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

950 Abstracts 43527-43531

12th World AIDS Conference

includes STD, HIV and AIDS epidemiogical surveillance (current status, design
and interpretation of surveillance); STD syndromic approach for primary level
(concept, training materials, policies, technical endorsement and advocacy); and
STD programme management (policies, advocacy and guidelines, improving and
expanding STD services, targeting vulnerable and core groups, planning, monitoring, evaluating and operational management). The course is highly participatory,
and participants are encouraged to contribute their own experiences.
Results: Two intercountry courses were organized in 1997 for Pacific Island
countries. Participant evaluations of these courses were positive. In 1998-99,
courses are planned for Malaysia, Papua New Guinea, the Philippines, China,
Vietnam, Cambodia, Laos and Mongolia.
Lessons Learned: Country specific STD programme management training
courses are needed to expand and improve STD services in a context of HIV
increasing transmission. A participatory training approach is well suited for experienced public health workers. Participants of previous courses have identified
future priorities as including: development of training, policies and guidelines;
improving the supply of STD drugs; and introduction of the syndromic approach.
S43527 New HIV planning challenges: Technical assistance (TA)
for federally-funded HIV care planning in the US
Joan Holloway, M. Gomez, J.F. O'Neill, A. Powell. US Health Resource &
Services Admin. (HRSA) 5600 Fishers Ln 7A03 Rockville, MD, USA
Issue: The US federally-funded Ryan White CARE Act requires HIV planning to
guide State/local level decisions on use of funds. In 1997, over 450 State/local
CARE Act planning bodies guided care delivery services to over 300,000 persons
living with HIV disease. Comprehensive planning examines HIV care needs and
assesses available resources to meet needs and overcome barriers to care.
Grantee planning success often requires TA to maintain planning over time and
respond to new challenges.
Project: The CARE Act has provided policy guidance and TA services on HIV
comprehensive planning. TA needs have focused on development of planning
infrastructures (participation, procedures, needs assessment, priority setting) and
sustaining planning (given member turnover, burnout, and complexity of planning
with new challenges). Emerging challenges include access to new therapies;
managed care and the cost-competitive health care system; health care financing
barriers that limit access; and the HIV care needs of persons who are newly-identified as HIV-infected and reaching persons who don't know their HIV status. TA is
in two broad areas: on-site TA and special projects. New TA initiatives include: TA
projects train on HIV service agency participation in managed care networks; TA
on cost-effective administration of Federal/State funded AIDS Drug Assistance
Programs that provide antiviral therapies and related HIV treatment; and national
TA reports and conference calls on innovative models of care.
Results: Effectiveness of TA includes documented grantee success in securing
additional resources, efficient planning activities, and planning that focuses on a
comprehensive service delivery systems.
Lessons Learned: Ongoing/new TA strategies are designed to address HIV
care planning needs. TA strategies are designed to address HIV care planning
needs. TA services effectively assist State and local planning bodies in maintaining HIV planning efforts over time as well as responding to emerging HIV service
challenges.
43528 Glimmers of hope: Selected STD control approaches in
Latin America and the Caribbean
Fernando Zacarias, R. Mazin-Reynoso, P. Cuchi, E. Galban. Pan American
Health organization Paho, 525 Twenty Third ST NW Washington DC 20037, USA
Issue: Despite their unquestionable public health importance, sexually transmitted diseases remain as neglected "priorities" in most countries in Latin America.
Project: Region-wide surveys conducted in 1992 and 1995 showed remarkable intercountry similarities regarding a persistent lack of political, technical,
and financial support for STD control programs. A more recent regional evaluation, however, disclosed positive changes in a few countries (e.g. Brazil, Peru,
Honduras, and Cuba).
Results: Successful changes were attributed to the personal ability of program
managers to "sell" their programs/projects through: a) better targeted interventions; b) a more focused approach to surveillance and/or research; c) syndromic
management and other practical measures to improve STD services; and d)
presenting STD control as a tool for HIV prevention or in the context of other
health services.
A common thread for eliciting support seems to be the rapid demonstration of
effectiveness/usefulness of the proposed changes.
43529 | A novel method to define appropriateness of HIV care in
Ontario, Canada: Is their agreement regarding viral load
test interpretation?
Lindy Samson1, G. Cleghorn2, G. Robinson2. 1Hospital for Sick Children 555

University Ave. Toronto, Ontario; 2HIV Health Evaluation Unit, Toronto, ON;
3Ontario HIV Viral Load; Expert Panel Toronto ON, Canada
Objectives: 1. To develop and implement a novel technique to define "appropriate, inappropriate, equivocal and indeterminate" antiretroviral treatment in
response to an initial viral load test in order to evaluate the use of HIV viral load
testing by the province's physicians.

2. To quantify the level of agreement amongst a panel of HIV experts in Ontario
regarding the use and interpretation of HIV viral load testing.
Description: Phase I: A 9 member panel of pediatric and adults HIV experts
was identified and endorsed by the Provincial HIV Viral Load Evaluation Committee. An initial meeting was convened to define key variables, viral load categories
and finalize the protocol.
Phase 2: A survey was constructed to ascertain opinions regarding the appropriateness of antiretroviral prescription for each of the pediatric (0-18 years) and
adult populations. All possible clinical scenarios using the independent variables
CD4 count, age, initial viral load test results and antiretroviral treatment were
included. The expert panel ranked each clinical scenario on a 9 point Likert scale
where 1-3 was labeled "appropriate", 4-6 "equivocal" and 7-9 "inappropriate".
Phase 3: Analysis was performed to quantify the extent of agreement between
the expert panel members. Agreement occurred if either: 1. all of the ratings were
within a single three point region- 1 to 3, 4 to 6, 7 to 9.; or 2. all of the ratings were
within any 3-point range: i.e. 2-5, 6-8. Scenarios were classified as indeterminate
if there was no agreement. The survey results will be presented.
Phase 4: A final expert panel meeting to reviews the results and clarifies any
issues not resolved by the surveys.
Conclusion: This process allows for the definition of appropriateness of care
in the absence of sufficient peer-reviewed data and could be applied to other
clinical scenarios.
143530 The integration of sexually transmitted diseases (STD)
case management as an strategy for STD control
Telma R. Queiroz1, N. Broutet2, T. Martins3, I. Feitosa4, I.C.B. Coelho5,
M.A. Araujo6, S. Melo6. 1Avenida Rui Barbosa 757 Apt. 302, Meireles,
Fortaleza; 3State Secretariat of Health, Fortaleza; 4State Central University,
Fortaleza; 5Federal University of Ceara, Fortaleza; 6Municipal Secretariat of
Health, Fortaleza, CE, Brazil; 2University of Bordeaux II, Bordeaux, France
Issue: Integration of STD care is an important strategy for STD control. The
process to achieve the integration at different levels of the health system requires innovative interventions. A pilot-project was developed from August 1995
through January 1997 in Fortaleza, Ceara, Brazil, whose objective was to improve
the quality of diagnosis, treatment, counseling and notification of STD patients
through the implementation of health units of intermediate level. This pilot phase
showed the necessity of creating a broader network of referral units covering
the entire city of Fortaleza and six major regions in the interior of the State for
achieving the integration of STD care in the state of Ceara, which is referred to
as the extension phase of the HIV/STD Project.
Project: Plans are to implement at least one health unit of intermediate level
for each one of the six administrative sectors in which the capital is divided, as
well as for each municipality chosen. Following its own training period, the health
unit of intermediate level will take responsibility for the training and supervision
of the units of primary level within the area of its coverage. The support for these
units are to be assured by the units of tertiary level and the central coordination
team, that integrates all the institutions involved in STD/HIV control in the State.
Results: Health units have been identified for each one of the regions, numbering a total of 15 new units. Adding to the ones of the previous phase there will be a
total of 19 health units. A referral system integrating the primary, intermediate and
tertiary level was proposed to the State. The situational diagnosis of each health
unit was made, the multidisciplinary teams were selected, and the acquisition of
part of the equipments is in the way. Training courses are planned for the first
trimester of this year.
Lessons Learned: The integration of the different institutions involved in the
control of STD/AIDS is very important for the promotion of integration of STD
case management at different levels of a health system. The context in which the
integration is to occur has to be considered as important as the intervention itself.
43531 Indicators for evaluating the AIDS prevention programs
Vikttorija CuciC, V. Bjegovid, D. Vukovic. School of Medicine Institute of Social
Medicine, Belgrade, Yugoslavia
Objectives: To identify HIV/AIDS related knowledge, attitudes and behavior and
to facilitate the monitoring of indicators for the evaluation of AIDS prevention.
Design: Cross-sectional study
Methods: The survey was conducted on a representative sample of households
from Belgrade's Palilula municipality, according to the methodology of the World
Health Organization. Special attention was paid to differences in answers between
respondents from urban communities and those from the rural communities and
between male and female respondents.
Results: One quarter of all respondents has had sex with strangers. This
kind of risk sexual behavior is much more widespread in the urban communities
and among the male respondents. As many as 38.5 percent of the respondents
practicing such sex do not use condoms. Such practices stand stark contrast with
the fact that nearly all of the respondents (over 90 percent), know where condoms
can be bought. The survey shows that more than 90% of the interviewed know

about two safe sex practices, and 70% is aware of three main preventive. The
respondents from urban areas are more knowledgeable comparing to those from
the rural areas.
Conclusions: The indicators for evaluating AIDS prevention confirm the success of the prevention activities carried out in accordance with the National
Program as far as the knowledge of prevention practices and the availability
of condoms at the peripheral level are concerned. However, the indicators for