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

834 Abstracts 42254-42305

12th World AIDS Conference

Women reported better relationships with providers, while African Americans
and Latinos reported more difficulty, more discrimination, and less satisfaction.
Respondents with histories of crack and/or heroin use also reported difficulties in
relationships with providers. Access to care variables were consistently related
to better cognitive functioning. Better relationships with providers was positively
associated with emotional well-being and perceived health. Sicker patients said
they had to wait longer and spent less time with providers.
Conclusions: Overall patients reported high satisfaction and few problems
with HIV treatment and monitoring. However, ethnic minorities, substance users,
and people with cognitive deficits or functional impairments seemed to have more
difficulties, and may be particularly vulnerable to changes that occur with the
advent of managed care.
42302 Access to treatment/care in Venezuela's social security
system void
Feliciano Reyna Ganteaume. Calle La Cinta Edificio Concepcion Apartamento 1
Las Mercedes Caracas, Venezuela
Issue: How can an NGO provide access to treatment in a country where the
Social Security System is near bankruptcy and has to be sued every time a new
group of people needs antirretroviral drugs.
Project: Acci6n Solidaria, a Venezuelan NGO, has already gathered 84 people
to donate funds on a monthly basis, through automatic fixed charges to their credit
cards, in order to provide regular access to antirretroviral drugs to HIV+ patients.
In a permanent fund-raising campaign, Accion Solidaria approaches individuals
to have them join the programme. The credit card system allows us to count on
a fixed monthly income in order to guarantee our beneficiaries the continuation
of treatment. With clear results to show, the project for 1998 is to also approach
medium-to-large-payroll companies in order to ask them to motivate employees
to join. Given the fact that the children and adults already enrolled as beneficiaries
are referred to us by physicians at low-income public hospitals, and that sometimes they have more pressing needs to provide for than the antirretroviral drugs,
we work together with NGO's that provide them other types of basic care -food,
clothing. Since there are still drugs that are not available in Venezuela, Acci6n
Solidaria counts on a network of support in the Miami area of the US in order
to provide them. They are brough into the country by a "bridge" of volunteers.
Together with members of the Red MetSIDA, a network of NGO's in the Capital
City of Caracas, Accion Solidaria also provides donations of HIV/AIDS specific
medicines sent to us both by venezuelan patients or by organizations in the US.
Results: As of January 1998, there are 24 patients -12 children, 12 adultsreceiving antirretroviral therapy on a regular monthly basis. Children receive full
treatment -two drugs- while adults receive a subsidy -the cost of Protease Inhibitors prevents us from providing them. However, four adults are being provided
with them via regular donations from the US.
Lessons Learned: If the Venezuelan Government is not recognizing publicly
the magnitude of the HIV/AIDS epidemic, has not informed its population of the
ways to prevent it, and is not taking any steps to provide for appropriate care for
those already infected, there are certain steps that the organized community can
take to try to fill the void. The fact that the impact may be very small should not
prevent us from trying to make a difference. Even if, so far, only 24 people benefit
from it...
42303 Viracept in the treatment of HIV patients: Patterns of use
and efficacy data in the French compassionate use
program
Aldo Trylesinski, E. Dohin, M. Andriamanamihaja, P. Correia, C. Delmas,
D. Szafir, J.M. Goehrs. Clinical Department, Roche France-52 BD Du Parc,
92521 Neuilly, Surseine, France
Objective: Describe the patterns of use and efficacy data in patients (pts) receiving Viracept through the French compassionate program (ATU) since April
97.
Patients and Methods: Inclusion criteria were: intolerance or contra-indication
to the 3 registered protease inhibitors or therapy failure to indinavir or ritonavir
(therapy failure was defined by a viral load (VL) >50000 copies/mL and CD4 cell
count <200/mm3). Viracept' was given at 750 mg t.i.d. in combination with at
least 1 nucleoside analogue. In Oct. 97, the French Drug Agency expanded the
criteria to all HIV + adults and allow Viracept'"' in combination with any antiretroviral
drugs.
Results: From Apr. 97 to Jan. 98, 3312 pts were included. Mean duration of
previous therapy was 3.4 years. Viracept was prescribed by 620 physicians in
200 hospitals. Viracept was the only change in therapy in 44.5% pts. It was
given as part of a triple-therapy regimen in 91.5% pts. During the 1 ATU period
(April 97-Oct. 97), 1279 HIV pts were included: 65% were at stage C on the
CDC classification, mean CD4 cell count was 108/mm3 and the mean VL was 5
logio. During the 2 period (Oct. 97-Jan. 98), 2033 pts were included, 180 pts
were naive to antiretroviral therapy. 40% were at stage C, mean CD4 cell count
was 263/mm3 and mean VL was 4.2log10. On the overall ATU Viracept" therapy

was discontinued in 123 (3.7%) pts. The reasons were: adverse events (AE): 49,
treatment failure: 38, death in 8 and others reasons: 28. The Viracept" related
AE concerning 222 out of 3312 (<7%) pts were: diarrhoea in 106 (3%), rash in 56
(2%), neutropenia in 13 (0.4%) and increased transaminases in 7 (0.2%). Data
concerning the 3 month-evaluation after the initiation of Viracept' were available
in 373 pts. Reduction in VL > 1 log1o was obtained in 100 (27%) pts, reduction in

VL between 0.5 and 0.99 loglo in 67 (18%) pts and an increase in CD4 cell count
of at least 50/mm3 without VL modification in 29 (8%) pts.
Conclusions: 1. The dynamic of inclusion of the patients in this ATU program
reflects the need for new and potent antiretroviral agents. 2. Viracept" has a
favourable safety profile and the most frequent adverse event was diarrhoea
occuring in 3%. 3. On a short term evaluation, an immunovirological improvement
was observed in approximatly half of this deeply immunocompromised cohort,
even when the introduction of Viracept"' was the only modification in antiretroviral
therapy in 50%.
42304 AIDS drugs logistics management - Sao Paulo, Brazil
Ana Maria Pluciennikaratangy. Sao Paulo State Health Department, Sao Paulo,
Brazil
Issues: By force of law, the Brazilian government has to provide free drugs for
all AIDS patients. The State of Sao Paulo has 50% of the country's AIDS cases
(30.000 live patients in January/98 in Sao Paulo). The difficulties to manage the
supply and distribution of these drugs are reported.
Project: In November/97, 10 AIDS drugs distributed in Sao Paulo costed US$
9,000,000.00 to the public budget. This figure has been growing approximately
10% each month. 70% of the drugs distributed are provided by the Ministry
of Health and the remaining 30% are bought with the State's budget. A public
health doctor, a pharmacist and a small staff are responsible for the logistics
management of these drugs which are distributed to 47 regional sites all over
the State. They redistribute to other sites what makes more than 160 sites in
the State that dispense drugs to AIDS patients. An information system monthly
provides consumption and stock data from all sites to the logistics sector. According to the information received, the logistics sector distributes the drugs for
the month, always considering the lead time between deliveries and the monthly
consumption's increases or decreases. The logistics sector is also responsible
for the forecast of drugs needs and it participates in the procurement processes.
Results: Due to the logistics management system there was no lack of AIDS
drugs in Sao Paulo in the year of 1997. Consumption trends could be observed
and expenditures could be programmed.
Lessons learned: Considering the cost of AIDS drugs and their need for the
pacient, it is important to have a professional or a team specially dedicated to
logistics management if we want to avoid treatment interruption and a rational
use of the ressources.
S42305 Access to treatment with protease inhibitor (PI)
containing regimens: Is it equal for all?
Valeriee Stone1, K.A. Steger2, L.R. Hirschhorn3, S.L. Boswell4, M.D. Stein5,
C.A. Duefield1, K.H. Mayer1, J.G. Clarke5, A.D. Monroe1, R.M. Poses'.
1Memorial Hospital of Rhode Island, 111 Brewster Street Pawtucket, RI 02860;
2Boston Medical Center, Boston, MA; 3 Dimmock Community Health Center,
Boston, MA; 4Fenway Community Health Center, Boston, MA; 5Rhode Island
Hospital, Providence, RI, USA
Objectives: Highly active antiretoviral therapy (HAART) with a PI is recommended
for many patients (pts) receiving care for HIV disease. We examined whether
receipt of this treatment differs by pt demographics.
Methods: In 1997, 248 pts with HIV/AIDS from three teaching hospitals and two
community health centers were interviewed regarding details of their clinical care,
including antiretroviral therapy (ART), other medications, provider relationships,
satisfaction with care, comorbidity, substance abuse, and demographic factors.
Clinical lab and virologic data were obtained from medical records; details of ART
and other medications were confirmed.
Results: Demographic characteristics of the 248 pts: White 51%, African American 27%, Latino 16%; men 72%, women 28%; HIV risk: 40% male sex with male
(MSM); 27% injection drug use (IDU); 34% heterosexual contact; mean age
was 38 years. All pts were asked whether they had ever been treated with a
PI containing regimen (PI rx). Photos and brand names were used as prompts.
Minority pts were significantly less likely to have received PI rx (p < 0.01): African
Americans 54.5%; Latinos 41.7%; compared to whites 70.4%. Men were also
more likely to receive PI rx than were women (68.6% vs. 46.1%; p < 0.01). Pts
with any college education were significantly more likely to receive PI rx compared
to others (70.3% vs. 54.9%; p < 0.01). Receipt of PI rx differed (p < 0.01) by HIV
risk group as well: MSM risk 79.4%; IDU 53.1%; heterosexual contact 50.6%.
Women, minorities and those with less education were less likely to have heard
of PIs (p < 0.05). Twelve pts were offered and refused PI rx; these pts were no
more likely to be women, minorities or IDUs. Those not receiving PI rx were less
likely to be satisfied with their care than those who were receiving PIs (77% vs.
87.3%; p < 0.05). There was no significant difference (p = 0.35) in length of time
in care between those who had received PIs rx (9 months) compared to those
who had not (8 months); similarly pts with more than one comorbid illness were
equally likely to receive PIs. Analysis of virologic data will be available at time of
presentation.
Conclusions: In clinical practice access to PIs appeared to vary significantly by

pt race/ethnicity, gender, HIV risk group, and educational attainment. Those who
were not receiving treatment with PI containing regimens were less likely to be
satisified with their care and less likely to have heard of PIs. It is not clear whether
these differences are due to differing levels of HIV/AIDS treatment information,
patient preferences, provider prescribing practices or clinical severity differences.
Viral load data analysis will assist with the latter.