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

230 Abstracts WePeE6588-WeOrF1l287

XIV International AIDS Conference

The number of teen-agers sexually active was 161. The average age of first nonprotected sexual intercourses was 12.6 ~ 3.2.
33 orphans asserted having already used condoms, it was used as contraceptive
in 29 cases (87.9%), in irregular way in 4 other cases(12.1%). There was not case
of systematic use of condom.
Conclusion: Beyond the social consequences, the loss of parents for AIDS has
repercussions on psychological development. In this work, psychological troubles
were observed in considerable number of orphans.
These troubles shall be confirmed by psychological tests.
In consequence, it is indispensable to integrate the psychological rehabilitation
into the program of Caring of AIDS orphans.
Presenting author: Julien Makaya, case J 043 V OCH Moungali III, B.P. 45,
Brazzaville, Congo, Tel.: [phone], Fax: [phone], E-mail: amabrazza
@yahoo.fr
WePeE6588 Assessment of the social situation AIDS orphans
in Brazzaville
F.F.R. Mboussou1, J. Makaya2, T. Bansimba2, A.S. Latifou3, A. Ambendet3,
M.F. Puruehnce4. 1, Case J 043 V OCH Moungali Ill, BP 45, Brazzaville, Congo;
2Medecins DAfrique, Brazzaville, Congo; 3UNICEF, Brazzaville, Congo;
4 Programme National de Lutte contrele Sida, Brazzaville, Congo
Background: The phenomenon of AIDS orphans is a well known disaster linked
to HIV/AIDS. The loss of parents make children undergo oppressive losses, particularly in developing countries weakened by poverty, wars and AIDS. Our aim
was to assess the importance of the phenomenon in Brazzaville and to appreciate the social repercussion on the child. It is link on "Caring of AIDS orphans"
program of NGO MEDECINS D'AFRIQUE sponsored by UNICEF-CONGO.
Methods: We have listed the adults death due to AIDS recorded in Brazzaville
hospitals between January 1998 to September 2001. Families of these old patients were inquired and visited. We have searched the partners' situation and
number of children of less than 18 years. Age, sex, schooling, tutor's situation
were precised for each child.
Results: On a amount of 1622 cases of deaths due to AIDS recorded, 1293
families have been visited. 3377 orphans were listed, 244 (7.2%) were under 5
years old, 2004 (59.4%) between 5 to 14 and 1129 (33.4%) between 15 to 18.
Average age of orphans was 11.7 ~ 4.4, with 1668 boys (49.3%) and 1709 girls
(50.7%). The majority of orphans were received by close parents: 3156 (93.4%)
vs. 27 (0.8%) lodged in orphanages. 194 orphans of less than 18 years became
heads of families. New tutors were jobless or retired in 1964 cases (58.2%), tutors of 945 orphans have average wages with at least 6 persons in charge. The
average number of persons in charge by family was 7.5~ 5.2. Among 3133 orphans in scholar age, 2578 (52.3%) were still at school. A school delay at least
two classes was noticed to 41.2%, 799 children have abandoned school and have
asked a support of the project.
Conclusion: The phenomenon of AIDS orphans constitute a real social crisis.
The one of parents' loss for AIDS decreases accessibility to basic social services
for many children, increasing so invulnerability in front of AIDS.
Presenting author: Franck F R Mboussou, Case J 043 V OCH Moungali Ill, BP
45, Brazzaville, Congo, Tel.: [phone], Fax: [phone], E-mail: fmboussou
@yahoo.fr
WeOrF12851 Dual tuberculosis and HIV epidemic in Chiang Rai,
Northern Thailand: The integrated approach
S. Supawitkul1, H. Yanai2, T. Yoshiyama3, S. Nedsuwan1. 1Chiang Rai
Provincial Health Office, Chiang Rai Provincial Health Office, Singhaklai Road,
Muang District, Chiang Rai, 57000, Thailand; 2Research Institute of
Tuberculosis, Japan, Chiang Rai, Thailand; 3Research Institute of Tuberculosis,
Japan, Kyose, Japan
Issues: Dual TB/HIV epidemic increases the problem-complexity and the careburden. It is essential to develop the appropriate public health strategy to contain
the epidemic.
Description: Chiang Rai, the northernmost province of Thailand, confronted the
explosive HIV spread since the early 1990s. At the end of year 2001, among its
1.2 million population, the official cumulative reported AIDS cases, AIDS related
deaths, and AIDS affected children mount to 20,600, 5,287, and 3,287 cases respectively. The relative previously well-controlled tuberculosis (TB) endemic rose
3.5 times after the 12-year of HIV epidemic. Tuberculosis was the major opportunistic infection in AIDS patients (14.3 E29.8%). HIV/TB co-infections among
new TB cases increased substantially (5.33% in 1990 to 42.85% in 1999). The
re-emerging of HIV/AIDS stigma and discrimination occurred due to missed interpretation of TB cases as AIDS and fear of care givers to acquire TB. The integrated TB/HIV services and personnel was adopted e.g. incorporating TB/HIV
counseling services, peer support activities to increase drug adherence, implementing DOTS for TB cases and ARV-treated AIDS patients, home and commu
nity based care for holistic and continual care; incorporating active case finding
and household contact case screening for TB in HIV cases; providing isoniazid
preventive therapy (IPT) for HIV infected people. PWA groups and day care center
services played vital roles in TB/HIV prevention and care. The treatment default
rate of TB-patients decreased from 24.2% in 1995 to 5.2% in 1999. The IPT noncompliance rate decreased from 57% in 1995 to 17% in 1999. The TB-MDR rate
gradually decreased from 6.5% to 2.8% during 1996-2000.

Lesson learned: The dual TB/HIV epidemic substantially follows the mature HIV
epidemic. Strengthening of existing TB and HIV services is crucial. Integrating
and incorporating TB and HIV services is a new effective public health approach
in resources-limit countries.
Presenting author: Somsak Supawitkul, Chiang Rai Provincial Health Office,
Singhaklai Road, Muang District, Chiang Rai, 57000, Thailand, Tel.: +66 53
711403, Fax: [phone], E-mail: [email protected]
WeOrF12861 A model intervention on HIVIAIDS/STI to poor
underserved populations in mega cities like Sao
Paulo
M.E.L. Fernandes1, P. Lamptey2, D.C. Costa Filho(in memorium)3,
M.P.S. Matos4, I.C. Gouveia4, A.D. Jatene4. 1Association for Family Health, Rua
Francisco lasi, 94, 05407-050 - Pinheiros, Brazil; 2Family Health International,
Washington, United States; 3State Department of Health, Sao Paulo, Brazil;
4Zerbini Foundation, Sao Paulo, Brazil
Background: During 2000-2001 Association for Family Health (AFH), Family
Health International (FHI), the State Department of Health and the Zerbini Foundation implemented a project to integrate HIV/AIDS/STI prevention and care to
existing primary health care services at 9 health care units located in the southeast region of Sao Paulo. The region includes 5 slum areas, and a population of
300.000 people. A budget of 8 million USD per year was committed for the payment of salaries, drugs and health care units maintainance. The HIV/AIDS project
funded by the Elton John AIDS Foundation (EJAF) provided 120.000 USD to integrate HIV/AIDS/STI.
Methodology: A field work team compromised of 187 health agents, 33 physicians, 33 nurses and 64 nurses aides were trained in human sexuality, reproductive health matters, including HIV/AIDS and STI, counseling, contraception and
so forth to conduct door-to-door outreach work with the population. Considerable
update courses and capacity building was conducted taking into account the individual and collective experiences. In order to implement the family health program
activities, the region was mapped and each trained health agent was responsible
for a specific geographic area called micro area containing a total of 200 families
with an average of 5 people per family.
Results: During a one year period a total of 312.482 contacts were performed by
trained teams; 70.000 women and 20.000 adolescents were educated 40 supervisory meetings were conducted and 30.979 patients were cared and treated at
9 different health care units. Due to relevant financial counterpart contribution the
HIV/AIDS activities were maintained after the EJAF funds were over.
Conclusion: The integration of HIV/AIDS prevention to the primary care program,
called Family Health Program is a model for the implementation of a sustained response to HIV/AIDS in Brazil to poor underserved populations.
Presenting author: Maria Eugenia Lemos Fernandes, Rua Francisco lasi, 94,
05407-050 - Pinheiros, Brazil, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WeOrF1 2871 The cost-effectiveness of the Zambian ProTest
Project: integrating voluntary counselling and
testing with tuberculosis activities
F. Terris-Prestholt1, L. Kumaranayake1, R. Ginwalla2, H. Ayles',
P. Godfrey-Faussett1. 1London School of Hygiene and Tropical Medicine,
LSHTM-HPU, Keppel Street, WC1E 7HT London, United Kingdom; 2Zambart,
Lusaka, Zambia
Background: The Zambian ProTest project encouraged voluntary counselling
and testing (VCT) as an entry point to integrate case management and prevention
of HIV-related tuberculosis (TB). A key aim was to enhance collaboration between
health services and community organisations. Core components of ProTest are
co-ordination between existing HIV/TB activities, provision of VCT with TB preventive therapy (PT), outreach and clinical services for HIV-related illnesses (ProTest
clinic). Other activities include youth friendly services, a hospice for terminally ill
patients and home based care (HBC). The ProTest project has lead to a substantial increase in people presenting for VCT, and has improved care for people living
with HIV. The cost-effectiveness for each activity for the 2 ProTest sites, Chawama
and Matero, was estimated.
Methods: Financial and economic costs were collected retrospectively from
November 2000 to October 2001 from the providers' perspective using the
ingredients-based approach. Costs for the start-up and implementation of ProTest
activities were included, all research related costs were excluded. Project outcomes and effectiveness indicators were collected prospectively by project staff.
Results: The total annual economic cost of co-ordinating all ProTest components was US$3189 and US$3504 in Chawama and Matero, reaching 3604 and
258 people, respectively. The cost-effectiveness of VCT was US$31-US$33 per
person post-test counselled and the incremental cost-effectiveness of PT was
US$17-US$24 per person completing the full 6-month course. A visit to the

ProTest-clinic costs US$7-US$8. Both the hospice and HBC rely heavily on donations and volunteer time, leading to a 3-fold difference between financial and
economic costs.
Conclusions: The additional cost of co-ordinating the services available to people with HIV and TB is very low, although the unit costs are highly dependant on
the size of the VCT service.