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

XIV International AIDS Conference

Abstracts ThOrF1518-ThPpF2158 575

ThOrF 518 Innovations in models of palliative care: A national
approach to delivering care to the
medically-underserved with HIV/AIDS
V.H. Raveis', D.G. Karus', K. Marconi2, P. Selwyn3, M. Perrone4, B. Hanna5,
E. Patterson6, H.A. Rosefield, Jr.7. 'Mailman School of Public Health, Columbia
University, Mailman School of Public Health, Columbia University, Center for the
Psychosocial Study of Health and Illness, 100 Haven Avenue, Suite 6-A, New
York, NY 10032-6266, United States; 2Health Resources and Services
Administration, Rockville, Maryland, United States; 3 Montefiore Medical Center,
Bronx, New York, United States; 4 University of Maryland, Baltimore, Baltimore,
Maryland, United States; 5AIDS Services Center, Inc., Anniston, Alabama,
United States; 6Catholic Community Services, Inc., Jersey City, New Jersey
United States; 7Volunteers of America, Inc., Alexandria, Virginia, United States
Issues: Although AIDS-related death rates have fallen in recent years, it remains
a fatal illness and the global burden of this disease continues to grow exponentially. For those unable to tolerate treatment or for whom aggressive therapy is no
longer effective, palliative care is essential.
Description: There are differences in the provision of palliative services to
HIV/AIDS populations not addressed within a "standard" palliative care model.
HIV disease is increasingly affecting segments of society that lack access to
health care or whose lifestyle and behavior adversely impacts treatment. An initiative by the HIV/AIDS Bureau, Health Resources and Services Admin, US Dept
of Health and Human Services, is supporting innovative palliative care programs
targeting the homeless, uninsured, substance abusers, mentally ill, and incarcerated indviduals with HIV/AIDS. This presentation will describe the range, focus,
delivery site and staffing of these five demonstration projects using illustrative
case studies.
Lessons learned: The special requirements and characteristics of the disease
and affected population necessitate that palliative care be delivered within the
societal context of the epidemic. The disease trajectory presents challenges in
determining when it is appropriate to institute palliative treatments. The lifestyleimposed treatment challenges of this patient population necessitate the inclusion
of professionals not traditionally represented on a palliative care service. Integrating care delivery with other HIV/AIDS services can facilitate a seamless transition
between active treatment and palliative care. Such an approach can decrease the
likelihood of gaps in care.
Recommendation: Ensuring appropriate care for individuals dying with
HIV/AIDS is a significant public health issue. Effective palliative care programs
need to incorporate clinical management of the disease course with an appreciation of the life circumstances of the affected population.
Presenting author: Victoria Raveis, PhD, Mailman School of Public Health,
Columbia University, Center for the Psychosocial Study of Health and Illness, 100
Haven Avenue, Suite 6-A, New York, NY 10032-6266, United States, Tel.: +(212)
304-5563, Fax: [phone], E-mail: vhrl @columbia.edu
ThOrF1519 From pilot projects to extended ARV programs; an
MSF experience
A. Calmy, L. Ciaffi, B. Pedrique, I. de Vincenzi, C. Michon, I. Andrieux-Meyer.
MSF 15 route de la tambourine, 1227 carouge, Switzerland
Issues: MSF-Switzerland started its ARV program in Yaounde and Guatemala
City at the end of 2000, aiming to show that ARV treatment was feasible and to
promote the introduction of cheaper ARV treatment. These pilot programs enrolled 100-150 patients each. They require improvement of laboratory support
and of overall patient care (e.g. psychosocial support).
To date, the efficacy of the ARV treatments given has been excellent: 70% of the
patients started on AZT/3TC/Nevirapine have < 100 copies of viral RNA /ml after
6 months, comparable to results obtained in Western Europe or North America.
However, programs are located within hospitals in the capital and most of the
HIV-positive patients have no access to these pilot programs.
Description: In order to increase the number of patients treated and hence to
adapt treatment to the needs, support of local treatment sites is necessary. Such
expansion necessitates simplification of the protocols through an active pursuit
of the following: clinical research in order to define protocols most adapted to
countries of limited resources (including new definition of the objectives of treatment and their evaluation by clinical parameters, new treatment strategies such
as interrupted treatment and directly observed treatment); large scale training and
reinforcement of health care teams, and lobbying for access to biological monitoring and to old and new drug molecules. A purely clinical surveillance of treatment
tolerance by the district health personnel should be possible, but requires specific
training.
Recommendations: Simplification of the protocols used in ARV treatment programs is a matter of urgency to respond to the number of people awaiting treatment. Our energies must be directed to activities of lobbying for access to biological monitoring and new drugs, clinical research, large scale training, and
reinforcement of health infrastructure in partnership with other concerned parties

Presenting author: alexandra calmy, 15 route de la tambourine, 1227 carouge,
Switzerland, Tel.: [phone], Fax: [phone], E-mail: alexandra.
[email protected]

ThPpF2157 Documentation/evaluation of the pilot phase
(September 2000/July 2001) of the Multi-sectoral
STI/HIV/AIDS Control Programme, Province of Poni,
Burkina Faso
J.C. Thouin', P. Champagne2, G. Delorme1, Y. Tavi Ouattara2
A.J. Tiendrebeogo3, S. Kabre4, J. Bidiga3, V. Yameogo4, E. Kambou5. 'CCISD,
Quebec, Canada; 2CCISD, Burkina Faso; 3 SP/CNLS-IST Ouagadougou,
Burkina Faso; 4PPLS/BM, Ouagadougou, Burkina Faso; 5EmP/JR,
Ouagadougou, Burkina Faso
Issues: Despite the technical and financial resources injected over the past 20
years into Africa to combat HIV/AIDS, rural populations still have mitigated access to resources. Access to resources was a major concern to the pilot project
phase which was part of the multi-sectoral and decentralised approach initiated
in Gaoua by UNAIDS (1997 to 2000). The project was meant to test at the level of
a province, the setting up of mechanisms for actually involving the communities
and decentralised administrative authorities, in the implementation and management of micro-projects (MP), in such a way that technical and financial resources
directly and rapidly reach down to the villages.
Description: This presentation is on the results of the assessment of the diagnosis of processes (planning, structuring, training, community mobilisation, capacity
to integrate and manage MPs, administrative/financial management) at all steps
of the project cycle. Within 4 months, the project has initiated 593 MPs for a total amount of US$ 174,892 and potentially outreached 209,335 persons out of
an estimated population of more than 240,000 inhabitants in 572 villages. The
average cost/beneficiary ratio is $ 0.84/inhabitant but interventions were almost
exclusively on IEC activities.
Lessons learned: The pilot project has demonstrated the possibility to rapidly
design a significant action at an acceptable cost and to channel technical and
financial resources down to the beneficiary level. However, despite the urgent
need to take action towards stopping the spread of HIV/AIDS, skipping the steps
on mobilisation for reasons of bureaucratic constraints is not an effective way of
doing things if the objective is to achieve sustainable ownership of the process.
To be successful, MPs should provide a high potential for innovation, creativity
and initiative taking at the decentralised level.
Recommendation: The project is replicable but under specific prerequisites
Presenting author: Pierre Champagne, 01 BP 6643 Ouagadougou, 1, Burkina
Faso, Tel.: [phone], Fax: [phone], E-mail: pierre.champagne@ccisd.
bf
ThPpF2158 Enhancing care initiative through
community-based organizations in Northern
Thailand
P. SaeTang', S. Phongphit2, P. Dechaboon3, N. Suwanpatthana4. The Church
of Christ in Thailand -AIDS Ministry, Chiang Mai, Thailand; 2 The Village
Foundation, Chiang Mai, Thailand; 3 The Upper Northern People Living with
HIV/AIDS Network, Chiang Mai Thailand; 4AIDS Network Development
Foundation, Chiang Mai, Thailand
Issues: Community self-reliance has been acknowledged as a sustainable development. A new approach is needed to enhance the role of community-based
organizations (CBOs) in Northern Thailand.
Descriptions: People Research and Development (PR&D) process has been
used in enhancing community care and community's self-reliance among CBOs
in Northern Thailand. The first phase is for paradigm change - people learn new
way of thinking, problem solving, and sustainable development. This new orientation focus on self-reliance rather than external resources. The Self-realization
phase - people are encouraged to rediscover themselves and identify their potential, in terms of community resources - local wisdom, human resources, natural
resources, and existing institutions. The third phase is learning about management of community resources from the best practice. People are encouraged to
reflect what they have learned regarding how to reorganize and manage their own
resources. The fourth phase is master plans development - people develop their
own master plans for further development which includes projects, and action
plans to be implemented. This plans focus on community self-development and
self-reliance. The final pahse is implementation phase - the ECI-Thai team provided those people from CBOs with the new knowledge and technology essential
to re-manage and use their own resources.
Lesson learned: According to self-evaluation, people verbalize new way of thinking about the roles of community-based organization. Their master plans focus on
issues of poverty, education, environment, food, narcotics, and HIV/AIDS. Selfreliance is recognized as a meaningful way of mobilizing indigenous resources in
the process of sustanable development.
Recommendations: PR&D is a new approach of sustainable development.
Community-based organizations should play important roles in enhancing quality
of life for everybody in terms of self-development and self-reliance.
Presenting author: Prasit SaeTang, 1/100 Wat-Gait, Ratanakosint Road, Mueng

Chiang Mai, Chiang Mai, Thailand, Tel.: [phone], Fax: [phone],
E-mail: psst543@ loxinfo.co.th