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

264 Abstracts WePeF6720-WePeF6724

XIV International AIDS Conference

WePeF6720I Presenting a screening tool for midwives to
identify HIV infected pregnant women with
advanced HIV related disease at risk of
complications
N.T.D. Naledi1, M.J. Besser2. 1University of Cape Town, 17 Chardonnay Rd,
Table view, 7441, South Africa; 2Groote Schuur Hosital, Cape Town, South Africa
Issues: In South Africa, HIV infection occurs in 24% of pregnant women. HIV
infection is the leading cause of morbidity and mortality in pregnancy. Immunocompromised HIV infected women are at greatest risk. Resources are not available to do CD4 tests or refer all HIV infected women to hospitals or doctors' care.
A simple screening tool is needed to identify women at greatest risk for adverse
outcomes due to advanced HIV related disease. These women can be referred to
providers and facilities able to care for patients at greatest risk for medical complications of HIV infection. The tool must be suitable for use by nurses and midwives
in a clinic setting.
Description: A screening tool identifies HIV infected pregnant women with advanced disease. At the initial booking visit women are screened with a tool featuring a 13-question clinical history, 5-point physical examination and haemoglobin
measurement. A nurse or midwife asks the questions and does the examination.
The nurse or midwife refers patients evaluated by the tool as "at risk" to doctors
who then decide if patients should be referred to a hospital for antenatal care
and/or delivery
Experience: The tool has been field tested in three peri-urban and two rural primary care centres. The experience of nurses and midwives using the screening
tool is good. An evaluation of the screening tool is underway looking at correlating
screening test results with CD4 and total lymphocyte counts.
Lessons learned: Pregnant women with advanced HIV disease are at greatest
risk for morbidity and mortality They can be identified using a simple screening tool designed for use by nurses and midwives. These patients can then be
referred appropriately.
Recommendations: All HIV infected pregnant women should undergo clinical
screening for advanced HIV infection. Women with advanced disease are best
cared for in facilities able to treat complications arising during antenatal care and
delivery.
Presenting author: Noncayana Tracey Naledi, 17 Chardonnay Rd, Table view,
7441, South Africa, Tel.: [phone], Fax: [phone], E-mail: Nnaledi
@pawc.wcape.gov.za
WePeF6721I PMTCT of HIV - Defining strategies to raise the
coverage of HIV+ pregnant women diagnosed and
treated
A.L.R. de Vasconcelos, E.C. de Oliveira, K.M. Sakita, I.N.Y Ayoub. STD/AIDS
Program-MOH, SQS 310 Bloco G ap.606, Asa Sul, Brasilia - DF, CEP:
70363-070, Brazil
Issues: The HIV epidemic in Brazil has reached smaller towns and people in the
lower socioeconomic class. Concerning PMTCT of HIV the main difficulties have
been the limitation of HIV test and qualified professionals in the antenatal clinics to offer HIV test with pre/post counselling. DESCRIPTION: Since 92, women
have been representing the largest growth of the epidemic, increasing the vertical transmission of HIV. The challenge has been to organize the diagnostic and
care facilities for HIV+ pregnant women in the speed that the epidemic has been
demanding. Brazil provides free of charge AZT and other ARV for HIV+ pregnant
women, IV AZT for them in labor and AZT and infantile formula for their infant. The
antenatal, the childbirth and the newly born care are also free of charge, meeting
in 86% the prenatal coverage and in 91.5% the hospital deliveries.
Lessons learned: From 91-94 when AZT was not being made available, the
growth of the cases of vertical transmission (VT) was accelerated, beginning to
drop the following years with the introduction of that ARV in spite of the low coverage of pregnant woman tested for HIV. Until Jun 2001 they were notified to the
MOH, 7314 cases of aids in children under 13 years of age, being 82% due to the
VT. The results show that is not enough the scientific progresses and the efforts
described above, to reduce VT of HIV for wanted levels demands the adoption of
strategies that quickly solves the problems that hinder the diagnosis and care for
HIV+ pregnant women.
Recommendations: The actions of PMTCT of HIV should be developed through
integrating activities/programs into woman and child health programs. In Brazil the
activities to PMTCT have been developed with the activities of those programs,
and through a Strategic Plan involving 724 of 5526 municipalities, allowing coverage for 100% of the pregnant woman.
Presenting author: Ana Lucia de Vasconcelos, SQS 310 Bloco G ap.606, Asa
Sul, Brasilia - DF, CEP: 70363-070, Brazil, Tel.: +55+61+4488008 or 4488071,
Fax: +55+61+4488057 or 2448633, E-mail: [email protected]

WePeF6722I Putting dual protection on the agenda in South
Africa
J.A. Smit1, M. Beksinska1, E. Gosa2. 'Reproductive Health Research Unit,
University of the Witwatersrand Health Consortium, Durban, South Africa;
2South African National Department of Health, Pretoria, South Africa
Issues: The prevalence of HIV in South Africa is unprecedently high, with an
estimated 4.7 million South Africans infected in 2000. Teenage pregnancy and

unwanted pregnancy rates are also high. The most commonly used contraceptive is the injectable method, which offers no protection against HIV, and condom
use is low. Promotion and implementation of dual protection strategies against
HIV and unwanted pregnancy are thus a priority in South Africa.
Description: This paper documents the proceedings of the first national symposium held in South Africa in November 2001 on dual protection strategies against
HIV, STIs and unwanted pregnancy. The aims of the symposium, attended by
representatives from the South African National Department of Health, local and
regional non-governmental organizations, and researchers, were to highlight the
need for a dual protection approach and to promote awareness, understanding
and implementation of dual protection strategies.
Lessons learned: The South African National Department of Health's reproductive health policies embrace the concept of dual protection and the Department
has the basic infrastructure in place to scale up the public sector condom programme. Yet, there is little promotion and practice of dual protection, and conflicting health messages are often conveyed by health service providers: one which
promotes the use of condoms to protect against infection; the other promoting the
use of non-barrier contraceptive methods to prevent pregnancy, because they are
regarded as more effective than barrier methods.
Recommendations: A commitment was made to re-orient health services to promote dual protection strategies by strengthening existing services and optimizing existing human and financial resources. Further, it was agreed that high risk
groups such as adolescents, pregnant and postnatal women, and core transmitters of HIV would be targeted for dual protection intervention strategies.
Presenting author: Jennifer Smit, P O Box 38084, Point, Durban, 4069, South
Africa, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeF6723 HIV/AIDS counselling by nurses and health care
workers - A YRG CARE Experience
S.K. Satish Kumar', S. Solomon1, A.K. Ganeshl, L. Mani', S.A. Thomas1,
R. D'Souza Yepthomi, K.H. Mayer2. 1YRG CARE, YRG CARE, #1 Raman St,
TNagar, Chennai 600017, Tamil Nadu, India; 2Brown University, Providence, RI,
United States
Issues: HIV/AIDS counseling assists people to make informed decisions, cope
better with their health condition, lead a more positive life, and prevent HIV transmission. When resource constraints prevent availability of trained counselors;
nurses and health care workers who have frequent patient contact are ideally
suited to fill the void. Though willing, implicating lack of skills they do not respond
to clients and patients in time of true need.
Description: YRG CARE through a grant from the World AIDS Foundation and
with technical support from the Fogarty program of Brown and Johns Hopkins Universities, conducted 6 three-day training workshop covering 202 nurse
and health care workers in 5 states in South India. Covering HIV/AIDS and
sex/sexuality issues, the trainers assisted participants to clarify their values and
attitudes, modify perceptions and outlook towards PLHA.
Lessons Learnt: Good counselling skills were best learnt through practice. Participants rated high mentoring sessions, interactions with those living with HIV
and review of case studies.
Recommendations: Patients value nurses and health care workers as competent professionals and repose faith and trust in them. HIV counselling delivered
by them ensures sustainability. Arguments that they are additionally burdened is
challenged when nurses and health care workers regarded psychosocial support
as an integral part of patient management and appreciated additional skill development. Additional recognition and financial compensation policy in hospitals
would be a motivator.
Presenting author: SK Satish Kumar, YRG CARE, #1 Raman St, T.Nagar, Chennai 600017, Tamil Nadu, India, Tel.: [phone], Fax: [phone], Email: [email protected]
WePeF6724 Guidance on care and support of HIV infected
women and children in the context of prevention of
mother to child transmission of HIV (PMTCT)
H. Dao', J. Perriens2, N. Shaffer3, E. Van Praag4, I. de Zoysa2. l WorldHealth
Organization/Centers for Disease Control and Prevention, Department of
HI V/AIDS, Geneva, Switzerland; 2 World Health Organization, Geneva,
Switzerland; 3Centers for Disease Control and Prevention, Atlanta, United
States; 4Family Health International, Virginia, United States
Issues: Prevention of Mother to Child Transmission (PMTCT) programmes allow
identification of HIV infected women and delivery of short course antiretrovirals
and other interventions to prevent HIV transmission to infants. They offer very limited direct benefit to HIV-infected women. Recent treatment breakthroughs and
their application in resource-constrained countries have led to demand for expanded care and support interventions that can benefit the health of the women
themselves during and after pregnancy, and the health of their children and fam
ilies. To date however, there is very little normative and strategic guidance on
care and support, particularly of HIV infected women and children in resourceconstrained settings. Additionally, recommendations on care and support of HIV
infected women or children are usually found in multiple documents, addressing
only parts of the care needs.
Description: The World Health Organization and its collaborative partners are
developing guidance on a comprehensive approach to care and support of HIV