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

948 Abstracts 43517-43521

12th World AIDS Conference

skills and approaches in sexual health, 3. Exposure visits providing opportunities
for exposure to successful targeted sexual health interventions to get new insights
on innovative approaches, 4. Participation in National and International conferences aiming at knowledge enhancement and networking, 5. Documentation
and information support, 6. Networking support and 7. Training of trainers and
production of training manuals for grass roots level community based training.
Results: 1. The training needs of the project partners have been identified
through a training needs assessment 2. The capacity of partner organisations
have been strengthened through the provision of a package of capacity building
activities, 3. The process and impact of capacity building programme is being
evaluated which is showing a significant improvement in the capacities of partner
organisations to deliver sexual health services.
Lessons learnt: For better sexual health programme management, capacity
building should be need based, catering to various needs of partners at different
levels, participatory, wherein the existing knowledge and skills of all actors are
pooled and shared, focusing on mutual learning, in an environment of confidentiality, trust, respect and openness, thus overcoming inhibitions on sex and sexuality,
and based on transfer of skills and expertise thereby enabling the translation of
learning into action for effective programme delivery.
43517 Patients who travel for HIV-related care: Shaping local
care management
Anna Margaret Molesworth, A.R. Brady. Imperial College School of Medicine,
London, UK
Background: Many of those with recognised HIV infection choose to receive their
HIV-related care outside their health district of residence. This study investigates
factors associated with patient travel in this population.
Method: Information was collected from providers of statutory medical services
in England and Wales on patients with diagnosed HIV infection who were seen
for HIV-related care during 1996. The survey collected demographic and epidemiological data, and included the location of treatment site and health district
of residence for patients living in England and Wales. Patients seen by more than
one service were allocated the service and health district of residence when last
seen. Uni-variate analysis and multiple logistic regression were used to investigate factors associated with travel outside the health district of residence for
care.
Results: Of 13947 patients seen for HIV-related care in 1996, 13524 could be
assigned a location of residence in England or Wales. Of these 5783 (43%) were
last seen outside their health district of residence and 7741 received care locally.
Using uni-variate analysis factors associated with travel for care were male sex,
ethnicity, socio-economic character of the health district of residence, probable
route of HIV infection, clinical stage of infection and the caseload of local treatment
centres (Chi-square, p < 0.001 for all factors). No association with age was found
(p = 0.70). Regression analysis confirmed independent association with travel for
care for all factors except male sex which was explained by exposure category.
Conclusions: A large proportion of HIV-infected patients currently seek treatment outside their local health district. The provision of local services for the
medical care of patients with HIV-infection may become a necessity as increasing
pressure is placed on health districts to take responsibility for their local population. If services are to be provided locally then consideration needs to be given to
meeting the needs of the patient groups who currently travel elsewhere for their
care.
43518 Consequences of the HIV epidemic on the health sector
in C6te d'lvoire: Implementation of the expanded
response to AIDS requires operational strategies for
effective health reform
Agnes Soucat1, S. Nitayarumphong2, W. Phoolcharoen3, J.L. Lamboray2.
139/111 LadPhrao soi33 Bangkok 10900; 2Office of Health Care Reform Project
Nothaburi 11000; 3AIDS Division CDC Northaburi 11000, Thailand
Issue: there is a general assumption that AIDS will have major consequences on
the health sector in countries with high HIV prevalence rates. This study of the
impact of the HIV epidemic on the public health system in C6te d'lvoire provides
an in-depth assessment of these consequences and their relevance for health
reform, using a retrospective analysis of empirical data between 1987 and 1996.
Project: review of available data nation-wide (routine data and studies) and
modelling of health care needs linked to HIV combined with in-depth analysis of a
sample of health facilities. Methods included surveys of patients and health staff,
interviews of PWAS and analysis of cost and funding a sample of health facilities.
Results: estimate for 1996 show the number of HIV+ and AIDS patients in
C6te d'lvoire to be respectively around 600,000 and 60,000-70% of cases outside
the capital city of Abidjan. Since 1987, increasing funding has been allocated
to the AIDS programme but overall per capita public health expenditures have
decreased. Despite increased drug availability at central level, most drugs especially for STD treatment are not available at user level. Generally, utilisation of
public health services has decreased over time. Hospital occupancy rates rarely

exceeded 100%. Even in infrastructure-doted Abidjan, estimates of the coverage
of health care needs of AIDS patients are less than 20% for consultations and
hospitalisation. Regardless of their HIV status, patients complain about cost of
drugs and poor quality of services and households probably carry more than 70%
of the burden of additional costs linked to AIDS care.
Conclusion: between 1987 and 1996, the public health system remained little
challenged by AIDS and the expected increase in activity and public health care

expenditures has not taken place. Systemic factors hampering the functioning of
the health system are the main obstacles to improving the response to AIDS:
health reformers need to adapt and design operational strategies for ensuring
availability of resources and access to key HIV/AIDS interventions all over the
country.
43519 Minimizing cost of decentralization of care to AIDS/HIV
patients to health center level requires health care reform
implementation strategies: Case study of Cote d'lvoire
Joseph Aka Kacou1, A. Soucat2, E. Malville3, T. Monnier3, B.T. N'Guessan4,
M. Coulibaly5. 1Service De Maladie Infectieuses Chu De Treichville Faculte De
Medecine; 4Faculte De Science Economiques Abidjan; 5PNLS Abidjan, Abidjan
Cote D'lvoire; 2Bangkok, Thailand; 3Cidef Paris, France
Objectives: to examine the cost of the minimum care package at health centre
level in urban C6te d'lvoire, following decentralisation of care to HIV/AIDS patients
to primary care facilities.
Design: transversal study.
Method: as part of the study "AIDS and the health sector" analysis of consequences and strategies of response, a case study of C6te d'lvoire" comparison of
functioning costs and activities of two primary care health centres covering target
population of comparable size: one rationalised centre (availability of essential
drugs, management systems, flow charts) and one comparison centre.
Results: in 1996 the utilisation rate for curative care was three times higher
in the rationalised health centre than in the comparison centre. Ten times more
AIDS patients and five times more TB patients are treated and followed-up in the
rationalised centre. The per capita cost of the minimum care package is however
comparable, US$2.40 for the rationalised centre and Usa$2.7 for the comparison centre. This is consistent with estimations of costs of treating AIDS patient
which show that amounts already spent by both governments and households
on AIDS patients (US$240 to US$310 per year per patient) could cover most of
the estimated cost of rationalised diagnosis and treatments for palliative care and
opportunistic infections (estimated by experts to US$350 per capita per year).
Conclusions: rationalising the supply of care to minimize the cost of diagnosis and treatment for patients through use of essential drugs, standardised
treatments and development of coherent management procedures is key to the
effectiveness and financial viability of decentralisation of care of AIDS patients
in Cbte d'lvoire. Design and implementation of operational strategies for health
reform are an essential condition for this rationalisation.
43520 Quick methods to overcome misconceptions about
HIV/AIDS
N.Sutrisaa Widjaya. 20 Melati St. Denpasar 80233, Indonesia
Issue: There are many misconceptions that dominate public and government
thought regarding HIV/AIDS in Indonesia. Misconceptions that were also found
to be held by many members of Provincial AIDS Commissions in Indonesia.
These misconceptions are major obstacles in prevention efforts and activities of
Provincial AIDS Commissions Working Groups.
Project: A total of 120 potentially active members of Provincial AIDS Commission Core Teams, NGOs, Educators and Presenters, in 2 Indonesian regions
were involved in these training programs. A participatory approach was utilised
which included: pre and post knowledge, attitudes and behaviours, (KAB) tests;
daily evaluations about the relevancy and effectiveness of sessions and content;
group evaluation of participants and reflection sessions. This program was carried
out over a 3 month period with training occurring over 3-5 day periods.
Results: The training program proved to be extremely successful with maximum participation where the KAB of participants improved and misconceptions
were dispelled. The most highly effective and relevant sessions/content was
shown to be the WILDFIRE simulation game, Transactional Analysis Concepts
and Basic Principles of IEC/Models of Behaviour Change. Individual participants
were also required to develop future plans of action. For maximum effectiveness group size was limited to 22 people allowing for dynamic exchange and
participation in simulation games and discussions.
Lessons Learned: There is a great need to develop techniques to demythologise existing misconceptions and taboos concerning HIV/AIDS at policy making levels in Indonesia. Through participatory approaches aimed at increasing
HIV/AIDS knowledge, individuals can be encouraged to overcome the inherent
reluctance to action which pervades in the current climate.
1 43521 | Developing a national framework of HIV/AIDS
surveillance
Hehe Cheng, S.Q. BI, J.D. Kou, M.H. Jia, Y.L. Ma, J.P. Zhang. Yunnan Center for
AIDS prevention, Care & Reasearch #158 Dongsi st., Kunming, China, China
Background: The development of the HIV epidemic will vary widely in different
provinces and the mode of HIV infection may change in the future. So it is

important to develop a national framework of HIV/AIDS surveillance (NFHAS) for
reflecting the whole picture of the HIV epidemic and its trends. That will 1) build
and improve the existing surveillance system;2) strengthen the leadership and
cooperation; 3) and improve the quality of surveillance data.
Methods: An original NFHAS by X.W Zheng was used as a reference, as
were comments from national and international experts, the knowledge acquired
during International Monitoring the AIDS Pandemic meeting in Manila, the dif