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

930 Abstracts 43429-43433

12th World AIDS Conference

tected sex (p = 0.07). Fewer than 50% of the discrepant results were reconciled in
the detailed interview. Reconciliations revealed more condom use and less risk.
Conclusions: Self-report of behaviors that involve two people may not always
coincide and disclosure of risk may be more difficult for the uninfected partner,
and perhaps even more so for men. These results highlight the importance of
interviewing both partners, establishing rapport, and supplementing behavioral
outcomes with biological markers of risk behavior such as sexually transmitted
diseases or pregnancy.
43429 A novel HIV tracking system for an innercity hospital of
high HIV seroprevalence
Irene Grant, J.A. Ernst. Bronx-Lebanon Hospital Center, 1650 Grand Bronx,
New York, NY, USA
Issue: With dwindling resources and high patient turnover rates due to decreased
length of stay, prompt HIV surveillance and HIV coordinated care delivery has
become problematic. The HIV seroprevalence has been estimated as high as
6.9% in patients seen in the Bronx-Lebanon Hospital Emergency Room without
HIV related conditions. In 1966 over 2,000 HIV+ patients were admitted.
Project: A 4 component system to achieve universal inpatient HIV counseling
and consolidated HIV clinical data delivery for all adult Medical/Surgical admissions was developed. The system is composed of 1) a HIV clinical database (linked
to the admitting database), 2) a data entry team, 3) a HIV counseling/phlebotomy
team, 4) a medical data quality team. With this coordinated system, all patients
are sorted within 24 hr of admission into those to receive counseling or HIV data
delivery with continuing quality improvement (CQI) reminders to care providers.
On discharge, consolidated HIV-related data is forwarded to receiving outpatient
care providers.
Results: Thus with limited staff, we have been able to 1) maximize inpatient
HIV capture & care delivery, 2) conserve resources through data consolidation,
minimizing test duplication and length of stay by assisting optimal hospital care
decisions early on, and 3) monitor trends in HIV seroprevalence, seroconversion,
opportunistic infections, CQI parameters, readmission rates, and staff productivity,
etc.
Conclusion: Efficient HIV epidemic management is possible with minimal staff
coordinated by a specialized clinical computer program.
143430 Assessing the security of HIV/AIDS surveillance systems
in the United States
Dawn S. Gnesda1, P.S. Sullivan2, J.M. Posid2, R.P. Metler2. 12434C Dunwoody
Crossing, Dunwoody Georgia 30338; 2Centers for Disease Control, Atlanta, GA,
USA
Background: To accurately monitor trends in the HIV/AIDS epidemic in the United
States, all states and territories routinely collect, transfer and store sensitive information, including patient's name and risk. Since the beginning of the epidemic,
evaluation of security systems that protect HIV/AIDS surveillance data has been
part of the Guidelines for HIV/AIDS Surveillance, and data security practices have
been excellent. The Centers for Disease Control and Prevention (CDC) provides
state and local surveillance program areas with reporting software that ensures
a standard level of security through password protection and encryption of transfer files. To assess the need for additional security measures for the national
HIV/AIDS surveillance system, CDC conducted a comprehensive, systematic
inventory of HIV/AIDS surveillance program security policies and practices.
Methods: A 124-question survey was administered, on site, to state and local
health department personnel by CDC staff in 70 cities including central (state)
surveillance offices and remote locations. This survey covered policies and procedures, data release, physical security, computer security, communication, and
field activities.
Results: Written procedures to protect HIV/AIDS surveillance data existed at
78% of the sites surveyed. They included specifics on when data should be
released (77%) and the length of time surveillance information is maintained
(39%). In addition to using secured government buildings to house surveillance
data, most (84%) locations maintained sensitive HIV/AIDS surveillance data in a
locked room, behind doors that lock automatically when closed (67%), and inside
locked cabinets (88%). Sensitive surveillance data were sent by facsimile (30%)
or by E-mail (11%) in some areas surveyed. Surveillance staff received security
training at least annually in 63% of the locations visited, and in 91% of the areas,
a security and confidentiality agreement was signed by staff as a condition of
employment.
Conclusions: The level of security protections for HIV/AIDS surveillance data
differed by State. CDC used this inventory to develop national minimum uniform
standards to protect HIV/AIDS surveillance data. Security standards should be
components of all HIV/AIDS surveillance systems.
43431 Tracking of hospital-based inpatient HIV/AIDS population
demonstrates changing trends in patient care

Mary Ann Turjanica. 4129 Meadow Field Court, Fairfax, Virginia 22033, USA
Issues: Tracking the HIV/AIDS population provides valuable data for directing
and allocating resources to meet the changing needs of this population.
Project: For the last ten years, the clinical nurse specialist of a large metropolitan hospital has collected data on demographic trends of the HIV/AIDS population.
Factors, such as advancements in anti-retroviral therapies, have caused shifts in

the trends of this data. This information guides administrators in directing financial
resources to the appropriate setting. Also, the information directs the focus of
nursing care for these patients.
Results: 1) a steady rise in the number of HIV/AIDS patient admissions with a
leveling off during the last three years; 2) a decline in the average length of stay;
3) a decline in hospital days; 4) a decrease in the average cost per admission;
5) average age remains in the upper 30s; 6) a doubling of the percentage of
female patients 7) pharmacy costs comprise approximately one-third of the overall
hospital costs.
Lessons Learned: The delivery of care for HIV/AIDS patients is shifting from
the acute care hospital to the outpatient setting. Therefore, hospitals will need
to direct resources to these areas. Nursing care needs to re-focus on assisting patients with adherence to complex medication regimens rather than acute
treatment of opportunistic infections.
S43432 Improving AIDS surveillance in special populations
Brian Gallagher1, M.D. Miele2. 1Bhae, Room 717, Coming TWR. Empire State
Plaza, Albany, New York; 2NYS Dept. of Health, Albany, USA
Issue: Passive surveillance of AIDS, which relies on health care providers to
initiate an AIDS case report, is inadequate to capture all cases, and can result in
significant undercounting in special populations.
Active case finding in the general population and in special populations is
essential to characterize the AIDS epidemic accurately.
Project: The New York State (NYS) Department of Health, Bureau of HIV/AIDS
Epidemiology, in co-operation with the NYS Department of Corrections and the
Centers for Disease Control and Prevention conducted a special active AIDS case
finding project for patients in prison. We analyzed data from the NYS Department
of Health, indicating prison inmate's immunologic status, and data from the NYS
Department of Corrections on imates in medical care who are suspect AIDS
cases.
Results: The project resulted in 1,400 AIDS cases being confirmed. From
1994-996 the Upstate New York AIDS surveillance region, which covers a population of 10 million people, averaged 2,400 AIDS cases reported per year. In
1997 2,600 cases were reported as a result of routine surveillance, and 1,400
additional cases were reported due to this special project. Case reports were
increased 54% as a result of this project.
Conclusions: Well funded traditional passive AIDS surveillance can substantially undercount the true number of AIDS cases. Surveillance jurisdictions should
evaluate the general population and special populations at risk for HIV infection
and initiate active surveillance when: 1) there are indications of undercounting in
sub-groups, 2) the subgroups are served by health or non-health institutions, 3)
administrative data is available from institutions. This targeted approach to active
case finding can be very cost effective.
94*/43433 Inequalities in declining HIV-related mortality:
Chicago, Illinois, USA - 1996
Steven Whitman, J.T. Murphy. Chicago Department of Public Health 333 South
State Street, Chicago, IL 60604-3972, Unites States
Background: In early 1997 public health authorities throughout the United States
announced unprecedented declines in HIV-related mortality occurring in 1996.
While many reports described mortality differences experienced by different demographic groups (i.e., gender and race/ethnicity) few delineated the differences
in mortality experienced among persons in the various transmission categories
for HIV.
Methods: Vital records computer files of all HIV-related deaths in Chicago
were electronically matched against the AIDS case registry to determine how the
decedents in seven annual death files (1990-1996) acquired their HIV infection.
Whereas vital records files contain much demographic information describing
persons who die of HIV-related illnesses, they do not contain information on how
the decedent became infected with HIV. Mortality declines were examined by
comparing a three-year average of deaths 1993-1995 with deaths in 1996.
Results: The overall decline for Chicago was 18%, or 170 fewer deaths. The
greatest mortality declines were seen among men who have sex with other men
(MSM) at 30%. Among them, the decline was greatest for White MSM (45%) with
lesser declines shown for Black and Hispanic MSM (19% and 4%). Among male
injection drug users (IDU), White and Hispanic male IDUs experienced declines
(19% and 31%) but Black male IDUs experienced a 9% increase. Females also
experienced an increase in mortality (9%). This overall figure includes declines
for White and Hispanic females (18% and 33%) but is balanced by increases for
Black females (28%) - IDUs (11%) and those having acquired HIV heterosexually,
predominantly from an IDU (45%). By the time of this conference, data for 1997
will also be available and will be presented.
Conclusions: National trends in declining HIV-related mortality are being attributed to several factors, including protease inhibitors and increased and early
access to care. However, these data demonstrate that there are important inequities in the declining mortality - between genders and among race/ethnicity

groups and transmission groups. Until we understand why these inequities exist
we will not be able to eliminate them and thus provide the benefits of new life
saving measures to all members of our society.