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

574 Abstracts ThOrF1514-ThOrF1517

XIV International AIDS Conference

Presenting author: Nandinee Bandopadhyay, Population Council/Horizons Program, 53 Lodi Estate, New Delhi, 110003, India, Tel.: [phone], Fax:
[phone], E-mail: horizons @ pcindia.org
ThOrF 514 Building up an AIDS care services network In Brazil
C.E. Santos, M.A.A. Vitoria, J.N. Lima. STD/AIDS Program - Ministry of Health
(MOH), SEPN 511, Bloco C, 20. Andar, Asa Norte, 70750-543, Brasilia / DF
Brazil
Issues: With the advent of HAART the Brazilian MOH alternative care programme
for patients with HIV/AIDS has been facilitating the people living with HIV/AIDS
(PLWA) treatment access, according to different complexity degrees, stimulating
out patient care, presenting better cost-benefit relationship and providing better
quality of life
Description: Since 1994 the MOH, through the National AIDS Program comes
implanting a network of reference care services for HIV carriers in Brazil, formed
by national health clinics (700), where the patient has access to the specialised
care, medications and preservatives; day-hospital (72) access to simple hospital procedures limited to some hours of the day; home care (54) characterised
by ambulatory/nosocomial attendance at home and accredited general hospitals
(375) for more complex procedures. Those actions are based on the following
guidelines: a) to promote and to facilitate the access to the services and to guarantee the quality of care; b) to guarantee the maintenance of the care actions in
the states and municipal districts; c) to guarantee training and bringing up to date
of knowledge of the multidisciplinary teams that render attendance in HIV related
care; d) to guarantee the standardisation of procedures and guidelines.
Lessons learned/Conclusions: Direct benefits obtained for the population include a major improvement in the quality of HIV/AIDS care and treatment services
for patients, resulting in increased life expectancy and a markedly better quality of
life for them. Other benefits were the notable reduction of number and complexity
of hospitalisation, increase in outpatient care with related cost-savings, and the
optimisation of both human and financial resources.
Presenting author: Marco Vitoria, SEPN 511, Bloco C, 2o. Andar, Asa Norte,
70750-543, Brasilia / DF, Brazil, Tel.: [phone], Fax: [phone], E-mail:
mvitoria@ aids.gov.br
ThOrF1515 Next steps for expanding access to antiretroviral
therapy in resource-restricted settings
E.M. Lackritz1, B.J. Marston2, R. Downing3, F Diomande4, D. Macharia5,
S. Malamba3, P. Solberg3, J.H. Mermin3, J. Nkengasong6, P.J. Weidle7,
T.V. Ellerbrock7. 'Centers for Disease Control and Prevention (CDC), CDC,
Mailstop E-41, 1600 Clifton Road, Atlanta, GA 30333, United States;
2CDC/KEMRI, Kisumu, Kenya; 3CDC, Entebbe, Uganda; 4Projet RETRO-CI,
Abidjan, Cote d7voire; 5CDC/KEMRI, Nairobi, Kenya; 6Projet RETRO-CI/CDC,
Abidjan, Cote d7voire; 7CDC, Atlanta, United States
Issues: Access to antiretroviral (ARV) therapy in resource-restricted countries
has been extremely limited due to the high cost of drugs and the technical complexity of patient management and laboratory monitoring. New approaches to
treatment are needed to expand ARV programs in countries with limited resources
and infrastructure.
Description: This presentation will review a framework for expanding ARV programs by use of practical, standardized algorithms for treatment and monitoring
and other components of comprehensive AIDS care.
Lessons Learned: Programs in Uganda, C6te d'lvoire, and Kenya have successfully managed patients with ARV therapy in resource-restricted countries.
However, highly individualized patient care and costly, technical laboratory tests
limit wide expansion of these programs. Patient viral load alone was rarely a criterion for initiation of therapy and contributed little to identification of eligible patients. Barriers to expanding access might be overcome by simplifying treatment
and monitoring. Standardized regimens can be developed using highly active
and durable ARVs. Criteria for regimen selection include drug cost, availability,
efficacy, toxicity, dosing schedules, refrigeration, safety during pregnancy, and
compatibility with tuberculosis medications. Standardized criteria for initiating and
changing therapy can also be standardized. Laboratory monitoring could rely on
less frequent, less expensive, or less complicated testing technologies; preliminary results are available for alternative methods for CD4+ and viral load testing.
Comprehensive programs also include patient and community education, social
support, adherence, and linkages to HIV prevention.
Recommendations: Implementation of simplified, standardized treatment and
monitoring algorithms will facilitate expansion of ARV programs. Programs will
vary according to local conditions and available resources. Program evaluation
will improve outcomes and facilitate expansion.
Presenting author: Eve Lackritz, CDC, Mailstop E-41, 1600 Clifton Road, Atlanta, GA 30333, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]

ThOrF1 516 Rwanda family package: Capacity expansion of
medical care and support services for hiv-infected
mothers and their families
E. Rwabuhihi1, A. Binagwaho2, A. Kagame3, E. Karita4, D. von Zinkernagel5,
M. Iskowitz6, S. Thurman6, E. Goosby5. 1Ministry of Health, Rwanda, Kigali,
Rwanda; 2Bureau de la Premiere Dame, Kigali, Rwanda; 3Centrale Hopital de
Kigali, Kigali, Rwanda; 4Ministry of Health, Kigali, Kigali, Rwanda; 5Pangaea
Global AIDS Foundation, San Francisco, California, United States; 6/nternational
AIDS Trust, Washington, DC, United States
Issue: The Rwanda Family Package is a model for expanding medical care and
support services for HIV/AIDS in community settings in a resource-constrained
environment. The goal is to extend survival benefits of MTCT programs to address the health needs of HIV+ parents and siblings as the first step in a national
treatment initiative.
Description: Two community clinics with MTCT programs were selected as pilot
sites by the Ministry of Health and paired with a reference hospital. HIV+ women
participating in MTCT, their children and partners receive follow-up care and treatment for HIV-related conditions. A national standard of care for diagnosis and
treatment of 01 s and STDs and for initiation of ARVs was established through
the MOH, and used to guide provider training and drug procurement in the clinics. Structured consultation and referral relationships with hospital-based experts
provide clinical support and continuity of patient care.
Lessons learned: Community-based MTCT programs can serve as a doorway
to medical care and support for families impacted by HIV. Building on existing
medical and community infrastructure allows for low costs and high quality medical services. Explicit relationships with medical expertise and training of mid-level
clinic providers are critical to successful implementation. Dialogue with the community allows for the development of peer-peer support groups focusing on ADL
needs, adherence with medications, and targeted prevention opportunities.
Recommendations: The Rwanda Family Package model will be replicated in
additional MTCT sites as the first step to extend treatment access in Rwanda.
Expansion into provincial medical delivery systems will be informed by rapid assessment processes. Plans to add food assistance and microfinance opportunities as part of the Family Package are in progress to further support family health
and stability.
Presenting author: david mckey, pangaea global aids foundation, 995 market
street, suite 200, san francisco, california, United States, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThOrF1 517 Public health services and community-based care
centres: competition or cooperation?
J. Potet, E. Fleutelot. Ensemble Contre le Sida, Ensemble Contre le Sida /
Sidaction, 228, rue du faubourg st-Martin, 75010, Paris, France
Issue: Ensemble Contre le Sida (ECS) has been supporting Aids Service Organisations and groups of people living with HIV/Aids (PWAs) in developing countries
for the last five years. One of the aspects of this support is in the in designand
implementation of innovative community-based care projects. Aren't those initiatives necessarily limited to isolated projects and do they discourage public health
services from setting up their own programs?
Descriptions: Three examples to question the extent of community-based initiatives and their consistency with activities conducted by public structures.
NGO-run specific HIV testing centres have sprouted up in many African cities,
because, unlike hospitals or blood transfusion centres, they provide nonjudgemental and confidential counselling. Yet some innovative referrals between
both sectors are now being implemented.
Psychological and social support -ie relief aid, access to credit, nutritional supplementation etc, has for long been conducted exclusively by NGOs. Public health
institutions lack funds for this type of program and are rarely geared up to offer a reassuring and trustful environment. Hospital psychiatrists have recently
committed to providing psychological care but are disconnected with NGO-based
activities.
Both NGOs and public health services provide medical care, but differently. NGOrun centres are similar to day hospitals; their fees are much more affordable;
their physicians are HIV specialists and can monitor HAART; home-based care
is widely provided. Recognition of the quality of medical care provided by NGOs
would facilitate referral and cooperation between both health sectors.
Lessons learned: Public health institutions and NGOs provide complementary
services and should cooperate rather than compete.
Recommendations: Involvement of PWAs in the public sector (hospitals etc) and
implementation of research projects in NGO-run health centres would promote
such cooperation.
Presenting author: Julien Potet, Ensemble Contre le Sida / Sidaction, 228, rue
du faubourg st-Martin, 75010, Paris, France, Tel.: [phone], Fax: +33 1
53 26 45 75, E-mail: [email protected]