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

278 Abstracts WePeF6786-WePeF6790

XIV International AIDS Conference

WePeF6786 Comprehensive care and treatment for PLWHA in
resource poor setting
R. Waikhom. Care Foundation, Mission Lane, Sanjenthong, Imphal-795001,
Manipur, India
Issue: Although much focus has ben made towards accessibility of care and treatment, majority of the PLWHAs cannot access such facility. In resource poor setting like Manipur 95% of the PLWHAs cannot have access on care and treatment.
Voluntary testing and counselling is also very remote.
Description: The Care Foundation, Imphal has been at its tiptoes in making accessible of comprehensive care and treatment to its 44 clients, out of which 24 are
on ARV and 20 of them are on chemoprophylaxis. Due to high price of the ARVs
only two out of 24 could managed the recommended 3-drug regimen, rest are on
double regimen. These ARVs are procured at subsidized rate from the stockiest
and the medicines for prophylaxis are procured free of charge from other GOs
and NGOs. The clients face real hard times in getting their blood tested for viral
load and CD4 due to unavailability of testing machines like FACS. Blood samples
are being sent to far off places like Bombay and the test results becomes inaccurate and discrepant. The care and treatment are also made home and community
based and thus try and involve as many family members and near and dear ones
as it could, and hence mitigate the impact of HIV/AIDS. Routine health check ups
and other health related programmes are also being organized. Care and support
it also being extended to the family members at the time of bereavement.
Lessons learned: Rate of morbidity and mortality has been drastically reduced
but the adherence to the medications is being hampered due to the financial
constraints; lack of experienced health care workers and adequate funding jeopardizes the project; proper monitoring could not be done due to lack of resource;
and there is need for better co-ordination between the family members and the
care providers.
Recommendations: More emphasis in resource poor setting should be made;
care and treatment to be included in the national policy; ARVs and the essential
medicines to be made accessible.
Presenting author: Ronny Waikhom, Mission Lane, Sanjenthong, Imphal795001, Manipur, India, Tel.: [phone], E-mail: ronny.waik@rediffmail.
com
WePeF6787 Home Care Management of HIV/AIDS Patients in
INDIA
G.R. Trivedi', R.D. Kharkar2, D.G. Saple3, S.B. Vaidya4. 1ATG, B,101,Nirman
Vihar, Rajmata Jijaibai Road,Pump House,Andheri East Mumbai 400 093, India;
2Holy Family Hospital, Mumbai, India; 3Grant Medical College & G T Hospital,
Mumbai, Mumbai, India; 4K J Somaiya Medical College, Mumbai, India
Issues: The galloping number of symptomatic HIV/AIDS patients and inadequately trained clinicians in public and private hospitals in addition to the socioeconomic structure of society & social stigmas, and cost of hospitalization have led
to the need for home based care of these patients.
Description: From Jan'00 to Dec'01 we have offered home based care to 200 HIV
symptomatic patients for following reasons: fear of social stigmas in 50 cases, refusal care & treatment by medicos in 43 cases, could not afford hospitalization 40
cases & end stage disease 67.
Lessons learnt: The issue of home-based care for the HIV/AIDS patients has
both pros & cons. The pros include homely environment, counseling is more effective & readily acceptable, better privacy & secrecy with helps in avoiding social stigma, cost effective & convenient for the patients and the family members.
The cons include small space especially in urban setting in India, less number of
trained clinicians lack of trained paramedics, unfeasibility of catering to medical
emergencies at home, increasing the anxiety levels of family members, bio-safety
measures become difficult to implement.
Recommendations: The need of home-based care for HIV/AIDS patients is
acutely felt and needs to be implemented on a larger scale with more participation of health care professionals.
Presenting author: Girish Trivedi, B,101,Nirman Vihar, Rajmata Jijaibai
Road,Pump House,Andheri East,Mumbai 400 093, India, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WePeF6788 Experience from a pilot telemedicine clinic for
management of HIV patients in the VA New Jersey
Health Care System -VANJHCS
R.H.K. Eng', R. Provenzo2, S. Chang2. 1VAMC, VAMC-Infect Dis, 385 Tremont
Avenue, Pm 5-197, East Orange, N J, United States; 2 VA Center for Quality
Management for HIV Palo Alto, Ca, United States
Background: VANJHCS provides services to veterans throughout the state. The
experienced HIV/ID practitioners are based in East Orange (EO) (Northern NJ).

Of the 550 HIV pts in VANJHCS, 20% live in Central/Shore areas of NJ and have
had to travel >50 mi for their care. VANJHCS has a Community Based Outpatient Clinic (CBOC) staffed by internists in Central Jersey which shares the same
electronic med record, lab, and pharm systems as the Med Ctr at EO.
Methods: An HIV Telemed Clinic (T-Clinic) was initiated between CBOC and EO
on April, 2001. Pts > 50 mi from EO and seen by ID MD and on ART participated
in T-Clinic by signing consent about the limitations and of higher risk for loss of
confidentiality through txm of voice and images. At the sched appt, pt sees the

CBOC nurse for vital signs. The ID MD elicits CC, Hx & ROS. Visual exams are
done by the ID MD using remote control of camera. Palp & ausc exams are done
with a CBOC internist. Notes, orders for med, consults, and lab tests are entered
by the ID MD in the VA's elect med record system accessible by both the CBOC
and the Med Ctr. All orders are seamlessly executed as if ordered at the CBOC.
Results: The distance between EO and the CBOC is 60 miles. Of the 10 patients
offered T-Clinic, he avg age was 57 yrs; avg yrs treated for HIVwas 6.5; the avg mi
from home to the CBOC was 14 mi; and from home to the EO was 58 mi. The avg
appts kept was 92% (67% for pts at EO). The avg HIV RNA was 146 c/mL (835
c/mL pts at EO. Complexity of patients included an HIV pt on h-dialysis, a pt s/p
TB and crypt meningitis, and 4 pts with hyperlipidemia. All patients had complete
satisfaction with T-Clinic over the alternative of traveling.
Conclusions: This pilot demonstrated that telemedicine HIV clinic at a CBOC
was feasible and can provide great convenience to HIV patients with improved
clinic attendance and patient satisfaction.
Presenting author: Robert Eng, VAMC-Infect Dis, 385 Tremont Avenue, Rm 5 -197, East Orange, NJ, United States, Tel.: [phone], Fax: [phone]
7093, E-mail: RHKEng @post.harvard.edu
WePeF6789 Hospitalisations profile, deaths and costs related
to HIV/AIDS care in Brazil (1996-2001)
C.E. Santos, M.A.A. Vitoria, J.N. Lima. STD/AIDS Program, Ministry of Hea/th,
SEPN 511, Bloco C, 2o. Andar - Asa Norte, 70750-543, Brasilia /DF, Brazil
Background: With the changes occurred in epidemiological and clinical profile
of AIDS epidemic in Brazil after the wide use of HAART in mid 90s, the Brazilian MOH start to analyse some aspects related to hospitalisation and deaths of
patients living with AIDS (PLWA), particularly the related costs in the accredited
hospitals for care of this population.
Methods: The descriptive statistics method was used to tabulate the number of
hospitalisations, deaths and costs in 375 accredited public hospitals in HIV/AIDS
care. The analysed data was assembled by the Informatics Department of MOH
(DATASUS).
Year 1996 1997 1998 1999 2000 2001
No. AIDS patients/year 15390 31140 43823 57604 69446 113000
No. Hospital Admissions 25458 25157 24541 25027 26655 25274
Hopsital Admissions/Patient 1.65 0.81 0.56 0.43 0.38 0.22
AIDS Deaths 7502 6318 5668 5509 5506 5083
Costs of hospitalizations (U$) 8330830 8206248 8890131 10501201 8954736 7601116
Costs (U$)/ Hospitalizations 327.20 326.20 359.92 419.59 335.94 300.75
Conclusions: This survey suggests that the offer of quality services for HIV/AIDS
care and wide access to antiretroviral therapy has significantly contributed to a decline in the number/complexity of hospital admissions and of AIDS related deaths.
It has also led to a reduction in demand for general medical care for this patients
and in direct and indirect costs overall.
Presenting author: Marco Vitoria, SEPN 511, Bloco C, 20. Andar - Asa Norte,
70750-543, Brasilia /DF, Brazil, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WePeF6790 Redefining Infrastructure: untapped potential of a
Peruvian community-based organization for
delivering anti retroviral therapy
M.C. Arbour', Z. Montin2, J.S. Mukherjee3, J.Y Kim4, J. Bayona5, A. Castro3,
A.M. Chavez6. ' Harvard Medical School, 95 Child St #2, Jamaica Plain, MA
02130, United States; 2Hogar San Camilo, Lima, Peru; 3Partners In Health and
Department of Social Medicine, Harvard Medical School, Boston, MA 02115,
United States; 4Partners In Health and Department of Social Medicine, Harvard
Medical School Boston, MA 02155, United States; 5Socios En Salud, Lima,
Peru; 6Ministerio de Salud, Lima, Peru
Drug cost and lack of infrastructure are cited as chief impediments to successful
anti-retroviral delivery in poor countries. But what exactly constitutes infrastructure? What elements are needed to run an ARV delivery program? Are any of
these elements in place in poor countries?
This ethnographic study describes a community-based organization (CBO) in
Lima, Peru. The CBO was not developed with the intent of treating HIV but
does possess many elements necessary for delivery of ARV therapy. Hogar San
Camilo (HSC) was established to support people living with HIV in times of crisis.
Today the former monastery provides: housing and food for men living with HIV,
classes for post-natal mothers referred by hospitals, prevention outreach run by
HIV+ residents, home visits by healthcare professionals, spiritual counseling, and
peer support groups. With a staff of psychologists, social workers, nurse, doctor and priest; ties with hospitals, VCT sites, and labs; dining facilities; minibus;
communication and computing technology; and cold storage capacity, HSC is

well-equipped to deliver a comprehensive intervention program which includes
ARVs.
HSC is one example of the untapped potential of CBOs for delivering ARV therapy
in poor countries. It indicates what may exist elsewhere. Comprehensive interventions can be designed to coordinate and maximize such existing infrastructure,
with the dual benefit of bolstering the public health system and building on community strengths.