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

XIV International AIDS Conference

Abstracts WePeF6716-WePeF6719 263

Presenting author: Piyada Kunawararak, CDC Region 10, 447 Lumphun Road,
Muang Distric, Chiangmai, 50000, Thailand, Tel.: [phone], Fax: [phone], E-mail: liew31 @hotmail.com
WePeF67166 Modified Drug Observed Treatment (DOT) of
Tuberculosis/HIV co-infecction: the adhesion
depends on everyone
L. Medeiros, PR. Pereira. Municipal Ambulatory of STD/AIDS (AMDA), 143,
Tijuca Street, Campinas, Brazil
Issues: The Tuberculosis/HIV co-infecction is a chalenge for the health professionals. The adhesion to the treatment is primordial to improve the AIDS patients'
prognostic, to break down the tuberculosis transmition chain, and also to prevent
the multidrug resistance (MDR) bacillus development.
Description: In 1999, DOT was implemented at the municipal ambulatory of reference of STD/HIV/AIDS, in Campinas, Brazil, and since that it has been additionated new different practices to DOT strategy, which is responsable for the
term "modified". A health agent makes home visits once or twice a week. The visits promotes the establishment of a confidance relation between the health agent
and the patient, which is based on information exchanges, respect, in addition to
the stimulus for the patient self-confidence and self-care. The results showed a
significant increment of tuberculosis cure rate on patients submitted to DOT (from
54,5% in 1998 to 72,5% in 2000). Also, there was a decrease of treatment abandon rate (from 19,8% in 1998 to 7,8% in 2000). On the other hand, patients that
did not adhere to the project (self-administrated treatment) presented a cure rate
equal 43,2% and treatment abandon rate equal 27,2%, during the same period.
Lessons learned: The "modified DOT" is efficacious in relation to tuberculosis
treatment adhesion and cure. The establishment of a closer relationship between
the health agent and the patient is important to their citizenship development.
Some of the patients that had their tuberculosis cured passed out, but was observed that they had a better life quality, and an easy death than those that did
not participate on the project.
Recommendation: The DOT should be implanted with additional observation on
the anti-retroviral medications and adequated to each local reality.
Presenting author: Luciene Medeiros, 143, Tijuca Street, Campinas, Brazil, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeF6717 Building an integrated model of an STD/Aids
action program in the basic health care system of
the state of Sao Paulo
M.C.S. Monteiro1, V.M. Pinto1, J. Caraciolo, R.A. Fraissat1, M.C. Gianna,
R.A.V. Lourenzo2, C.R.P. Barros3, M.C. Megid4. 1STD/AIDS State Programme
of Sao Paulo, Rua Santa Cruz, 81, Vila Mariana, Sao Paulo, 04121000, Brazil;
2Family Health State Programme of Sao Paulo, Sao Paulo, Brazil; 3Family
Health State Programme of Sao Paulo, Sao Paulo, Brazil; 4Health Secretary of
the State of Sao Paulo, Sao Paulo, Brazil
SubjectPublic health services are part of Single Health System(SUS) on the
three government levels, forming a regionalized and hierarchy network organized
to provide full health care which includes the participation of the community. State
Coordination of the STD/Aids Program/Sao Paulo, seeking more integration with
the network, has prepared the document "STD/Aids Prevention/ Assistance Actions in the Basic Health System of the State of Sao Paulo" with the purpose
of starting a broad discussion on such actions on the central level of the Health
Authority, involving the SDT/AIDS Program, the Health and Family Health Community Agents Program, and the Women, Children and Adolescents Health Program.
DescriptionDiagnosis was done for the situation of the Regional Health Management Offices and cities regarding the integration of STD/Aids prevention/assistance which identified items such as the lack of commitment from managers and professionals, lack of guidelines, lack of articulation involving reference
and counter-reference. Based on the results achieved by this questionnaire, 03
workshops were put up by strategically dividing the State in three areas, which
considered similarity to make the discussion of the proposal politically easier. At
the workshop, discussions were fruiftul and enabled to identify hindrances to the
integration of programs. At the end of each workshop, an action plan was developed for each area, and the process was assessed in detail which generated a
report that consolidates the base document and the guidelines
Lessons LearnedThis process confirms that the lack of integration among the
programs is an obstacle to the development of STD/Aids prevention/assistance
actions.
RecommendationsThe political discussions between the several government
levels must enable to identify handicaps that prevent the integration of programs.
They must also serve as a tool for the process as a guide for the "prevention
model".
Presenting author: Maria do Carmo Monteiro, Rua Santa Cruz, 81, Vila Mari
ana, Sao Paulo, 4121000, Brazil, Tel.: [phone], Fax: [phone],
E-mail: [email protected]

WePeF6718 The Start study: A pilot project to integrate
antiretroviral therapy into Tuberculosis directly
observed therapy/short course (TBDOTS) program
in a resource constrained setting
C. Jack1, G. Friedland2, U. Lalloo3, W.M. EI-Sadr4, M. Murrman5, 0. Abdool
Karim6, S. Abdool Karim6. IDepartment of Medicine, Nelson Mandela School of
Medicine, University of Natal, AIDS Program, Yale School of Medicine, 135
College Street, New Haven, CT South Africa; 2AIDS Program, Yale University,
New Haven, CT 06437, United States; 3Department of Medicine, University of
Natal, Durban, South Africa; 4Mailman School of Public Health, Columbia
University and Harlem Hospital, New York, N. Y, United States; 5Mailman School
of Public Health, Columbia University, New York, N. Y, United States; 6University
of Natal, Durban, South Africa
Issues: Tuberculosis (TB) is the leading cause of death in patients (Pts) with
HIV/AIDS in Africa and up to two thirds of pts with TB have HIV(TB/HIV). Even
with successful TB treatment, 30% of TB/HIV pts die within one year of diagnosis
due to untreated HIV. Antiretroviral therapy (ART) has resulted in 90% decrease
in mortality in TB/HIV pts. Treatment of both HIV and TB requires attention to multiple factors including adherence. The utility of using existing TBDOTS programs,
which exist in many resource-constrained settings, as sites for initiation of ART
has not been explored.
Description: A pilot study in pts with TB/HIV at Durban City Chest Clinic, South
Africa to address attitudinal, logistical, clinical and training issues needed to provide co-administration of once a day and TB and HIV therapy(rx). Training and
planning activities developed and well received by TB program staff. Procedures
developed for identification of eligible pts, provision of HIV counseling and testing and addressing confidentiality and stigma concerns. ART regimen: lx daily
didanosine, lamivudine, and efavirenz (directly observed 5 days/week with TB
meds; self-administered on weekends). Pts adherence training for weekend and
eventual self-administration to be conducted. Follow-up for HIV disease at HIV
clinic at completion of TB treatment. Monitoring for pregnancy (efavirenz) and
drug toxicities, adherence and drug interactions (trough levels of efavirenz and
rifampin) and measures of efficacy developed. Enrollment of pts to be completed
by April 2002.
Lessons learned: Addressing multiple medical, behavioral, training, and logistical issues requires on-site attention and both TB and HIV expertise and staff
collaboration.
Recommendations: TBDOTS programs represent logical and efficient potential
sites for introduction of ARTin resource-constrained settings. Logistical, training
and medical issues must first be successfully addressed and feasibility determined.
Presenting author: Gerald Friedland, AIDS Program, Yale School of Medicine,
135 College Street, New Haven, CT, United States, Tel.: [phone], E-mail:
gerald.friedland @yale.edu
WePeF6719 Experience of field-testing clinical guides on
prevention of mother-to-child transmission of HIV
J. Mandala Kol, E. Hoff2, J. McIntyre3, T. Farley1. 1 World Health Organization,
WHO, FCH/RHR, 20, avenue Appia, ch- 1211, Geneva 27, Switzerland; 2World
Health Organization, Harare, Zimbabwe; 3University of of Wiwatersrand,
Johanesbourg, South Africa
Background: Rapid progress made in developments in mother-to-child transmission (MTCT) of HIV need to be translated into recommendations for health care
workers particularly in resource-limited settings. The World Health Organization
(WHO) developed "Clinical guides for the management of pregnant women with
HIV infection."
The objective of the field-testing is to assess whether the guides are user friendly
and contain adequate and relevant guidance.
Methods: Since August 2001, five developing countries in three different cultural
setting and with different experience in preventing MTCT of HIV, were invited:
Thailand, Ethiopia Kenya, the Bahamas and Guyana. A limited number of health
workers from urban and rural areas, from all levels of the health system, were
asked to read and assess if the guides would be helpful and relevant in their own
setting. Their feedback was collected through group discussion and individual interviews.
Results: The field testing has been completed in Thailand and Ethiopia. The
clinical guides were well received but some changes were suggested, including: further simplify the presentation and remove information of little relevance
in resource-limited settings; adapt the illustrations to the cultural context. Other
suggestions differed between countries: e.g. Ethiopia felt that termination of pregnancy could be considered under certain conditions to prevent MTCT, but Thailand strongly suggested this not be mentioned. All the health workers felt that
field testing was an important step in acceptance and adoption of the clinical
guides.
Conclusions: The field testing allows to adapt the content and format of the
guides which should be generic with flexibility for country adaptation. A benefit of

field testing is to facilitate acceptance of the manuals by health workers.
Presenting author: Justin Mandala Kol, WHO, FCH/RHR, 20, avenue Appia, ch1211, Geneva 27, Switzerland, Tel.: [phone], Fax: [phone],
E-mail: [email protected]