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

890 Abstracts 43220-43223

12th World AIDS Conference

a registered society that will allow flexibility and creativity & ensure accountability
was established with an Exec. Committee comprising of the Secretary Health,
representatives of select secretaries and technical heads of various departments.
This committee is competent to sanction all projects This mechanism dispenses
the need to obtain government approvals in the normal channel. With the Project
director as the chief executive, the society developed a separate administrative
framework with technical officers in charge of key areas such as Blood safety, STD
control etc who prepare and assist the implementation of various activities. An
annual action plan is approved by NACO & funds are released through the state
government and credited to the society's account. Hence the society accesses
funds quickly. E.C clears proposals prepared by the technical team after which
they are taken up for implementation immediately. This has led to expansion of
various activities.
Results/Achievements: Delays were reduced. Many NGO proposals have
been approved in a short time. Modernisation of Blood Banks and Strengthening
of STD clinics have been key aspects. Impressed with the progress made in the
state of TN, Government of India is keen to extend this model to other states.
Lessons Learnt: Extraordinary situations warrant extremely quick response
through devolution of governance. Flexibility, innovation, openness to experimentation, coupled with accountability in combating an epidemic of this nature is
called for in a country like India.
43220 Cost-effectiveness of primary HIV-prevention -
A systematic review using the criteria of the BMJ
Economic Evaluation Working Group
Matthias Schrappe1, K. Lauterbach2. 1 University Clinic of Cologne, Cologne;
2lnst. of Health Econonics, Cologne, Germany
Objectives: Systematic review on cost-effectiveness of primary non-medical HIVprevention programs, focussing on methodological issues and outcome-specific
cost-effectiveness data.
Design: Rating of publications including published review guidelines.
Methods: Studies defined by intervention, study population, method of analysis
and at least one endpoint for evaluation of intervention were analyzed according
given general and economic parameters. Methods to generate effectiveness data
and for estimation of costs were documented, inclusion of human costs and outcome parameters for economic evaluation were noted. For methodological issues,
the guidelines of the BMJ economic evaluation working party were applied.
Results: Forty studies were identified (34 publications), 30/40 from the United
States, 22 supported by public funding, only 5 studies (12%) were directed to
traditional risk groups. Screening and counseling accounted for 30/40 studies.
Complete research question (intervention and outcome stated) was presented in
29/40 studies (72.5%). Thirty-four studies were conducted from the societal perspective, the viewpoint was clearly stated in 31/40 studies. Incremental analysis
was performed in 21 studies, discounting in 23/29 appropriate studies, sensitivity analysis in 23/40. Effectiveness data were presented in 38 studies (source
displayed in 36). Diagnosis of unknown HIV-infection was the most common
economic outcome parameter (n = 11), followed by sexual (n = 7) and vertical
transmission (n = 6), infection of patients by health care workers and life years
saved (both n = 6). In 21 studies (52.5%, 6/22 CEA's), human costs were included
in estimation of costs, 9 studies used the human capital approach. Cost-effectiveness data showed costs between US$ 460 and US$ 1.2 Mill. in studies
per case of previously unknown HIV-infection prevented, strongly depending on
prevalence. Studies on sexual and vertical transmission demonstrate lower costs
when benefits of treatment are included. Depending on prevalence, costs for one
life year saved vary between $29,000 and $458,000.
Conclusions: Systematic review of cost-effectiveness studies on primary HIVinfection using the BMJ working party guidelines is feasible. The quality of
published studies varies widely. Clear definition of outcome parameters as object
of economic evaluation can be regarded as crucial, besides incremental analysis,
discounting and inclusion of human costs. Further work has to be done for developing and evaluating a rating system for the topic of cost-effectiveness analysis
in this field.
S43221 Evaluation of efforts to build HIV prevention capacity in
minority communities in the United States
Daniel Gentry1, K. Scott1, M. Green1, C. Lopez2, E. Gants-McKay3, S. Myhre4,
F. Angeles5. 1Saint Louis Univ. Sch. of Public Health; 2Mosaica, Washington,
DC; 3Stanford University, Palo Alto, CA; 4Hasbro Children's Foundation, New
York, NY, USA
Background: Conduct a structure, process, and outcome evaluation of the US's
National and Regional Minority Organizations (NRMOs) Program, by examining:
1) factors that contribute to successful capacity building, 2) the training and technical assistance (T/TA) models/approaches used to build capacity in constituent
organizations, and 3) the extent of reported change in capacity among recipients
of T/TA. This is the first comprehensive evaluation of this national ten year old
program, a program which is one of the US's most important programs for building
HIV prevention capacity in the African American, Hispanic, Native American, and

Asian and Pacific Islander American communities.
Design: Retrospective, non-experimental evaluation study, with organizations
as unit of analysis.
Methods: Combination of qualitative and quantitative methods were used to
conduct the evaluation of all 22 federally funded NRMOs. This included archival
reviews of documentation, survey research, structured interviews and directed

dialogues, and site visits. Additionally, all recipients of T/TA during the past
two years were surveyed. These recipients included community-based organizations, coalitions, planning groups, local health departments and grass-roots
organizations.
Results: The 22 NRMOs reported serving over 900 organizations during a
two-year period. T/TA services to build capacity were provided in the following areas: board development/governance, resource development, fiscal management, human resources management, program planning and development,
program evaluation, service integration, networking/community organizing, and
cultural awareness/sensitivity. The most often provided T/TA were in the areas
of community organizing/networking and human resources management. While
67% of the NRMOs reported that they always conduct formal needs assessments
for their client organizations, only 47% reported that they always provide a written
comprehensive plan. While recipients of T/TA were very satisfied with the content
and quality of the T/TA services in general, they were less satisfied with the
preparation before T/TA, the opportunity to evaluate T/TA, and follow-up after
completion of T/TA.
Conclusions: Evidence shows that the 22 NRMOs have good access to minority communities affected by HIV in the US. While the common goal of the Program
is to build HIV prevention capacity among minority populations, each of the NRMOs have unique relationships with their constituencies. Common approaches
were found. These include intensive "on-going" T/TA partnerships, "mini" grants to
CBOs, utilization of existing networks, and adoption of culturally-based strategies
to gain "access" to the communities.
143222 1 Interface between national and international AIDS
policies
Miguel Fontes. S Rtn Qd. 701 Cj. C No. 124 Sala 314-A 70710-200, Brasilia-DF,
Brazil
Issue: Interface between international and national AIDS policies developed by
aid organizations and local governments respectively should be better evaluated
to facilitate implementation of new cooperation projects in Brazil.
Project: As part of an ongoing project coordinated by ABIA and supported by
the Ford Foundation, this research project aims at defining the interface between
the international and national AIDS policies in Brazil, making an analysis on
how policies are developed by different bilateral, multilateral and UNAIDS organizations and their program negotiations with the Brazilian government and civil
society organizations. Between 1992 and 1997, more than US$ 278 million dollars
have been spent in Brazil for development of cooperation programs. During this
research, cooperation programs of all major bilateral and multilateral organizations were reviewed; and semi-structured interviews were undertaken with their
representatives on specific topics, such as: a) the process to develop policies for
AIDS prevention and care; b) specific political influences for development of new
policies; c) interface between policies developed by individual agencies and local
organizations, including civil society.
Results: The majority of AIDS cooperation agencies develop their policies in
partnership with host government, represented by the local Ministry of Health
STD/AIDS Program. However, policies developed by multilateral organizations
present a greater interface with national policies in comparison to bilateral organizations. In addition, differences were found between bilateral AIDS policies
developed by US and European aid organizations.
Lessons Learned: Bilateral organizations and UNAIDS should intensify discussions with Brazilian government and civil society on HIV/AIDS policies so that
increased interface will lead to greater partnership and promotion of new collaborative approaches. Strategies intending to restrain duplication of cooperation
policies and priorities should be considered.
43223 HIV/AIDS response analysis in Azerbaijan: Obstacles and
lessons learned
Jamila Ibrahimova1, R.U.A. Alekperov2. 13 UN 50th Anniversary Str, Baku
370001; 2UNAIDS Focal Point, Baku, Azerbaijan
Issue: HIV/AIDS is regarded as a highly medicalised issue and as a result
lack of comprehensive, multisectoral approach is one of the major obstacles in
addressing the HIV/AIDS problem in Azerbaijan.
Project: Situation analysis was carried out through the review of
HIV/AIDS-related activities undertaken by the Government and NGOs. Major
findings are as follows: 1) registered HIV rate remains at low level; 2) blood
safety is not ensured; 3) official STDa rate has grown up 3-fold since 1991; 4)
10-fold increase in registered drug users was recorded from 1989 to 1995; 5)
increase in commercial sex activities. Other factors contributing to the spread of
HIV/AIDS: 1) lack of awareness about safe sex practices; 2) family life education
is not introduced in schools; 3) very few activities were implemented outside
the Ministry of Health; 4) poor relationship between the Government and NGO
sector; 5) lack of financial resources to ensure supply of disposable equipment; 6)
lack of technical capacity in formulation and development of strategic HIV/AIDS
planning.

Lessons Learned: 1. Establishment of National Inter-ministerial AIDS committee is recommended to develop a comprehensive strategic plan on HIV/AIDS
prevention and care; 2. Active support should be provided to strengthen the
capacities of nascent NGO sector in the country to launch an efficient outreach
programme targeted at the vulnerable groups of the population.