Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts WePeC6087-WePeC6090 105

varying risk of HIV infection are substantial and thus the overall HIV prevalence
in the general population is unlikely to be similar to the unadjusted neonatal seroprevalence.
Presenting author: Susan Cliffe, Centre for Paediatric Epidemiology & Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom, Tel.: [phone], Fax: [phone], E-mail: [email protected]
SWePeC6087 ]Improved HIVIAIDS/STI serosurveillance among
antenatal clinic enrollees in Tanzania, 2001-2002
G.R. Somi, R.O. Swai. NACP Tanzania, Box 11857, Dar es Salaam, Tanzania
Background: In order to monitor the prevalence of HIV infection and to provide HIV/AIDS and STI data, sentinel surveillance was established in 1990. In
response to increased data needs from resource-limited settings and to prepare
for second generation surveillance, the National AIDS Control Programme modified sentinel surveillance in 2001-2002.
Objectives: To measure prevalence of HIV/AIDS and syphilis among pregnant
women.
Methods: Six regions and four antenatal clinics (ANC) per region were selected
for geographical and ecological representativeness, ethnicity, and social and cultural mix. Data were collected for three months from all pregnant women attending selected ANC for the first time for any pregnancy An estimated 400 and 200
clients enroll at each urban and rural ANC, respectively All ANC surveillance personnel participated in a 2-day protocol training and DBS preparation practicum
prior to data collection.
At booking a woman is interviewed and 3-5 ml of blood is collected for Rapid
Plasma Reagin (RPR) test and dried blood spot (DBS) preparation. DBS cards
are tested by serial ELISA tests at the HIV National Reference Laboratory.
Results: Nearly 10,000 ANC clients were tested during the 2001-2002 study period. Preliminary data reveal highest HIV/AIDS prevalence among young clients
attending urban vs rural sites in most geographic regions of Tanzania. Similarly,
highest RPR reactivity appears to be among young, unmarried women in urban
sites.
Conclusion: A higher level of standardization was introduced in this surveillance
cycle by centralized ANC staff training and DBS testing at the National Reference
Laboratory. DBS are prepared readily at room temperature and store efficiently.
This simple innovation enhances data collection in urban, rural and resourcelimited settings. Similarly, syphilis rapid assays that can be stored at room temperature are being evaluated in Tanzania and are also expected to improve STI
surveillance.
Presenting author: Geoffrey Somi, Box 11857, Dar es Salaam, Tanzania, Tel.:
[phone], Fax: [phone], E-mail: [email protected]

Presenting author: Ignacio Alastrue Loscos, Centro de Informaci6n y Prevenci6n del SIDA (CIPS), Direcci6n General de Salud POblica, C/ Micer Masc6 21,
46010 -Valencia, Spain, Tel.: [phone], E-mail: [email protected]
WePeC6089 Comparison between HIV and AIDS reporting data
for early detection of changes in epidemiological
patterns
C. Moreno', V. Martfnez Artola2, C. Fernandez3, M. Urtiagal, P. Sobrino4,
J. Castilla4. l nstituto de Salud Pilblica, Instituto de Salud Pdb/ica, Leyre, 15,
31003 Pamplona, Navarra, Spain; 2Hospital Virgen del Camino, Pamplona,
Spain; 3Hospital de Navarra, Pamplona, Spain; 4Centro Nacional de
Epidemiologfa (ISCIII) y Secretaria del Plan Nacional sobre Sida, Madrid, Spain
Background: HIV reporting systems provide information about the changes in
HIV transmission patterns earlier than AIDS case registers. We analysed time
elapsed between epidemiological findings detected by an HIV reporting system
and their manifestation in AIDS case statistics.
Methods: Navarra (Spanish region of a half million inhabitants) is doted with notification systems of AIDS cases and of HIV diagnoses since the mid-eighties.
We compared annual trends of HIV diagnoses and AIDS cases with information
updated in June of 2001.
Results: Until December 2000, 2345 persons were diagnosed with HIV infection,
of which 747 persons (32%) also had an AIDS diagnosis. The annual number of
HIV diagnoses reached its highest level between 1987 and 1992 (rates over 380
per million), and since then has decreased regularly, falling by nearly 83% until
2000 (65 per million). The annual AIDS incidence rate rose until 1995 (189 per
million), and after then presented a rapid decrease up to 37 per million in 2000.
Among injecting drugs users (IDU) the maximum number of new HIV diagnoses
occurred in 1987, whereas AIDS incidence reached its peak between 1993 and
1995. Among non IDU (mainly sexual transmitted cases) the annual number of
HIV diagnoses rose until 1992 and then showed a slow descent; nevertheless,
AIDS incidence reached its maximum in 1996. During last years a change in the
epidemiological pattern has occurred, from a predominant transmission pattern
among IDU to a predominant sexual transmission pattern. This crossing of both
transmission categories occurred in 1996 among new HIV diagnoses and in 2000
among new AIDS cases.
Conclusions: The HIV reporting system enables to detect epidemiological
changes in HIV transmission an average 4 years earlier than AIDS data, and
6-8 years earlier in the case of IDU. Advances in antiretroviral therapy are modifying AIDS incidence and thus makes it more difficult to identify changes in HIV
transmission from AIDS case data.
Presenting author: Conchi Moreno, Instituto de Salud POblica, Leyre, 15, 31003
Pamplona, Navarra, Spain, Tel.: [phone], Fax: [phone], E-mail:
[email protected]

I WePeC6088

Is the number of the HIV-infections rising in the
Valencia Community? Comparative analysis of HIV WePeC6090I Risk factors for HIV among late-presenting
seroprevalence and risk practices in the patients pregnant women in Porto Alegre (POA), southern,
that attended the AIDS information and prevention and Rio de Janeiro (RJ), southeastern Brazil
t-aEtrEa CUIPS fr th) f i t ti in tho ra 1999

IIrIb )L r or er meilt:115 1. yea st 5 I
and 2000
J.I. Alastrue Loscos1, C. Santos Rubio1, T Tasa Zapater', J. Trullen Gas2,
J. Belda Ibanez3, A. Fenosa Salillas 2, E. Fernandez Garcia3, C. Altava Padilla2,
R. Martinez Quintero3. '1AIDS Information and Prevention Centre (CIPS) -
Direccidn general de Salud Ptblica, Centro de Informacidn y Prevencidn del
SIDA (CIPS), Direccidn General de Salud Piblica, C/ Micer Masdc6 21, 46010
-Valencia, Spain; 2CIPS of Castellon, Castellon, Spain; 3CIPS of Alicante,
Alicante, Spain
Background: Despite the fall in the number of new AIDS patients in recent years,
there is uncertainty about the real evolution of new HIV-infections.
Methods: Hypothesis: the prevalence of HIV-infections has increased between
the years 1999 and 2000 in the patients that attended the 3 CIPS of the Valencia
Community first time. The study population was the 2359 people who attended at
first times the 3 CIPS in 1999 and the 2930 persons who attended in 2000. We
calculated seroprevalence by means of the binomial test with confidence interval
of 95%. To compare the two years, we used the Chi square test with significance
level of p<0.05.
Results: HIV-infection prevalence in 1999 was 3.60% (CI 95%, 2.89-4.44) and in
2000 it was 4.27% (CI 95%, 3.56-5.06). When we analyse the prevalence by risk
practices, we find that in 1999 15.99% of the Injecting Drug Users (IDU) were HIV
(+) and in 2000 they were 24.27% HIV (+) (p<0.05); that in 1999 the 5.58% of
male homosexuals were HIV (+) and in 2000 they were 5.71% (p>0.05) and that
if in 1999 the 1.52% of patients who attended because of heterosexual relations
were HIV (+), in the 2000 they were 1.44% (p>0.05).
Conclusions: Despite the rises of the seroprevalences are not statistically significant, except the IDU case, the break of the trend to the reduction, which was
taking place until 1999, calls our attention. The heterosexual relations' transmission has fallen, but in women with unprotected heterosexual relations, prevalence
has risen from 1.18% in 1999 to 1.61% in 2000 (p>0.05) so that in the year 2000
72% of the infections with origin in heterosexual relations appeared in women. On
the other hand, the fact that drug consumption has been responsible for 66,4%
of the infections by HIV in the 2000 makes it essential to reinforce the programs
directed to diminish the risk of infection in these patients.

El. Bastos', M. Derrico', V.G. Veloso', K. Nielsen2, M.G. Morgado',
J.H. Pilotto3, E. Joao4, B. Grinsztejn', R. Kreichtmann5, R. Fonseca6
B. Riegel7, B. Busch8, Y. Bryson2. 1'Oswaldo Cruz Foundation, Rio de Janeiro,
Brazil; 2UCLA, Los Angeles, United States; 30swaldo Cruz Foundation & Nova
Iguacu Reference Center and University, Rio de Janeiro, Brazil; 4Servidores do
Estado Hospital, Rio de Janeiro, Brazil; 5Porto Alegre Municipal Health Center,
Porto Alegre, Brazil; 6Femina Hospital, Porto Alegre, Brazil; 7N S Conceicao
Hospital, Porto Alegre, Brazil; 8 Praca XV Maternity Rio de Janeiro, Brazil
Background: The South (SO) and southeastern (SE) regions of Brazil have
demonstrated different profiles of the HIV epidemic since the mid-1990s. While
the epidemic has reached a plateau in SE metropolitan cities, it has been escalating in the SO. Disadvantaged women and/or those injecting drugs have been
particularly affected in this area
Methods: As part of a research project targeting pregnant women in the peripartum period who attended prenatal care in an irregular way & were unaware of
their HIV status, 4,562 women were recruited from 6 maternities in the metropolitan area of RJ (n=3,458) and POA (n=979), counseled and tested for HIV using
Determine~ rapid test, and answered a brief questionnaire. Risk factors for those
women testing positive for HIV (rapid test + WB) were assessed through contingence table statistics and logistic regression
Results: HIV prevalence was high in POA (6.1%), 4 times higher than in RJ
(1.4%), approximately 4x (POA) and 2x (RJ) higher than surveillance data for
pregnant women regularly attending prenatal care in these respective areas. The
following risk factors were independently associated with HIV seroprevalence: in
RJ: monthly family income less than US$ 40.00 (AOR 2.96; 95%CI 1.30-6.78);
history of miscarriages (AOR 1.96; 95%CI 1,09-3.55); less than 3 consults during
prenatal care (AOR 2.76; 95%CI 1.46-5.18), being of younger age (<21 y) was
negatively associated (AOR 0.31; 95C1% 0.13-0.74); in POA the major risk factors
were monthly familiar income less than US$40.00 (AOR 4.14; 95C1% 1.46-11.71)
and being Afro-Brazilian (AOR 2.62; 95%CI 1.48-4.65)
Conclusions: While Brazilian efforts to curb HIV epidemic have been successful
in different populations, high prevalence among women living in dire poverty is of
particular concern, especially in the south, and all efforts must be made to enroll
them in comprehensive prenatal care and to implement intervention strategies in
vulnerable communities