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

272 Abstracts WePeF6757-WePeF6760

XIV International AIDS Conference

Province, South Africa. Since then PMTCT programs have been extended to 60%
of pregnant women in the province. By June 2002, 95% of pregnant women will
have access to PMTCT demonstrating the feasibility of scaling up this program to
cover large populations. Standardized protocols for counselling and testing (VCT),
maternal and neonatal care and paediatric follow-up have been developed to educate and instruct health care providers. These protocols will be available to a
wider audience through a provincial web site.
Description: PMTCT protocols have been developed, field-tested and refined.
The protocol describes a nevirapine-based PMTCT program. There are two editions of the protocol. A comprehensive edition details policy and practice in text
and flowcharts. It captures operational aspects of program implementation including detailed explanations of logbooks and monitoring forms. This edition is
intended for site managers and staff training. A summary edition details procedures for clinic personnel and is intended for active use by clinic staff. There are
flowcharts for VCT, labour and delivery care, postnatal administration of nevirapine to the baby, paediatric follow-up and paediatric testing. The protocols have
been used successfully in 15 sites; including urban, peri-urban and rural settings.
Lessons learned: Protocols are a useful tool for ensuring program implementation is coherent and consistent. Protocols must be both comprehensive and userfriendly. Two editions of protocols are available to serve multiple purposes. The
protocols have proven effective in numerous field settings and can be adapted to
suit the needs of a site.
Recommendations: PMTCT programs can use standardized protocols modified
for managers, trainers and clinic staff. Protocols can be adapted for use in a variety of settings.
Presenting author: Mitchell Besser, PO. Box 16239, Vlaeberg 8018, Cape Town,
South Africa, E-mail: [email protected]
WePeF6757 A model of mentoring for community based
physicians who prescribe HIV antiretroviral
therapies
S.M. Lambert. The University of Queensland, HIV & HCV Education Projects,
School of Medicine, The Uni of QIld, Herston Rd, Herston Old 4006, Australia
Issues: As HIV treatment has developed in complexity, informal relationships
have developed between community prescribers and specialist physicians. Questions arise as to who is best placed to provide optimum care for people with HIV,
what caseload a community physician needs to provide optimum care and what
level of training and supervision is required for the provision of optimum care.
Formalisation of the relationship between community prescribers and specialist
physicians through a mentor model provides a means to address these questions.
Descriptions: In Queensland, Australia, community physicians who wish to prescribe HIV drugs are required to undertake education and assessment activities and become accredited by the local health authority. Accreditation is usually granted for a two year period. Nomination of a mentoring treatment unit and
HIV specialist physician is required as part of this accreditation process. Practise
has already demonstrated the existence of, and competent utilisation of an effective partnership / mentoring system. In 2001 - 2002 formalisation of this system
through the introduction of protocols and a model of mentoring to 'fill the gaps'
where no mentoring relationship was developed. This presentation explores the
characteristics of the model of mentoring and related protocols in Queensland,
Australia and the lessons for countries where HIV drugs are available.
Lessons learned: An informal relationship naturally develops between community physicians who prescribe HIV antiretroviral therapies and HIV specialist physicians. This informal relationship is effective for those physicians with a
strong interest in HIV. Formalisation of the relationship and adherence to a model
of mentoring is required to assist other physicians in their provision of optimal
care.
Recommendation: Where community physicians prescribe HIV drugs a formalised model of mentoring needs to be adopted as standard practice.
Presenting author: Stephen Lambert, HIV & HCV Education Projects, School
of MedicineThe Uni of QId, Herston Rd, Herston QId 4006, Australia, Tel.: +61 7
3365 5045, Fax: [phone], E-mail: [email protected]
WePeF6758 Responding to the growing care burden in
Cambodia
S. Samreth C. Kaoeun, P Prom, V. Seng, C.K.M. Chea, S. Tep, P. Sok. National
Centre for HI V/A IDS, Dermatology and STD, Phnom Penh, Cambodia
Issues: The escalating HIV epidemic in Cambodia is producing an expanding
need for HIV/AIDS care, as people progress to advanced and symptomatic HIV
disease, which will increase considerably over the next decade, with an estimated
three-fold increase in the number of new AIDS cases between 1999 and 2005.
The limited resources of the health care system will be further stretched due to
this impact of HIV/AIDS on care needs.

Description: Most health care for PLWHA will be delivered within the general
private and public health care systems in Cambodia. The majority of people with
HIV infection are undiagnosed and initially present with conditions which do not
require specific HIV/AIDS management. Unfortunately, the present weakness of
the health care services means that many opportunities to provide this first level of
care are missed, often with serious health status and economic consequences. At
later stages, however, specific HIV/AIDS initiatives and services are often needed.

In recognition of this, the government strategy for HIV/AIDS care has been developed to provide a broad "continuum of care". The main elements of this strategy
are, in the next three years:
- to extend Voluntary Testing and Counselling services beyond the present 6
Center to 24
- to introduce Home-based care in 25 of the 73 Operational Districts (OD)
- to ensure that every referral hospital in all 73 ODs has a core of clinicians trained
in AIDS Case Management
- to link AIDS Care and TB care in a variety of ways (eg Home-based care teams
working on HIV and DOTS)
- to assess and expand the pilot ART programmes
- to introduce PMTCT in 20 of the 73 ODs.
Lessons learned: An approach based on piloting interventions and then developing strategic models for nation-wide expansion has been found to be effective
in Cambodia for both prevention and care interventions.
Recommendations: This approach will be adopted for all elements of the continuum of care in Cambodia
Presenting author: Sovannarith Samreth, 170 Sihanouk Blvd, Phnom Penh,
Cambodia, Tel.: [phone], Fax: [phone], E-mail: aidscareunit
@bigpond.com.kh
WePeF6759 Strategies for improving access to HIV/AIDS
services for emerging and underserved
populations
L.A. Narciso, S. MacDonald, G. Bochynek, C. Gibson, K. Wulf. Casey House,
Toronto, Canada
Issues: AIDS service organizations (ASOs) in Toronto, Canada are developing
programs and services to address the needs of emerging and underserved populations. This participatory action research project explored barriers that women,
people from HIV-endemic regions, and homeless people experience when trying
to access HIV/AIDS services. Improving access to services was also explored
and, because of the focus on action in this model of research, findings served as
a catalyst for organizational and programmatic change.
Description: A qualitative research approach to understanding barriers was
adopted. Using purposeful sampling, barriers were identified through in-depth
interviews and focus group discussions with stakeholders including service
providers and people living with HIV/AIDS (PHAs).
Lessons learned: Collaborating with relevant community-based organizations
to access underserved PHAs was critical to the project's success. Through this
process, a range of barriers was identified including systemic barriers (such as
lack of access to affordable housing, treatments, and employment) through to
programmatic and organizational barriers (such as lack of access to linguistically
and culturally appropriate information and services as well as lack of services for
families with affected and/or infected children).
Recommendations: Ultimately, the research project developed short-term and
long-term strategies for increasing access to programs and services for diverse
communities. Priority areas were identified and, because of the continued involvement of the community advisory committee, sustainable program and service
planning, implementation and evaluation was ensured. The project also served
as a replicable model for conducting community-based research in ASO settings.
Presenting author: Scott Macdonald, 9 Huntley Street, Toronto, Ontario, M4Y
2K8, Canada, Tel.: [phone], Fax: [phone], E-mail: smacdonald
@caseyhouse.on.ca
WePeF6760 TB control with DOTS needs more understanding
about HIV/AIDS
A. Sae Lim. NGO, 48/282 center place, Ramkhamhang Rd., Sapansoong,
Bangkok, Thailand
Issues: Thai Public Health structure and system is a good example one that
cover nearly the whole country in different level but it dose not guarantee the
access to care for most of people. TB control program during AIDS epidemic is
one reflection that the management does not catch up with the current situation.
Many areas, the complete treatment rate is lower than 85% while defaulter rate is
climbing up. Some patients loss to follow up and died during treatment.
Description: MSF and ACCESS foundation had worked with one district hospital since 2001. We found that Health workers who take care of TB patients in
sanitation unit lacked of knowledge about HIV/AIDS so they did not know how to
manage with the concurrent health problems that occurred and impacted to TB
treatment. In the project, we provided training and worked alongside with them.
During 10 months, 28 patients were screened, 8 of these (28.6%) were HIV positive. All of them got health check in each visit and some would be referred to
doctors if they had Ols. PCP prophylaxis was offered to PHAs with TB. After intensive phase, patients might be referred to health center or home health care as
they request.

Lessons learned: Using DOTS to control TB is not enough at present, health
workers really need more information and understanding about HIV/AIDS in different issues in order to adapt TB program to the reality.
Recommendation: The issue of TB and AIDS must be prioritized and healthcare
providers need more training in opportunistic infections treatment.
Presenting author: Amnuayporn Sae Lim, 48/282 center place, Ramkhamhang