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

244 Abstracts WePeF6629-WePeF6633

XIV International AIDS Conference

PLWHAs were turned away from other Christian Church rehabilitation centers.
This was due to the lack of HIV/AIDS education and awareness of these centers.
Faith Helping Centre has thus taken on drug users with HIV
Discussion: In 1994, the Faith Helping Centre accepted 2 HIV carriers. This
began the Centre's acceptance of HIV positive drug users into its programmes.
Many who have gone through the rehabilitation programmes were successful with
them rejoining the work force. Some have stayed on at the centre as volunteers
or social workers. There also a number of who have passed away. In 1996, the
Centre began providing lodging for AIDS patients who are not necessarily drug
users but have no family support. This may be due to incidences of discrimination
faced by them by their own family and community Family members and AIDS
patients accepted at the Centre are required to follow the rules and regulations
set forth.
Conclusion: Under the programme, during the first three months, the family
members are given information, guidance and education on care giving so that
the family members are able to understand and accept AIDS patients. Family
members were also requested to give financial and emotional support to them in
order that the patients were able to face their future with hope.
Presenting author: Shiuh Yun Chow, No.1, Jalan 7/18C, Taman Mastiara, Jalan
lpoh Batu 5 1/2, 51200 Kuala Lumpur, Malaysia, Tel.: [phone], Fax: +603
4042 6133, E-mail: [email protected]
WePeF6629 Reorganizing district hospital system, the second
step to improve care for PHAs
K. Weisuthanon. Government officer, Panomtuan distric hospital, Panomtuan
distric, Kanchanaburi, 71140, Thailand
Issues: There has been more pressure on district hospitals providing care for
PHAs according to the increasing number of symptomatic PHAs over the country. Since the universal health coverage scheme has been implemented last year,
most district hospitals still hesitate to deliver care due to attitude problem toward
HIV/AIDS, lack of knowledge and passive approach system.
Description: Panomtuan district hospital incorporated with NGOs has launched
the project in 2000 aimed to develop the model of PHAs friendly district hospital.
Series of training were done changing the attitude and improving knowledge of
health staff and health workers from target health centers. During the first year,
Home health Care team was set up and nurses started visiting patients at home
usually providing counseling and nursing care which was not enough in current
situation. Therefore, problems were discussed further in term of nurse's role and
essential medical supply that was needed. Finally, drugs for treating Ols got into
the hospital drug list and nurses had the authority to treat some common Ols
following the AIDS Treatment Guideline.
Result: Home Health Care nurses are able to manage their 30 clients at home
effectively through the guideline. All patients have continuum of care.
Recommendation: All district hospitals can be a center for AIDS care due to
their capacity and flexibility To develop this model, not only knowledge need to
be given to healthcare providers but system must be reorganized especially the
care center must be shifted from doctors to nurses.
Presenting author: Kasem Wejsuthanon, Panomtuan distric hospital, Panomtuan distric, Kanchanaburi, 71140, Thailand, Tel.: [phone], Fax: +66034
630407, E-mail: msfbthai @ ksc.th.com
WePeF6630 Use of anti-retrovirals in a slum-based home care
setting: The slum doctor programme model
S. Obwogo. po box 2563 (knh) Nairobi, kenya, Kenya
Issues: Use of antiretrovirals (ARVS) in poor resource settings is often discouraged, because of lack of monitoring facilities, inability to sustain therapy due to
high cost of drugs, fears of poor compliance due to pill burden, side effects, illetracy, and poor dosing schedules.This Home Based Care Programme targeting
slum dwellers incorporated anti-retroviral therapy with very good results.
Description: This programme was instituted by the Slum Doctor Programme
to follow up patients discharged from Kenyatta National Referral and Teaching
Hospital, in which, up to 70% of its beds are occupied by HIV patients. This
situation had led to congestion due to frequent re-admissions, and long hospital stay. Reasons for prolonged hospital stay included diarrhoea, chronic cough,
and headaches, and neglect by relatives. ToTs were trained and sent out to the
slum community to train the family members on how to care for their sick. They
also acted as Treatment Educators where ARVs and Opportunistic Infection (O)
drugs, mostly donations, were prescribed. They kept a daily tally of medications
taken, and recorded side effects, for the doctor's weekly perusal. Symptomatology determined initiation of therapy. Patients' progress was monitored by weight
gain, abscence of O.s, few admisions, clinical improvement, resumption of work,
and gained appetite. A marked difference was noted between patients on ARVs
and those on none. Drug compliance was 100%.
Lessons learned: A well coordinated Home Based Care Programme with the

family, community and doctor at the core, and lacking expensive laboratory back
up, can still in corporate ARVs with good results.
Recommendations: This research recommends use of simple monitoring techniques to enable use of ARVS in resourse poor Home Based Care Models.
Presenting author: Subiri Obwogo, po box 2563 (knh) Nairobi, kenya, Kenya,
Tel.: [phone], Fax: [phone], E-mail: [email protected]

WePeF6631I Problems encountered during supervisory visits of
home based care teams in Nchelenge District
Northern Zambia
E. Hart, C.P. Situmbeko. Medecins Sans Frontieres, Mddecins Sans Frontibres,
Zambezi Road 609, Roma - Lusaka, Zambia
Issues: In 2001 there were two different structures of Home Based Care (HBC)
teams in Nchelenge district. After meeting with the supervisors of both teams it
was decided to retrain one set of teams to the level of the other. This training
included multiple topics such as identification of patients for registering with the
HBC teams, the care of clients with chronic diarrhoea and with chronic cough.
Six teams were retrained. To assess the introduction of new information and to
discover new problems, regular supervisory visits were carried out.
Description: Monthly visits were performed by a medical doctor with experience
in HIV These aimed to 1. provide ongoing care to the chronically ill on the HBC
register 2. assess any gaps in the knowledge of care givers. 3. provide continuous support to the HBC teams 4. continue education to care supporters and
care givers 5. discover problems at site level that were not evident in the monthly
reports of each team. A record was kept of the clients visited and information
provided to the clients by the care givers was noted.
Lessons learned: Despite a week's intensive training there were still large gaps
in the knowledge of care givers. Record keeping was sporadically done. The commonest problems encountered were chronic diarrhoea and chronic cough. The
majority of care givers knew about ORS (oral rehydration solution) but were unable to provide clear directions for making it and were unable to provide information and guidance on sputum collection. There were problems with the supply of
record sheets and equipment needed for the smooth running of the teams.
Recommendations: 1. Initial training should include practical sessions at clients'
homes. 2. Ongoing training for the care givers should be provided in regular sessions using the information collected during supervisory visits to tailor the sessions to clients' needs and the gaps in the knowledge of care givers. 3. Emphasis
should be on regular and clear record keeping.
Presenting author: Elizabeth Hart, Medecins Sans Frontibres, Zambezi Road
609, Roma - Lusaka, Zambia, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
WePeF6632 Home based care in the rural setting
I.Y. Wong, M.B. Krauthamer, D.E. Coppock, E. Gustafson, C.W. Carter. Yale
School of Medicine, New Haven, CT United States
Issues: Home-based care (HBC) has emerged as a viable method of providing
for the diverse needs of people living with HIV/AIDS. However, various challenges
to the implementation of HBC exist, particularly in rural settings such as the Northern Province of South Africa.
Description: Qualitative research (situational analysis) to assess the potential
for implementation of home-based care in the Bushbuckridge Region of South
Africa's Northern Province. Research goals included 1) identification of existing home care services, 2) assessment of community health and education
resources, 3) the identification, through semi-structured questionnaires, of the
unique needs of potential recipients of HBC in the Bushbuckridge region, 4) synthesis of above findings into a framework for the regional Department of Health's
own HBC initiative.
Lessons learned: Though HBC has been identified by the South African government as a key response to the HIV/AIDS epidemic, few regions have initiated such
programs. However, when presented to a gathering of stakeholders, the results
of this situational analysis created considerable momentum toward government
buy-in. A three-tiered model was proposed which brought together the Bushbuckridge region's unique resources, namely: 1) trained volunteer DOTS supporters;
2) paid Community Rehabilitation Workers (CRWs); 3) local hospital and clinic
nurses.
Recommendations: 1. Mobilize the community's strengths (ie: volunteerism) and
use existing resources. 2. Model the program after a best practice model. 3. Create a strong link to formal health care institutions. 4. Recognize that HBC programs must be malleable. Some communities have more "basic" needs (ie: food
and water) and this may be the first step in the care of PLWHAs. 5. Emphasize
community ownership of the HBC program (ie: through town meetings, election
of caregivers). 6. Be cognizant of the challenges of transportation and communication in rural areas
Presenting author: Ilene Wong, 123 York Street, Apt 22U, United States, Tel.:
[phone], E-mail: [email protected]
WePeF6633 Challenges of expanding Home Care Networks
S. Plum. Khana, Phnom Penh, Cambodia
Issues: Home-based care is an essential part of Care and Support for people
living with and affected by HIV/AIDS (PLHA) in countries where access to health

service is minimal. Cambodia with 169, 000 cases of HIV/AIDS and the highest
prevalence in S.E. Asia face a severe shortage in the provision of care to PLHA.
Description: In an effort to mobilize government/NGO resources and remove
overlapping activities for PLHA in Phnom Penh the Home Care Network Group
(HCNG) was developed from an amalgamation of Home Care Programs (HCP).
HCNG enables a common agenda between government/NGOs in:decisionmaking;co-ordination;technical support; monitoring;supervision and representa