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

12th World AIDS Conference

Abstracts 42426-42430 859

tions are not also treatable as a result humane-care and respect for HIV/AIDS
cases is minimal. To change this thinking and to reduce the cost of medical care
our CBHC use povidone iodine for oval thrush, plant extract (plumeria rubra)
which has polyphenolics and tannins for herpes zoster, papaya seeds for worms,
chlorohexidine/cetrimide for itchy skin rashes.
Results: These preparations have proved very effective on all these recurrent
infections and cheap. Community has accepted this treatment and HIV/AIDS
patients come freely to the clinics.
Conclusion: This method has been adopted as the cheap effective treatment
for opportunistic infection by NGOs in Kenya. A cheap, effective and affordable
medical care encourages community to be responsible for HIV/AIDS patients.
42426 HIV infection in children and the community
Anca Irina Celareanu', S. Petrea2, M. Mardarescu2, S. Popovici2, S. Asandi3,
A. Ann-McNicholas4, Jammes Perry5. 'Spit, Boli Inf Colentina Bucuresti, Str
Grozovici, Nr 1 Sector 2; 2Hospital for Infectious Diseases Colentina, Bucharest;
3Romanian Angel Appeal, Bucharest, Romania; 4Health AID-UK, Rochadale,
UK;5 Romanian Angel Appeal, London, England
Issue: In Romania in the early 90's nursing was something unknown, a new
concept. The staff of Colentina Hospital, Bucharest, in cooperation with a large
team of English specialists set up the first school for nursing in this country. That
was the initiative of an English NGO, named Health Aid UK, wich gave a lot in the
care of children with HIV and AIDS. This cooperation opened minds and doors
for other important cooperations.
So, another English NGO, named Romanian Angel Appeal, set up in the same
Colentina Hospital the first Day Clinic for children with HIV/AIDS. In this Day
Clinic more than 900 children with HIV/AIDS recive medical care, social support,
education. The staff of the Day Clinic and of the NGO are very deep involved and
decided to involve more deeply the European Community. Now we have a new
partenership between the Day Clinic, Romanian Angel Appeal and the European
Community thoug Phare-SESAM wich offers to our little patients good treatment,
nursing, social and psychological support, education, in fact patient and family
complex support. In three years, the number of the patients who came to Day
Clinic increased from 200 to more than 900.
Lesson learned: If people cares and the staff is interested to offer better care
to the patient, always the community will come to help, trying to do the best for
the people in need.
|42427 Prevention and care for migrant labors cross-border
neighbouring countries Thailand/Myanmar
Udomsiri Parnrat. Provincial Hospital Divison Office, The Permanent Secretary
Ministry Public Health, Tivanond RD Nonthaburi, Thailand
Statement of the problem: Over the last two decades, the rapid economic growth
in Thailand has attracted thousands of migrant labors from its poorer neighboring
countries. A great majority of them have come from Myanmar who entered Thailand through several borders crossing points namely Ranong-Kawthaung. Mae
Sot-Myawaddy, Mae Sai-Tacheleik, Kanchanburi. Cross-border trading between
the two countries has also increased dramatically and traders from both countries
are making frequent trips to the border towns on both sides, Ranong-Kawthaung
is one of the main cross border routes between two countries and the only point
separated by the Andaman sea and approximately 150,000 Myanmar stay in Ranong province. These migrant Myanmar are highly vulnerable to risk of HIV/AIDS
because of multiplicity of factors separation from societal and culture norm, sudden exposure to an environment which lures them to engage in risky lifestyle,
look of sense and structure of community, presence of predominantly male population, deprivation of basic necessary services and information, unavailability of
prevention measure specifically targeting targeting them and language barrier.
The project extended the target area and integrated Primary Health Care.
One of the three main objectives was to foster closer cross-border collaboration
between Government Health Institutes and relevant NGOs working in both sides
of the sea border to address health problems in the cross-border context.
42428 Treatment seeking behaviours in rural community
Jacqueline Kabambe. Actionaid-Malawi PO Box 30735 Lilongwe 3 Malawi,
Malawi
Issue: Traditional Healers are the first source of treatment for the chronically ill
patients in Chiringa Community.
Project: The NACP in conjunction with the UNAIDS conducted a rapid assessment on Improved Access to HIV related drugs in Chiringa area with an
intention of assessing the situation with regard to improving access to drugs by
the chronically ill, particularly in the rural Malawi.
Results: Out of 9 patients interviewed, 7 sought treatment from the Traditional
Healers, I from an AIDS Service Organisation and 1 from a vendor. Nobody
sought their first treatment from any formal bio medical facility. Realising that

most patient believed witchcraft was the cause of their illness, it was logical
that people sought their first treatment from the Traditional Healer. However this
choice of treatment was made by the care givers as opposed to the patients. The
majority of visits irrespective of source of treatment, yielded no improvements in
the conditions of patients. This makes it likely that patients were AIDS cases. It
also indicates that the treatment given may not have been appropriate. The other
fact is that there are more Traditional healers than hospitals hence people sought

treatment from the nearest and cheapest facility. The cost of visiting Traditional
Healer ranges from K5 to K130 while the hospital is from K20 to K292.
Lessons Learnt: People attribute the cause of AIDS to witchcraft. People's
lower income levels also attributes to this treatment seeking pattern.
443*/42429 Inversion of inpatient/outpatient HIV service
utilization: Impact of improved therapies, clinician
education and case management in the US
Department of Veterans Affairs
Abid Rahman, L.R. Deyton, M.B. Goetz, D. Rimland, M.S. Simberkoff. 1AIDS
Service Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC;
2West Los Angeles VA Medical Center, Los Angeles, CA; 3 Veterans Affairs
Medical Center, Atlanta; GA; 4New York VA Medical Center, New York, NY USA
The Department of Veterans Affairs (VA) is the largest single provider of HIV medical and preventive services in the US. The cumulative number of HIV patients
seen at 173 VA medical centers and 500+ ambulatory care and community based
outpatient clinics was over 59,000 through December 1997. The VA national HIV
registry that was implemented in 1992 indicates that in 1997 alone, over 17,000
veterans received HIV services that included 1,172,565 outpatient clinic stops
and 170,579 days of hospitalization. An outpatient clinic stop represents discrete
episode of care such as physical exam, pharmacy, lab tests, etc. (each visit may
result in multiple stops). The VA has implemented a comprehensive HIV care
program consisting of increased emphasis on outpatient services, broad access
to all approved HIV therapies through a national drug formulary, implementation
of national clinician education on HIV treatment guidelines, early access to advanced diagnostics and proactive case management for HIV infected patients.
Continuing a trend which began in 1994, significant inversion of inpatient and
outpatient services has been seen. For veterans seeking HIV care in VA facilities
between 1996 and 1997, a 38% increase was observed in the number of clinic
stops. There was a concomitant 37% decrease in the number of hospital admissions and a 41% decrease in the total number of hospital days. The decreased
utilization in inpatient services combined with the increased outpatient utilization
including all drug costs created an estimated net saving of $18 million in 1997
alone from the initially projected total budget for HIV/AIDS patient care services.
The advent of improved therapies and continued implementation of a comprehensive HIV care program of outpatient services, access to all approved
drugs, aggressive clinical education on current treatment guidelines and case
management has lead to improved patient and institutional outcomes.
442*/42430 Changes in HIV/AIDS patterns of care and
estimated costs at an urban medical center during
the era of heart
James E. Rawlings', J. Holmes2, B. Belton2, P. Selwyn3, G. Friedland2. 120
York Street New Haven Connecticut 06515; 2 Yale New Haven Hospital New
Haven; 3 Yale New Haven Hospital Selwyn, USA
Objective: To estimate the patterns and costs of HIV/AIDS inpatient and outpatient care at a 700 bed urban hospital in the era of highly active retroviral therapy
(HAART).
Methods: Evaluation of utilization of inpatient and outpatient hospital services;
all patients with HIV/AIDS related admissions identified by ICD-9 coded discharge
diagnoses; outpatients identified by attendance at hospital-based HIV-specific primary care clinic. Cost of care determined by Resource Information Management
System (RIMS), a computerized fiscal data system which assigns costs for all
inpatient and outpatient hospital-related services. Antiviral and nursing home
costs were estimated from separate patient matched databases.

Admissions
Inpatient days
Average Length of Stay
Unique outpatients
Outpatient visits
Inpatient service costs
Outpatient service costs
AIDS nursing home
Antiviral costs (estimated)
Viral load costs
Total cost
Cost/patient/year

10/94-9/95
830 ( 10%)
9102( 12%)
10.9 (4%)
660
5523 (+3%)
$10,101,399
$1,554,761
$1,481,000

10/95-9/96
801 (-3%)
7258 (-20%)
9(-15%)
692 (5%)
5920 (+7%)
$8,542,171 ( 15%)
$1,588,857
$693,600
$1,992,000 (+35%)

10/96-9/97
662(-17%)
5368 (26%)
8.1 ( 10%)
741 (7%)
6522 (+9%)
$6,483,350 (-24%)
$1,754,634
$658,920
$4,039,000 (+103%)
$125,031
$13,060,935
$16,736

$13,137,160 $12,816,628
$19,904 $17,519

Changes compared to previous year.
Conclusion: During the period of introduction and availability of HAART, acceleration of already occurring favorable shifts in utilization of services and
associated costs occurred. Outpatient and non-hospital utilization/cost and antiviral costs increased, but were offset by dramatic decreases in utilization/cost
of inpatient care. Although the total number of patients in care increased, overall
costs remained level and cost/patient/year decreased. Our analysis suggests that
HAART is cost-effective.