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

12th World AIDS Conference

Abstracts 43522-43526 949

ferent situation of HIV/AIDS and the surveillance system in different areas. Also
the principle that surveillance should be voluntary, anonymous and confidential.
A draft of NFHAS was finished based on the above and expanding the Yunnan
Model of HIV surveillance.
Expected Results: The strategy of China's HIV/AIDS surveillance is a combination of HIV surveillance (HS), AIDS surveillance (AS) and Risk behavior
surveillance (RBS). Of these 3 parts, HS is the main focus. HS is a comprehensive strategy led by sentinel surveillance (SS), the prevalence survey (PS)
can supplement in area SS can not be set or where surveillance populations or
areas can not be expanded; Voluntary and anonymous testing is promoted even
though sampling bias existed; and routine testing for high risk population is only
conducted in the areas without SS or PS for finding HIV infection. The main focus
of AS is AIDS cases reporting. The work is weak in China. The medical staff at
different level should be trained to learn the diagnosis of AIDS cases, especially
for the primary health care. Reporting system and procedures should be same as
other diseases. RBS uses random sampling method to survey the risk behavior
among the general population. Pilot study first, then expand to promote the RBS.
The structure and responsibility of surveillance network the strategy of testing,
the funding support and the evaluation also are described.
Conclusions: The draft will be discussed by the experts at country level and
officials of MOPH in March 1998. It is still in the planing stage. More advice is
welcome.
43522 Need assessment: A foundation for strengthening
capacity of HIV/AIDS workers
Boongium Tragoolvongse. Asean Institute for Health Development Mahidol
University Salaya, Nakornpathom, Thailand
Issues: Training activities have been considered a major component to strengthen
capacities of NGO's and GO's. Training needs to find out the real needs of trainees,
which are often neglected. Quantitative and qualitative procedures have been employed in obtaining - information which is deemed necessary to plan appropriate
training programs.
Project: The EC/AIHD AIDS Project funded by the European Community's
Program on HIV/AIDS in Developing countries and implemented by the ASEAN
Institute for Health Development began with investigating specific areas of interests and needs of HIV/AIDS Trainers and workers in Thailand.
Results: Results from a questionnaire survey, focus group discussion and
workshop discussions were summarized: Community-based care: There is a
need to increase skills in taking care of PHA with opportunistic diseases, increase
the knowledge of basic medication and how to work with PHA and their families.
Project management: There is a need for management skills on personnel and
office management, project evaluation skills that field staff can use, and managing and marketing income generation projects. Interventions for behavior change:
There is a need for development of skills for active participatory learning, team
building, communication and counseling skills. Specifically, participants demand
more exchange on knowledge relating to HIV/AIDS issues.
Lesson Learned: Information gathered from Training need assessments have
served as a foundation for planning training programs to fit the real needs of
trainees.
43523 HIV/STD prevention in high risk, low prevalence Asian
nations: Bangladesh, Pakistan, and Mongolia
Jeffrey S.A. Stringer2, T. Aira3, M.P. Bhatta', J. Schwebkel, M. Sarkar1,
S.A. Shah4, S.H. Vermund1. University of Alabama; 2Dept Ob-Gyn, 618 South
20th St., Birmingham, AL, USA; 3Ministry of Health, Ulaanbaatar, Mongolia;
4AIDS Control Programme, Sindh, Farachi, Pakistan
Issue: Countries with many serious medical challenges but with inapparent
HIV/AIDS epidemics are often inexperienced in key prevention issues including
sexually transmitted disease (STD) control and HIV surveillance.
Project: Through Ministries of Health, universities, non-governmental organizations, and the Fogarty International Center AIDS International Training and
Research Program (FIC AITRP), partnerships in Bangladesh, Pakistan, and Mongolia have been established for training in STD control and HIV surveillance. The
collaborating US institutions are the University of Alabama at Birmingham (UAB),
University of California at Los Angeles (UCLA), and Brown University. Short term
in-country training in HIV surveillance has included evaluation and upgrading
of the national or regional surveillance programs. In Mongolia, World Health
Organization syndromic management training documents have been translated
and over 50 Dermato-venereologists have been trained. A long term (1-3 years)
public health training program has been established at UAB. Returning long term
trainees are working on research projects including gonorrhea resistance, STD
prevalence, STD surveillance, targeted work among truck drivers and high risk
women, and HIV surveillance.
Results: An increased profile for the importance of STD control and HIV prevention in high risk and low prevalence countries has been noted with the training
support of the FIC AITRP. For example, a trainee (T.A.) and UAB faculty (J.S.,

S.V.) have documented penicillinase-producing Neisseria gonorrhoeae in 42% of
232 isolates in an Ulaanbaatar, Mongolia STD clinic.
Lessons Learned: International collaboration for training and research can
assist low prevalence nations with emerging epidemic to organize STD control
and HIV prevention programs before explosive HIV expansion occus. It is not
known what the true impact of these training efforts is at this time.

43524 Gathering the evidence to inform pragmatic decisions in
HIV prevention and to identify research gaps
Greet Peersman, S. Oliver, A. Aokley, J. Thomas, A. Nicholas. EPI-Center
(SSRU) University of London, 18 Woburn Square, London, UK
Issue: Planners, providers and users of services, as well as researchers in HIV
prevention, need to be able to access research findings efficiently.
Project: An infrastructure was developed to gather and make readily available information to guide the planning, implementation and evaluation of HIV
prevention services, and to identify relevant research needs. Reports of sexual
health promotion studies were identified and compiled in a bibliographic register.
A standardised coding system was designed to enable their retrieval according to
type of study, country, population and, for intervention studies, the type, provider
and setting of the intervention. A specialist database, EPIC, was developed, to
compile the results of systematically reviewing evaluation studies with respect to
the development, content and delivery of the intervention, the population involved,
and the findings in relation to both outcome and process measures.
Results: The bibliographic register contains over 1,200 references and allows
for a mapping of HIV prevention-related research already carried out and the
identification of major research gaps. EPIC contains over 150 evaluation studies
and permits pragmatic questions to be answered such as: which types of HIV prevention activities are effective in a health care setting; what methods have been
applied to assess skill development for sexual health promotion; or how can users
be involved in the planning and evaluation of services? EPIC can also be used
to compile systematic reviews of the effectiveness of interventions in particular
settings or populations, or of particular approaches. Both databases are regularly
updated and are attached to an enquiry service which provided a tailored answer
to over 350 purchasers, providers and researchers over a period of one year.
Lessons Learned: Those wishing to advance evidence-based HIV prevention
can draw on the support of an information centre with research-based information readily available to answer their pragmatic questions about the delivery of
services. Pragmatic questions without research-based answers identify important
research needs.
43525 Evaluating the impact of highly active antiretroviral
therapy (HAART) on the HIV/AIDS service delivery
system of Metropolitan Boston
Laureen Kunches', J.M. Day', J.B. De Cristofaro', G. Fallas', S. Landers',
R. Stevens2. 1JSI, 44 Farnsworth St, Boston, MA 02210; 2Boston Public Health
Commision, Boston, MA, USA
Objectives: To assess current needs of people living with HIV (PLWH), describe
recent changes, and recommend directions for future service planning in the
context of improved HIV therapy and survival.
Design: Evaluation within Ryan White CARE Act Title I service network conducted from 9/97 thru 1/98 in the Boston eligible metropolitan area (EMA), where
no significant financial barriers to accessing HIV medications exist.
Methods: Primarily qualitative methods (including focus groups with 59 PLWH
and 34 HIV care providers, telephone surveys of 48 clinical sites and service
agencies, and 15 key informant interviews addressing identified priority services)
enhanced with quantitative service demand and utilization data.
Results: Agency survey responses indicated that most (median 60%) PLWH
are currently on HAART. Primary reasons given by agencies for their clients
not being on HAART included lack of clinical indication (54%), client preference/refusal (54%), drug intolerance (37%) and difficulty with adherence (34%).
Special adherence-enhancing programs are in place in 87% of agencies surveyed. Respondents reported increased complexity of client interactions (63/%)
but minimal change in frequency or length of visits. Survey results confirmed
the focus group themes of significantly increased needs for housing, mental
health and substance abuse treatment, but also identified increasing demands
for food pantry, social case management, transportation and employment training/placement services.
Conclusion: Appropriate HIV service planning and resource allocation in the
HAART era will require adjustments that support the therapy-related needs of
PLWH and expand key community services (housing, mental health and substance abuse treatment) to accommodate the growing client base, improved level
of functioning, and markedly extended survival of populations in need.
43526 STD programme management course for central level
and mid-level managers
Gilles Poumerol', A.E. Ghee2, N. Fee2, S. Omi2, P. Exon2. 1 United Nations Ave.
PO. Box 2932, 1000 Manila; 2 World Health Organization, Manila, Philippines
Issues: STD programmes and services are insufficiently developed in most of
Asia and the Pacific. The majority of STD patients use the informal sector for
STD treatment. There is an urgent need to improve STD prevention and care
by mobilising public health workers and improving their technical and managerial
capacity, especially in light of the increasing evidence that STDs are closely linked

to HIV, and to reduce HIV transmission.
Project: A 5days course on STD programme management was designed by the
WHO Western Pacific Regional Office. The course is aimed at experienced public
health workers from the national and regional levels. The course assists participants in developing skills in advocating for and organizing sexually transmitted
disease (STD) prevention and control programmes. The course is modular, and
can be adapted to the needs of specific areas or countries. The course curriculum