was distributed to hospitalised patients the day before their discharge.
Results: 37 AIDS patients and 80 patients with pulmonary diseases participated in the study. The satisfaction of patients with AIDS and patients with other
diseases was very high. Persons with HIV infection were slightly more satisfied with the medical care. They reported more frequent medical visits including
more physical examinations and visits of longer duration than patients with other
diseases. The degree of satisfaction with nursing care was the same. Persons
with HIV infection were slightly more demanding. A larger percentage of them
preferred to be hospitalised in a single room. They wanted to see a physician
every day, including during the weekend, and requested more detailed information
concerning their health status than other patients.
Conclusions: Because of a highly motivated hospital staff the satisfaction of
persons with HIV infection at the University Hospital Antwerp with medical and
nursing care was very high. Hospitalised AIDS patients may be slightly more
demanding compared with patients with other diseases.
S42220 From the hospital to shelter for AIDS patients: Methods
of integration and assessment of quality of life
Gabriele Codini, L. Doniseti, F. Sbatella, M. Galli, M. Granelli. Via S. Pellico 1,
Milano; 2Municipality of Milan, Milan; 3Catholic University Milan; 4Medical
University, Milan; 5Caritas Ambrosiana, Milan, Italy
Objectives: The research aims at providing the scientific material and an assessment of projects implemented to date both to facilitate the processes of
integration within the communities and evaluate the answers required for a better
quality of life in shelters for AIDS patients. The work has been performed by
the associations based in Milan, by the Municipality of Milan and by the hospital
infectious diseases departments in order to study the medical problems of the
patients applying for communities. In 1998 a joint (with Madrid and Munich),
EU-funded research project started.
Methods: The two year research has identified the criteria for evaluating conditions/characteristics of applicants, and the quality of life of people living in the
shelters. The work of a municipal social secretariat (which prepared the procedures for better integration of those concerned) was studied as well. Together
with the social and psychological difficulties of running the communities, the
medical problems which may cause slower and more difficult integration were
also researched. A research project was instituted in two Milanese Hospitals
into the characteristics of patients hospitalised over a defined period of time
and the outcome of this hospitalisation, focusing on the difficulties of discharging
patients due to the delay in including them in extramoenia treatment programmes
(communities and home care).
Results: The research into admission considered 123 patients admitted from
January to March 1997 in the two hospital departments. According to the analysis of the procedures it was found that for 18.7% of patient's discharge was
delayed due to the difficulty in finding housing or assignment of home care. The
research on shelters have analyzed characteristics of applicants - characteristics
of guests - quality of life - factor influencing quality of life. During the congress
the conclusive data of the two researches, continued in 1998, will be presented
and a comparison made with the other two European cities of Madrid and Munich
(working group additional component: Corsi L., Omodei C., Granata Rovedo V.,
Zaniboni M., Palermo R., Moioli M.C., Ravasio L., Caggese L., Moroni M.).
Conclusion: A range of indicators, tests for analising the quality of life have
been produced and tested in the shelters. Psychiatric and clinical problems appear
to be the main cause of delays in shelters admission. Homeless, transsexuals,
foreigners and those who have not already in AIDS but suffering severe diseases
have been discovered most difficult to receive adeguate extra moenia assistance.
Research project funded by the Board of the Ministry of health, Social Plan I
and II, and by the European Community.

42221 Improving quality of care for sexually transmitted
infections - Methodological issues
Saiqa Mullick', M. Colvin2, Q. Abdool Karim2. 1771 Umbilo Road, Congella,
4013 Durban; 2 Medical Research Council Durban, South Africa
Issues: Quality of care needs to be measured and monitored over time, however,
there are universal problems with assessing quality of care in any setting. Varied

perceptions, lack of a standard definition of what quality of care means and multiple levels at which it can be assessed make measurement difficult. In resource
limited settings, such as South Africa, where routine data is poor, notification
systems ineffective, standard national guidelines and definitions for management
absent and large numbers of people seek health care from traditional healers,
the problems of measuring quality of care are compounded.
Project: The 1997 National HIV/AIDS & STI Review in South Africa identified
the need for quantitative assessment of the quality of care provided to patients
with a sexually transmitted infections (STI). Subsequently, a plan to monitor and
evaluate the National HIV/AIDS and STI programme was drawn up and the issue
of quality of care for STIs addressed.
Results: After a review of various methods, relatively cheap methods such
as record review, pharmacy prescription review, inventory of drugs and supplies,
the use of simulated patients and interviews with key informants have been
proposed to assess the quality of care given to STI patients. These methods are
advantageous in that they are not reliant on good quality routine data or efficient
notification systems and do not require specialist skills or resource intensive
studies to carry. out. Data collection by these methods can be simple and yet
provide important information on the nature and magnitude of problems in the
quality of care for STIs.
Lessons learned: Improving access to and quality of STI services are imperative to impact not only on HIV transmission and other STI related complications but
also on health seeking behaviours. The approaches proposed here to measure
quality of care are feasible to implement in resource limited settings.
42222 Role of the social workers in the health care for drug
users and HIV infected people in Ukraine
Natalia Lukyaniva, S. Lukashov, N.B. Pidlisna. 5A Demiyivskiy Side Alley
252039 Kiev, Ukraine
Social workers is a new profession in the health care of Ukraine. Some years ago
the responsibilities of the social workers lied on the physicians, nurses and psychologists. At present a lot of medical and social institutes look for the professional
social workers. The main professional values of social work as confidentiality and
trusting relationships have the great meaning for working with drug users and HIV
infected people.
Main Objectives: Increase the health care quality of Ukrainian Treatment Centers for Drug Addicts with the active participation of the social workers in the area
of early intervention and rehabilitation.
Methodology: The main contacts with the addicts must be established through
the social or outreach workers who can come to drug addicts environment and get
trust from them. The supervising, the individual interviews, the dissemination of
prevention materials, the surveys and conversations give main information about
the behavior features of the HIV infected drug users, about social needs of these
target groups. The social workers must be active in primary and secondary prevention, have the basic knowledge and skills in individual and group work, skills
of psychosocial support of HIV infected people and their relatives, representation
and protection the interest of their clients in public and private sectors.
Results: (a) More clients involvement to the treatment process.
(b) Providing the different models of psychosocial support and rehabilitation of
the clients.
(c) Introducing the drug users and HIV infected people to the social work
Conclusions: This work gives the possibility to improve the quality assistance
for the drug users and HIV infected people in the medical and social institutes by
organizing the network of social workers. It has promotional effect for development
of the social work in Ukrainian health care.
42223 Improving the ethics of HIV clinical research
Maggie Atkinson', G. Robinson'. 'AIDS Action Now! 517 College Street
Toronto, Ontario, Canada
Issue: New treatment options for HIV infection have made both treatment decisions and clinical trial design far more complex. As more people with HIV/AIDS
have become involved in treatment activism, they have begun to criticize the
ethics of HIV clinical research.
Project: The authors examine the ethical issues in clinical research based on
their experience as AIDS advocates and make recommendations to improve the
ethics of HIV clinical research. The authors draw on their participation on various
scientific, ethics review, and community advisory committees.
Results: As the standard of care has so rapidly evolved so too must HIV clinical
research. Researchers, pharmaceutical companies, and government regulators
can benefit from the imput of the HIV community. The lived experience that
people with HIV have is essential to a true analysis of the ethics of research
in this community. Too often the founding principles of research ethics set out
in documents such as the Helsinki Declaration and the Geneva Convention are
ignored in the practice of HIV clinical research. Research ethics issues may be
looked at under two main headings: infrastructural and scientific. Under "infrastructural", some of the issues are: the drug approval process; compassionate

and expanded access programs; drug access before and after licensing; drug
pricing; observational databases; community involvement and community-based
research. Under "scientific": the consent process; trial design and implementation;
stopping rules; responsibility to maintain the ethics of an ongoing trial; implications
of resistance for phase I safety trials; standards of care in control arms; requirement of equipoise in all arms; defining treatment failure with real-time surrogate
marker results; and post -marketing studies.