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

XIV International AIDS Conference

Abstracts ThPeF8218-ThPeF8222 637

Certain steps were followed: listing of pathologies causing abdominal pain in
PLHA, important signs and symptoms for differential diagnosis, relevant diagnostic tools and drugs adapted to a resource-poor setting. Members also identified
unresolved questions that need more research.
In the end, combining clinical experience and newly acquired evidence from the
literature, members proposed diagnostic and therapeutic flowcharts. A palliative
care section closes the chapter. HIV-experienced medical doctors from MSF Belgium and HIV experts from the Institute of Tropical Medicine in Antwerp were
asked to give feedback on the draft. The flowcharts were field tested. A final version was written.
Lessons learned: Involving a multi-disciplinary team of physicians from a
resource-poor setting in the development of a clinical guideline is a good didactic
model to study the HIV related diseases and how to deal with diagnostic limitations.
Recommendations: Participation in the development of guidelines favors subsequent adherence to them.
Use of the guideline will decrease the delay in diagnosis and therefore mortality
in PLHA presenting with abdominal pain.
Presenting author: Lutgarde Lynen, po Box 2318, Phnom Penh, Cambodia, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeF821 8 Embrace: A collaborative approach to HIV health
promotion for African communities in the UK
J.M. Parr1,, S.L. Namaganda2, T. Skelton1. IGlaxoSmithKline UK,
GlaxoSmithKline UK, Stockley Park West, Uxbridge, Middlesex, UB11 1BT,
United Kingdom; 2Black Health Agency Manchester, United Kingdom
Issues: Approximately one third of the estimated 30,000 people living with HIV in
the UK are undiagnosed. People of African origin account for an increasing proportion of new diagnoses (35% in the year 2000). Many are diagnosed late with
symptomatic HIV infection at a stage when anti-HIV medications may be less effective. African communities are hard to reach with traditional health promotion
activities, so innovative programmes are required that meet the unique needs of
African people.
Description: The Embrace programme is an integrated health promotion programme with visible and impactful branding. It aims to increase the level of HIV
diagnosis within African communities in the UK by overcoming or minimising
the barriers to accessing HIV testing and specialist healthcare services. Embrace was developed by GlaxoSmithKline UK working collaboratively with a multidisciplinary specialist group representing physicians, healthcare commissioners,
African voluntary organisations and African people living with HIV. Culturally accessible information on HIV is provided through collaboration with the African
AIDS Helpline, a service provided by the Black Health Agency, and through music, peer education and support networks.
Lessons learned: Embrace has helped to develop an effective model for public/private sector collaboration in HIV health promotion that addresses the high
levels of stigma and discrimination surrounding HIV within African communities,
and the general lack of HIV knowledge and awareness.
Recommendations: Within a highly fragmented HIV sector the effectiveness of
health promotion activities may be enhanced by combining resources and expertise within a framework of shared objectives and measures.
Presenting author: Judith M Parr, GlaxoSmithKline UK, Stockley Park West,
Uxbridge, Middlesex, UB11 1BT, United Kingdom, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeF82199 Implementation of guidelines for the management
of tuberculosis in HIV-infected persons
F Palmieri1, E. Girardil, N. Petrosillo1, G. Antonucci', A. Antinori', P. Narciso1,
C. Saltini1, L. Pucillo', C. Bibbolino1, F.N. Lauria1, G. Ippolito 2 1National
Institute for Infectious Diseases L. Spallanzani - IRCCS, via portuense 292
00152 rome, Italy; 2National Institute for Infectious Diseases L. Spallanzani -
IRCCS, Rome, Italy
Issues: In order to clarify the principles of the clinical management of tuberculosis (TB) in HIV-infected persons to all care providers; to improve the awareness
of patients on current management of TB at National Institute for Infectious Diseases L.Spallanzani, Rome; to standardize the clinical practice of care providers
and to improve the quality, the efficiency, and the appropriateness of care, a panel
of experts at our Institution developed clinical guidelines for HIV-associated TB.
Description: Our aim was to evaluate the adherence and the effectiveness to
these guidelines at our Institution, where about 3 thousand HIV-infected patients
are cared for. Eleven performance indicators have been provided with the benchmark expectation of the frequency with which the recommended practice should
be followed. Guidelines were implemented in January 2001.
Lesson learned: We studied 47 patients admitted before (1998-99) and 44 patients admitted after the implementation. In the two periods: a. 87% and 95%

of patients with sputum smear-positive TB remained in respiratory isolation until
smear converts to negative, respectively; b. patients with or suspected of having
TB who had 3 culture for mycobacteria obtained before initiation of antituberculous therapy, were 79% and 95%, respectively; c. new TB cases who started the
induction phase of treatment with 4 drugs increased from 59 to 86%, respectively;
d. previously treated TB cases who started the induction phase of treatment with
at least 5 drugs increased from 51 to 84%; e. patients with suspected treatment

failure who had repeated culture and susceptibility testing, added at least two new
antituberculous agents and who have received medications by DOT increased
from 59 to 91%, respectively.
Recommendations: Adherence to these guidelines results in an improved efficiency and appropriateness of the management and the care of HIV-infected
persons with TB, and consequently it will result in a better control of TB.
Presenting author: Fabrizio Palmieri, via portuense 292 00152 rome, Italy, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeF8220 Living well with AIDS means more than controlling
HIV
A.L.C. Weinstein, A.C. Weinstein, M.B. Souza, N. Tebet, A.C. Monteiro,
A.R. Carretes. Institution, rua presidente domiciano, n 150 - inga 24210-271, rio
de janeiro, Brazil
Issues: Free and universal access to antiretroviral drugs in developing countries
has represented an improvement in the life quality of people living with AIDS.
However, traditional lack of adequate support to actions fostering health and integral health - as well as a strong healing and medication culture fossilized within
health sectors - may jeopardize the effectiveness of this access, thus increasing
the risks of opportunistic infections, and endangering the lives of less wealthy
people living with AIDS.
Description: This paper will describe the project developed by the joint efforts
of a Non Governmental Organization and other Non Governmental Organization
form New York which aims at promoting notions relative to integral health, fostering health and prevention of opportunistic infections among people living with
AIDS in Brazil. It will also present the actions taken for the effective implementation of these objectives, such as the gathering of information on the expectations
and needs of the target population and the elaboration of an educative campaign
on integral health and AIDS. It will show the material published for the campaign
- 3 posters and 3 booklets - whose themes were oral health, skin health and
collateral effects of medication in its various aspects.
Lessons learned: The format and the language used in the 18,000 posters and
booklets published managed to attract and interest both individuals and organizations, who reported having broadened their perspective on health, which improved their general well-being and their power to influence their own treatment
and health-disease process.
Recommendations: The receptiveness achieved by this initiative indicates the
need for investment on strategies for the dissemination of information to people
living with AIDS that can put them in control of their own health so as to improve
their life quality
Presenting author: ana lucia weinstein, rua presidente domiciano, n 150 - inga
24210-271, rio de janeiro, Brazil, Tel.: [phone], Fax: [phone],
E-mail: analucia@ pelavidda-niteroi.org.br
ThPeF8221I Will I ever get relief? - problems faced in treatment
seeking by people living with HIV/AIDS in rural
areas of Maharashtra
L.F. Garda, V.N. Rao, A. Bopardekar, P.B. Raut. Hospital, KEM Hospital
Research Centre, Rasta Peth, Pune - 411 011, Maharashtra, India
Issues: The research paper proceeds to highlight the issues related to treatment
seeking for HIV/AIDS in rural Maharashtra.
Description: Qualitative data collected on the above issues from a study in rural
Maharashtra among 40 people living with HIV/AIDS (PLHA) has been reported.
Lessons learnt: In rural areas various types of providers exist treating problems
associated with HIV/AIDS. Health problems reported by PLHA indicate different
opportunistic infections (OI). Major issues raised included repeated episodes of
possible OI; no relief from symptoms, hence repeated visits to different practitioners was essential making treatment unaffordable. In some cases rejection of
treatment because of positive status was also seen. Among PLHA 30% reported
treatment from traditional providers. Interviewing fifteen rural medical practitioners
(RMP) indicated lack of standardized treatment, inadequate laboratory facilities,
loss to follow up and improper referral facilities.
Recommendations: RMP should be provided with standardized treatment
schedules for O along with locally available drugs. Strengthening of existing referral system, making available simple laboratory tests for monitoring progress of
infection and a follow up plan; needs to be formulated for PLHAs in 'low resource'
rural settings to get appropriate and affordable treatment.
Presenting author: Laila Garda, KEM Hospital Research Centre, Rasta Peth,
Pune - 411 011, Maharashtra, India, Tel.: [phone] Ext. 336, Fax: [phone], E-mail: [email protected]

ThPeF8222 Health status characteristics of HIV/AIDS patients
in the u.s.-Mexico border region
B.D. Estrada A.L. Estrada. Impact Consultants, impact consultants, 5632 n
cherokee ridge road, tucson, az 85750, United States
Background: Research has shown that the U.S.-Mexico border region is beset
by numerous health problems, with escalating rates of diabetes, drug abuse, tuberculosis, infectious hepatitis and HIV/AIDS. However, relatively little is known