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

12th World AIDS Conference

Abstracts 43532-43537 951

evaluating the behavior of the respondents are unsatisfactory as regards the
frequency of casual sex and practice of using condoms during casual sex.
43532 1Learning by doing: A motivation for public health
workers in a Thai-German cooperation project
Kumnuan Ungchusak', M. Kanato2, P. Konasol', K. Radtanasudsatum3,
C. Kuchaisit2, S. Bambeq4. 1Division of Epidemiology, Ministry of Public Health,
Nonthabuqi; 2Khonkaen University, Khonkaen; 3Burapa University, Chongguci;
4AIDSNET Foundation, Ubon Qatchatthani, Thailand
Issue: Thailand is one of the country that has widespread HIV infection and high
number of AIDS cases. The public health people who are working in HIV/AIDS
are loaded with work and can not leave for formal academic course. The only
possible way is to learn from their job.
Project: This project is implemented in 4 cities in different regions of the country
starting from 1996 and will end in 1999. The provincial health staff selected target
population to implement intervention program according to local situation. Population included were workers (3 provinces), students (2 provinces), fisherman
(1 province), commercial sex worker (1 province) and continuum care for people
with AIDS (3 provinces). Academics from local university were invited to work as
local consultants. Health staff interacted with local consultants on a monthly basis
by asking technical opinions and practicing qualitative study when working with
target population. Every three month all staff and the consultants came to share
their experiences.
Results: The project were carried out without foreign experts. It has changed
from a top-down direction to the bottom-up planning and implementation. Approximately 40 staff and 10 knowledgeable academic professors are involved. A
sense of ownership and confident has increased among staff. They were able
to use focus group discussion and in-depth interview to understand the need of
the people with HIV, villager leaders, factory managers and workers, teachers
and students, sex workers and brothel owners. Relationship of field people and
academics staff were builded up with mutual respect.
Lessons Learned: Opportunity to learn and develop the skill while working is
one of the most important motivation for public health workers in the project.
143533 | An old method for a new problem
Eliana Mattos', G.B.P. Rigotti2, L.G.G. Mondini2, D. Rerin2, P.D. Piccon2,
F.J. Kanter2, N.T. Barcellos2. 'Rua Olavo Bilac, Porto Alegre, RS; 2Health State
Secretariat, Porto Alegre, RS, Brazil
Background - Rio Grande do Sul state (RS), had 7135 AIDS cases until the
end of 1997, 50% of them from outside the Capital. The state is divided in 467
cities organized in 18 Heath Regional Delegacies (HRD). The Health Government
Department from the state started, in 1996, based in 1970 Tuberculosis Program
experiences, the implantation of his 39 greatest priorities, including the AIDS
Control Program, in the 18 HRD.
Methods: - The project that was planned to be finished in three years, ended
its second year with 12 HRD impacted with AIDS Program. A technical and
operational rule (with technical recommendations) and a planning matrix are
discussed after a sensitization workshop. The implantation takes 2 days. In each
implantation, two AIDS technicians visited the HRD and there are representative
participation from the great majority of the cities of the HRD. In July, 1997, a
parallel supervision program with trained technicians from the HRD was impacted.
Results: - The AIDS Program implantation brought information about prevention and HIV HIV/AIDS cases handling for 12 HRD (and a mean of 300 cities),
stimulated prevention activities organization, HIV testing with counseling and
local clinical care, with all laboratory and drug facilities, to the identified HIV/AIDS
patients as a trial to fix them in their own living city, relieving capital attendance
that has their resources exhausted yet.
Conclusions: - In a developing country, where the health system is almost
broken down, new accesses, and even old strategies are valid ways to disseminate the knowledge on a pathology that bring about discrimination and refusal
reactions. Fundamentally, time and resources are being spent with a specific
objective, an evaluation method and an excellent immediate response.
S43534 Setting priorities for HIV AIDS research in countries with
limited resources
John Rwomushana. Uganda AIDS Commission, PO Box 10779 Kampala 28-30
bombo Rd, Kampala, Uganda
Issue: Comprehensive reviews and analysis for gaps and policy implications are
required for effective prioritisation of HIV/AIDS research.
Reviews: Uganda's expanded multisectoral HIV/AIDS strategy has been supported by a broard research base since 1986. As part of developing for 1998-2002
National Strategic Framework, an updated inventory of ongoing and completed
research was compiled at the end of 1996. Available reports were reviewed and
categorised into: basic, clinical, epidemiologic, social and economic areas. A

comprehensive national review of AIDS control activities was also carried out at
the same time.
Results: It was noted that most research findings were published outside the
country and not available for local application, for example in policy development.
Analysis of the nearly 400 research reports revealed a relative lack of basic
biomedical and clinical research activity. The comprehensive review identified
inter alia, a need for greater emphasis on strategies to consolidate behaviour

change, improve HIV/AIDS treatment and strengthen vaccine development. The
follow-up prioritisation of the research agenda identified for the next 5 years is
now being effectively guided by these observations.
Lessons learned: Regular reviews, analysis and local dissemination of research findings are beneficial for policy decision-making and designing future
strategies.
S43535 Implementation strategies of AIDS care programmes in
Brazil
Claudia Cunha', Ana Vasconcelos2, V.G.V. Santos2, P.J.N. Chequer. 'Brazilian
AIDS Program MOH Espl. Ministerios BL. G Brasilia-DF Brazil-70058-900 G;
2Brazilian AIDS Program-MOH Brasilia DF, Brazil
Issue: Evaluation of strategies of government health programmes on HIV/AIDS is
necessary to measure impact and compare to the results of different interventions.
Project: Aiming at promoting the improve of quality of life for patients with
AIDS, the Brazilian Ministry of Health has been developing, since 1994, the
Program of Alternative Assistance. To this effect, economical resources has been
available to projects of Specialized Assistance Service -SAS- and Therapeutical
Domicile Assistance -TDA both out patients services. Strategies included the
transfer of resources to local Programmes on STD/AIDS in order to implement
the SAS in institutions or through direct financial agreement with public health
services, in the case of TDA. Resources are available to acquire equipments,
laboratory materials and ambulances. The payment of the technical staff wages
is the institution counter part.
Results: The structural evaluation in 1996, carried out in 08 services of SAS
and TDA, in 04 states of Brazil, verified that 80% of SAS rated a regular to poor
graduation, and 80% of projects of TDA rated it a satisfactory, when compared to
initial objectives and actual performance.
Lessons Learned: Although the differences observed, it is probably that the
best acting of TDA services is associated to the process driven by the central
level. In the case of government, the strategy of establishing a direct financial
agreement with public health institutions, assured a best performance of services.
From this data, a profound change has been occurred in the politics of implementation. Since January, 1997, we adopted these strategy to promote the expansion
of this services in the country.
43536 Getting things done on AIDS: Tool for self-assessment
and action by health districts
Agnes Soucat', S. Nitayarumpong', W. Phoolcharoen2, J.L. Lamboray'. 1Health
Care Reform & HIV Office of Health Care Reform Project Ministry of Public
Health Nonthaburi; 2CDC Nonthaburi, Thailand
Issue: district level implementers of the expanded response to HIV/AIDS need a
set of operational strategies and tools to help them translate the concept into the
reality of life of their constituents.
Project: an analytical tool for self-assessment and action by districts was
developed in Thailand as part of the Health Reform and HIV agenda supported
by UNAIDS, the Thai health Care Reform project and the Thai AIDS division. It
is designed for districts to analyse and improve the specific contribution of the
health care sector to the expanded response to HIV/AIDS. The tool assesses
the different stages of production of health outcomes in a systematic organized
way, looking at effectiveness, efficiency and financial viability. Starting from the
household up to the policy level it analyses the package of interventions offered
by the health system, as well as the availability of resources, access to the health
system, acceptability of services, continuity, quality, impact, equity and empowerment capacity of the health services provided. A problem solving framework helps
to identify local management factors and reform measures to be implemented to
improve the health sector response to AIDS. The analytical tool will be used to
regularly monitor the process of actual implementation of an improved response
to AIDS by the district health teams.
Expected Result: the tool will be tested by Thai provinces during the first
semester 1998, providing better knowledge on the response of the health sector
to AIDS and detailed insights on management and reform measures required to
improve this response in the near future. The tool and preliminary results will be
shared at the Conference. It will then be offered to other implementing agencies
worldwide.
S43537 Development of standards for cost-effectiveness
preventive approaches for STDs and AIDS in Honduras
Norma Patricia Rivera Scott. Col: Lara 2 Calle 2 Ave. Teguc Igalpa Honduras
Central America, Honduras
Issues: There has been few considerations regarding the costs of preventive
programs on AIDS and their sustainability, once external financing is finished.
There were no standards nor specified expected outcomes of such actions and
little information of the human resources profile required.

Project: Five expected outcomes were defined with health personel and communitary workers in collaboration with the 25 people hired by the Project to work
in 40 municipalities of priority in AIDS prevention and control.
Results: Local preventive health workers' profile: BS or MS university level,
social orientation, experienced in education and group work and organization,
trained in sexuality, gender, decision-making processes, discorse analyzis. Project
provides 100% salary for a year (US$7200) and 15% materials (US$400) trainer