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

858 Abstracts 42420-42425

12th World AIDS Conference

available, they are interpreted by an HIV pharmacy specialist using the database.
Recommendations are then made to the patients' provider, along with the results.
Results: During the last quarter of 1997, 1344 clinic visits were recorded.
Medication adherence (patient reporting of doses missed in the past 48 hours)
was addressed at 753 visits: no missed doses at 44%, a single missed dose in
43%, and more than a single missed dose in 13% of these visits. Data -entry
takes about 8 hours/week. New antiretrovirals were prescribed at rate of 25/week.
We estimate the time required to evaluate HIV-RNA results was reduced from 20
to 5 minutes.
Lessons Learned: Computerization of antiretroviral use, tolerance, adherence, and surrogate marker data, improves the accuracy and efficiency of patient
monitoring and rational selection of alternative antiretroviral regimens for patients
failing therapy.
42420 Cytomegalovirus screening in HIV-infected patients
Brian Boyle, S. Merrick, J. Jacobs, K. Septkowitz. New York Hospital-Cornell
Med. Center, 525 E 68th St F24 New York NY 10021, USA
Background: Cytomegalovirus (CMV) remains a major cause of morbidity and
mortality in HIV-infected patients. Previous studies have shown CMV infection to
be associated with non-white race, older age, lower socioeconomic conditions,
promiscuity and poor general hygiene. Studies have also found a high incidence
of CMV infection in the homosexual male population. In noninfected patients,
the risk of CMV infection can be reduced if appropriate precautions are taken
regarding blood and platelet transfusion and through avoidance of other infected
body fluids. We undertook this study to determine the seroprevalence of CMV
infection in a diverse population of HIV-infected patients and whether it was cost
effective to include CMV screening and education in the standard of care for
HIV-infected patients.
Method: A cross-sectional survey of 794 HIV-infected patients at a hospitalbased HIV clinic in New York City to determine CMV seroprevalence by HIV risk
factor, race, age, gender and CD4 count. The cost of screening with Diamedix
CMV Microassays for the semi-quantitative determination of IgM and IgG was
determined and compared to the cost of treating one HIV-infected patient with
CMV retinitis.
Results: Overall, 11% (98 of 794) of the patients were CMV seronegative. CMV
infection was lowest in hemophiliacs (42% seropositive) and highest in homosexual men (>98.5% seropositive). The intravenous drug use (80% seropositive) and
heterosexual intercourse (90% seropositive) risk-factor groups had the largest
number of seronegative patients, 53 and 17, respectively. There was a statistically significant increase in CMV infection in older and non-white patients, but the
likelihood of CMV infection was unrelated to gender or CD4 count. The total cost
of screening all patients was significantly less than the cost of providing care for
one patient with CMV retinitis and the usual complications.
Conclusion: Contrary to common belief, many HIV-infected patients are not
CMV infected and it is cost effective for HIV-infected patients to be screened for
CMV infection. Appropriate precautions should be taken in seronegative patients
to prevent infection, including the utilization of leukocyte filters or CMV-negative
blood products and education regarding strategies to avoid CMV infection, which
should include the importance of safer sex and good hygiene.
42421 A medical record for HIV primary care
James Witek, S.M. Wightman, L.M. Dean, L.A. Evangelista, M.J. Gold. Allegheny
University Health Sciences MS 405 Broad & Vine Philadelphia 19102, USA
Issues: The Partnership Comprehensive Care Practice provides primary care to
700 men and women with HIV at Allegheny University Hospitals in Philadelphia,
PA. Medical. social service, gynecological, and nutrition care are all provided onsite. Concurrent delivery of comprehensive primary medical care and HIV-specific
care, coupled with the demands of managed care and report requirements of
external funders necessitated the creation of a new medical record.
Project: Care providers collaborated to develop a multi-user medical record
to improve documentation and communication. Forms were devised to organize
and monitor patient care and outcomes.
Results: A six section medical record was produced which organizes care
delivered by all providers. Comprehensive psychosocial, initial medical, and nutrition assessment forms were devised. Forms to track anti-HIV therapy, lab data
and preventive medical screening were developed. Standard medication lists and
problem lists were included. Policies addressing medical record function and use
were developed.
Lessons Learned: Care providers can collaborate to develop a multidisciplinary medical record which improves communication and efficiency and better
documents care delivery. The design of the medical record can improve quality
and continuity of care and simplify quality improvement activities. Provider input
in the development and staff involvement in the implementation of such a medical
record is critical to its success.

42422 Clinical and virologic outcomes after HAART in private
practice
Diane Lapins, R. Daly, D. Sinclair. Clincal Partners, 1390 Market St. Suite 310
San Francisco, CA 94102, USA
Objectives: To determine the impact of Highly Affective Antiretroviral Therapy
(HAART) when utilized for patients in advanced disease states.

Design: Retrospective review of standardized flow charts detailing oral medication history and virologic response.
Methods: After 2 years of experience, the records of patients at Tower I.D., a
specialized HIV private practice providing care to 500+ HIV patients (Nadir CD4%
< 50:22%; 48% < 200; 44% 200-500; 8% > 500), were evaluated. Standardized flow charts detailing complete ARV history (including pre-PI) and virologic
response for 407 patients were reviewed retrospectively.
Results: 48/248 (19%) patients received NNRTI with PI. Potent PI failures were
noted in 61 (25%); PI successes were noted in 133 current patients with one PI
(82), combined PI (57), and PI/NNRTI (19). 54 patients are under active therapy.
Mean of 2.2 (range 0-6) therapy changes recorded. PI "failures" (to reach or
sustain prolonged undetectable viral levels with emergence of resistance) were
associated with (1) Advanced disease state with extensive NA pretreatment; (2)
extended use of saquinavir HGC beyond a few months; (3) sequential introduction of HAART agents in advanced disease states; (4) deployment of lamivudine
before potent PI; (5) Patient noncompliance.
Conclusions: More aggressive regimens should be employed in advanced
disease states; for PI naive and NA - heavily experienced patients, background
NA's should be changed; consideration should be given to combining Pi's or to
reserving PI therapy until combined with other novel agents (NNRTI, nucleotides,
etc.) are available. Data on additional 100 patients will be presented along with
pharmacoeconomic impact.
42423 Home care of AIDS patients from the medical and nursing
viewpoint - A project in Ife-ljesa zone, Osun State,
Nigeria
Ibiyemi Fakande, 0. Malomo. Centre for Medical & Social Sciences Research
and Development, PO Box 15063, Agodi PO, Ibadan, Nigeria
Aim of the study was to evaluate the cost-effectiveness, the practicability, and the
influence of home care on the outcome of the patients.
Three Community-based, home-delivered meal programs were engaged to
meet the specialized nutrition needs of home-bound people living with HIV/AIDS.
During a 1-year period, 15 AIDS patients were treated by 3 Nurses and 1
Doctor in a home care setting; 7 of these patients were immobile and needed
nursing, while the 8 others received their parenteral therapy at home.
The hospital cost analysis showed that $1,345 would be expended on a patient
for only 90 days as against $511.25 expended on the home base setting. This
was found to be just 38% of the total expected expenditure in a proper hospitalbased treatment. In addition, the feeding is routine and programme in a hospital
setting, unlike the home-base where patients could take meals that attract their
fancy, which are also nutritious. A soya-bean meal homely experiment achieved
considerable result.
The advantage of home care of AIDS patients over the hospital-based system
is not only on the cost, but with a friendly environment with blood relations coupled with identical cultural background assists in ameliorating pains of HIV/AIDS
patients.
42424 Care service delivery in peripheric areas of Cote D'lvoire,
West Africa
Youssouf Sawadogo, N.K.H. Ngoran, K.F. Kaba, C.I.M. Coulibaly, K.J. Kouame.
SPNLS MST TUB, 04 Abidjan 04; 2GAPS+, Abidjan; 3Lumiere Action, Abidjan,
Cote d'lvoire
Issues: As of December, 31 1996, a total of 37.963 AIDS cases has been officially reported in C6te d'lvoire. The estimated prevalence of HIV infection in all
the population varied between 10 and 15%. The care provision structures are
localized in Abidjan (the economic capital).
Objective: To describe the care mode of HIV/AIDS patients in peripheric areas
of Ivory Coast where 75% of the whole population lived.
Methods: Prospective cross-sectional survey based on direct observation and
interview with questionnaire
Results: HIV/AIDS infection is lately diagnosed in 90% cases in C6te d'lvoire.
The rapid test of HIV cost average 7 US dollars in institutional care service delivery. The confirmation test of HIV infection was at the same level. HIV patients
serostatus was not most of the time announced. Specialized AIDS care service
delivery was available in three cities (Bouake, Bondoukou, Korhogo). Home care
is provided to infected persons in only one city (Bouake).
Conclusion: All HIV infected persons in Ivory Coast did not have access to the
same quality of care. Efficiency in AIDS prevention need the same care service
delivery all over the country.
69* /42425 Affordable medical care for HIV/AIDS patients to
control opportunistic infections
Wanjiku Rosalind Neugi1, Alice Njoroge2, G. Horsefield2. 1New-Born-Kenyatta
Hosp. 20723 Nairobi; 2AIDS Relief Catholic Church Kenya Nairobi, Nairobi,
Kenya

Issues: HIV/AIDS is now recognised in Kenya not only as a major public health
nightmare but also as a most serious socio-economic problem. Due to poverty
and high cost of drugs for treating opportunistic infection about 30% of AIDS
patients die without ever being in contact with health care system.
Project: At CBHC programme in Nairobi slums (Kibera) it was observed that
people believe because AIDS is untreatable and fatal so, opportunistic infec