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

242 Abstracts WePeF6619-WePeF6623

XIV International AIDS Conference

WePeF6619 Neuropsychology in community management of
complex clients with HIV/AIDS
M. Holmes, R. Attwood, G. Cole, P. Ditzell, J. Thompson, D.S. Murray. ADAHPT
Darlinghurst NSW Australia
Issues: ADAHPT is a statewide tertiary service for people with HIV and complex
needs in New South Wales, Australia, established in 1997 as a response to the
needs of people with AIDS dementia complex (ADC) and HIV psychiatric conditions. The advent of HAART and its associated physical health and longevity
has led to an increasing number of clients with multiple complex issues, such as
ADC, psychiatric conditions, substance abuse issues, and psychosocial issues.
Thus ADAHPT has expanded its role to include "people with HIV and complex
needs". Along with this expanded role, the role of the neuropsychologist has also
changed.
Descriptions: For the clients of our team, management planning is not merely
about prescribing medications. Indeed, many of our clients do not take antiretroviral medications at all. Rather, it is aimed at managing these clients in
the community, and as such neuropsychological assessments play an important role due to the relatively high incidence of cognitive impairment in this client
group.
Lessons learned: This paper will discuss in detail the role of neuropsychological
testing in community management planning, and its role within this team. Examples will be given of how neuropsychological test results and recommended
strategies can be used within a community setting, regardless of whether or not
the client is on HAART.
Recommendations: It will also be argued that even when access to diagnostic
testing is unavailable, management strategies can nevertheless be employed if
cognitive impairments are detected and recognised as such.
Presenting author: Michelle Holmes, 301 Forbes St, Darlinghurst NSW 2010,
Australia, Tel.: [phone], Fax: [phone], E-mail: holmesm
@sesahs.nsw.gov.au
WePeF6620 Sustainability of home-based care and support
programs in Western Kenya
S.W. Wangila1, S.W. Wafula2, K. Mukhwana3. 1Family Health International, P0.
Box 135, Kakamega, Kenya; 2Family Planning Association of Kenya, Kakamega,
Kenya; 3 Population Services International, Kakamega, Kenya
Issues: Home-based care is one of the newer interventions that is being implemented to deal with the explosion of AIDS clients in Africa. In Western
Province of Kenya two home-based care projects are being implemented to serve
the population in need but also to learn lessons on how to make such programs
sustainable. Home-based care programs, while reducing the costs of hospital admission, are also costly and ways must be found to make them as sustainable as
possible, as these types of programs can quickly drain the resources of NGOs
and CBOs, which are caring for the sick patients.
Description: This paper will attempt to examine the Alma Ata declaration, which
laid the foundation of empowering the community taking responsibility in its own
health using community health workers. The role of the CHW does change, however, when dealing with AIDS patients, from a preventive focus to a palliative
one. The paper elucidates the challenges, opportunities and constraints experienced in implementing home based care and support projects looking particularly
as how they can become sustainable in resource poor environments. The paper
concludes with recommendations on sustainable program designs from the local
and international experience.
Lessons learned: Establishing referral networks and building local and international alliances is important. Empowering the community and the local
CBOs / NGOs with technical capacity building, proposal writing and project management skills is needed for sustainability. Building family and community local
resources makes external resource complementary. Need to rethink the use of
volunteers and the involvement of PLWHAs in care and support activities. Care
and support begins at the time of diagnosis of HIV.
Recommendation: A participatory program design process using PRA/RRA approaches can empower the community and CBOS / NGOs to initiate, manage
and sustain a home-based care and support project.
Presenting author: Silas Wangila Walumbe, P.O. Box 135, Kakamega, Kenya,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeF6621 Domestic home help & assistance in France: from
a 10 years experience with PWAs to offering same
services to persons concerned by a chronic
disease
B. Hup. Aides I/e-de-France, Aides lie de France, Coordination du Maintien a
Domicile, 39 rue des JEUNEURS, 75002 PARIS, France

Issue: Since 1990, AIDES, a French NGO, the French Ministry of Health and the
contributory Social Security services have been associated to provide domestic
help and assistance to families living with Aids who don't need to stay in a hospital. Public funds are used to cover housekeeping and/or home helper, home night
sitter salaries and also evaluation and coordination cost. After 1996, these services have been extended nationwide, being available for each needing person
in France, involving also financially each French "conseil Generaux" (each local
area assembly).

Description: In Paris, 15 private organisations are working with AIDES ILE DE
FRANCE in order to provide home care and various services to 300 families living
with aids, for more than 6 000 hours per month.
Currently, this service has been extended to a group of 50 persons (monthly
helped with 1250 hours of housekeeping and/or assistance) who are not suffering from aids but have nevertheless great needs because of chronic diseases,
physical disabilities, long-term health conditions, dementia, or terminal illnesses.
Lessons learned: these services need to consider the person as the center of
everyone's attention and support; in order to establish the needs, the evaluation
and the coordination have to be local and near; the home helpers and night sitters
have to receive a specific training; the allowance must be guaranteed and flexible. Professionals involved in care or help services and assistance have to work
together for the most efficient result.
Recommendations: There is a benefit in terms of health-related quality of life in
providing subsidized home help involving profesionnal services (services such as
housekeeping, meal preparation, home & outside attendant or home-health aide)
to PWAs that can be extended also to persons concerned by any chronic disease.
Presenting author: Bruno Hup, Aides lie de France, Coordination du Maintien A
Domicile, 39 rue des JEUNEURS, 75002 PARIS, France, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WePeF6622I Building the capacity of young people to care for
PLHA and orphans and vulnerable children (OVC)
J. Motsepe1, E. Esu Williams1, M. Chambeshi-Moyo2, M. Chomba3. 1Population
Council/Horizons Program, Box 2823 Randburg 21125, Johannesburg, South
Africa; 2CARE/Zambia, Lusaka, Zambia; 3Population Council, Lusaka, Zambia
Issues: Young people are increasingly caring for PLHA and OVC. To make these
experiences productive and positive, young people need to be properly trained
and supported.
Description: The Horizons Program and CARE/Zambia are conducting an intervention study to build the capacity of young people to care for and support PLHA
and OVC. The study involves about 1,000 youth, belonging to 30 school-based
and community clubs. Prior to intervention activities, the attitudes of young people toward PLHA and orphans and treatment of orphans in the community were
determined from a PLA study and in-depth interviews. A training curriculum was
developed and pre-tested, covering topics such as: stigma and HIV disclosure,
gender, children's rights, HIV/AIDS related conditions, VCT, referral, community
and home-based care, youth and community involvement in care and support
and monitoring. Follow-on field activities were conducted and club patrons were
trained to facilitate activities of youth caregivers. Ten kits containing basic materials such as apron, soap, salt, disinfectant, gloves, cotton wool, bandages, notebooks, pens and monitoring forms were provided to each club and instructions
on use provided. The support of adult home-based caregivers, clinic staff, village
chiefs and leaders was solicited.
Lessons Learned: Workshop-based and hands-on field training activities are important ways to build the capacity of youth caregivers. Gender-related care and
support capacity needs of youth caregivers should be indentified and addressed.
Advocacy to enhance the participation of OVC in club activities is important.
Recommendations: Periodic retraining and feedback are essential to strengthen
skills and to address emerging issues. Effective ways to monitor and sustain youth
care and support activities, and the use of consumable materials should be established.
Presenting author: Eka Esu-williams, Box 2823 Randburg 21125, Johannesburg, South Africa, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeF6623 Quality of services for people living with HIV/AIDS
and TB in developing countries
D. Haran, V. Doyle. Liverpool School of Tropical Medicine, Livernpool School of
Tropical Medicine, Pembroke Place, Liverpool, L3 50A, United Kingdom
Issues: In many countries the prevalence of HIV and TB infection is so high as
to threaten the viability of the public health facilities. The imperative to deal with
the sheer volume of work has until now detracted attention from the quality of the
services provided. Quality of TB and HIV/AIDS programmes is important because
their effectiveness is directly affected by how well the services are provided from
a professional, service provider and client perspective.
Professional standards and guidelines should be, but are not always, based upon
evidence of effectiveness. Staff views of quality often influence their compliance
with professional standards and the interpersonal skills they bring into play in
care-giving. Client views of quality influence their response to health services
and their perceptions of the benefits of different types of service delivery. In TB
services they can also substantially influence the effectiveness of the TB programme itself since patients who perceive that the service is of poor quality may
discontinue treatment.

Description: Experience from two projects on TB services and HIV/AIDS community based care will be described to identify the important dimensions of quality
for HIV and TB services.
Lessons learned: At the individual level quality relates to the effectiveness of the
care provided in meeting the specific needs of that individual, the acceptability of
the way in which the care was provided and the interpersonal factors that ensure
that the episode of care was perceived as useful. At the service level quality re