Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

throughout South Africa. The program uses a unique public-private partnership
which matches an existing network of 5000 community-based doctors with
patients from existing community-based support organizations (CSOs) and
government ARV sites which are at capacity (e.g. by removing patients from
waiting lists, down-referrals, etc.).
The model uses technology and telemedicine to task-shift and tap into the
capacity of 5000 community-based general practitioners. It does this by
leveraging the expertise of a few HIVAIDS clinicians to monitor and to provide
real-time training. Preliminary results estimate that the doctors can take on
500,000 patients in five years.
Rollout occurred using a replicable yet adaptable methodology with training
manuals, standard operating procedures, workplans, and toolkits. In the pilot
phase, this approach allowed the program to expand to 16 communities in five
provinces, impacting over 2000 people in 6 months.
Lessons learned: New paradigms for HAART delivery that move away from
traditional staffing and operating models are essential for success -
- Better utilization of general healthcare providers can be accomplished through
a unique combination of training, technology, and telemedicine.
- Technology, when appropriately utilized, can ensure quality care in limited
settings
- Better utilization of civil society (CSOs and healthcare providers) can alleviate
capacity constraints
- Ideas and systems thinking adopted from other industries can provide
innovative solutions
Recommendations: This model should be investigated for larger-scale rollout
to complement country-wide rollouts throughout the world.
TUPEO208
HIV+ in New York city and not in care
V. Sharp', H. Wolfe', C. Maslow', D. Haller2. 1St. Luke's-Roosevelt Medical
Center, HIV Center for Comprehensive Care, New York, United States, 2St.
Luke's-Roosevelt Medical Center, Psychiatry, New York, United States
Background: In New York City (NYC), with abundant HIV/AIDS care and
nearly-universal coverage of treatment costs, many people who know their HIV
status may not be receiving care. In 2003 we found 18% of HIV+ inpatients in
our NYC hospital were not receiving outpatient HIV care. To better understand
behavior and demographics of those not in care, and the effectiveness of
"standard" linkage to outpatient services, we collected data on 2004-5 inpatient
admissions and tracked referral to and retention in outpatient care.
Methods: Data were abstracted from our electronic medical record for 468
HIV+ patients admitted to St. Luke's-Roosevelt between 10/04 and 4/05.
Results: Subjects were: 30% female, 59% Black, 27% Hispanic; mean age
46, 88% on public insurance (at or below poverty level). Mean hospitalizations/
patient was 1.7; range 1-7. 80/468 (16%) were not receiving outpatient HIV
care. Homelessness (p<.0001; 29% of homeless vs. 13% with stable housing
not receiving care); and lack of social support (p<.001; 34% with little or
no social support were out of care, vs. 19% with some and only 5% with a
lot) predicted being out of care. No other factors (race, gender, age) were
predictive. 52 patients were referred by inpatient social work for outpatient
HIVcare; 18/52 showed up in clinics within 2 months post-discharge. Of the 18,
10 returned for >1 follow-up visits. Only problematic substance use predicted
care linkage (76% of substance users failed to show for outpatient care, vs.
32% of non-users; p<.0001.) Housing status and social support approached
significance.
Conclusions: Close to 1/5 HIV+ inpatients were not receiving outpatient HIV
care. Those not in care were more likely to be homeless and to lack social
support. Active substance users were less likely to follow through with postdischarge referrals. Intensive linkage interventions are required to engage
these patients in care.
TUPEO209
Is HIV/AIDS treatment universal and equitable?
A retrospective assessment of HAART scale-up
during the "3 by 5" Initiative in Europe
J.V. Lazarus, A. Bollerup, S. Nielsen, M. Donoghoe, S. Matic. World Health
Organization Regional Office for Europe, Sexually transmitted infections/HIV/
AIDS, Copenhagen, Denmark
Background: In 2003, WHO and UNAIDS launched the "3 by 5" Initiative to
advocate for highly active antiretroviral therapy (HAART) to an additional 3
million people in developing and transition countries by the end of 2005. This
paper provides a retrospective assessment of HAART scale-up in the WHO
European Region.
Methods: Three surveys of all 52 Member States of the WHO European Region,
each evaluating a range of HIV/AIDS treatment and care related indicators
and including 28, 7 and 36 items, respectively, were conducted by WHO
Europe between January 2003 and July 2005. For countries unable to provide
data, WHO estimates are employed. The scale-up is evaluated both in terms
of number of individuals on HAART, and the number of countries providing

universal and equitable access to HAART.
Results: During the study period, the total number of individuals receiving
HAART increased from an estimated 242 000 to 342 000, 86 000 of those in
western Europe. In central and eastern Europe, the number increased from
an estimated 7000 to 21 000 (a 200% increase). The number of countries
providing universal access to HAART grew from 29 to 41. While there were
differences between population groups and between countries, women and
children had equitable access to HAART throughout Europe. Access of injecting

drug users (IDUs) to HAART has improved but is still poor in many eastern
European countries. Further, prisoners represent only a very small number of
the individuals on HAART.
Conclusions: Despite universal coverage in many countries, access is still
inequitable in terms of transmission route, imprisonment status and geographic
location, with many individuals left untreated. Furthermore, the treatment
need is increasing much faster than the current rate of scale-up, challenging
countries already providing universal access to maintain this level.
TUPEO210
AIDS Vancouver's case management program:
meeting the diverse needs of persons living with
HIV/AIDS in British Columbia
M. Compton, L. Mervyn, H. Hoiness, V. Bright, E. Mo. AIDS Vancouver, Client
Services, Vancouver, Canada
Issues: AIDS Vancouver's community-based case management program
delivers comprehensive support to persons living with HIV/AIDS (PWAs)
throughout the Vancouver region. Our challenge is to deliver interventions that
meet the needs of an increasingly broad and heterogeneous client base.
Description: Services are provided to a diversity of women, youth, gay men,
seniors, injection drug users, immigrants, sex trade workers, aboriginal men
and women, families, and persons with mental health diagnoses. Using a social
determinants of health framework, individualized care plans seek to increase
access to adequate health care, housing and income, and to strengthen support
networks. Interventions strive to increase skills and capacity regarding health
practices. Services include on-going referral, information and support, care
coordination, liaison with health care providers, and advocacy within health/
social service networks. The overall goal is to provide PWAs with the tools to
achieve and maintain stabilized health.
Lessons learned: Over ten years experience delivering support to more than
4,000 clients has demonstrated that ensuring adequate resources to meet daily
needs (e.g. knowledgeable and responsive practitioners, affordable housing,
stabilized income, sufficient nutritional resources, increased psycho-social
support), is vital to clients' capacity to successfully manage the complexities
of living with HIV disease. Interventions have a positive impact on treatment
uptake and adherence, symptom management, disease progression and
capacity to make safer choices in daily life. While these basic needs transcend
cultural differences within the broad population of PWAs, some client groups
are more difficult to reach than others: Successful client connection depends
upon the provision of a range of pathways to services (drop-in, appointments,
outreach, home visits). Program design, content, and delivery muist remain
responsive to the changing needs of affected communities.
Recommendations: The integration of community-based case management
with clinical health services will strengthen the continuum of treatment and
care and improve client health outcomes.
TUPE0211
Designin9 laboratory logistics system for expanding
ART services
C. McLaughlin, A. Diallo, W. Nicodemus. JSI's DELIVER Project funded by
USAID, Arlington, United States
Issues: As ART services expand, laboratory services must expand exponentially
to meet the growing demand for routine laboratory services required for the
diagnosis, clinical investigations for treatment eligibility, and monitoring of
treatment efficacy and toxicity. Critical to the support of expanded laboratory
services is a well-designed logistics management system that ensures the
availability of essential laboratory supplies and reagents. Laboratory logistics
systems are often already under-resourced and over burdened and need to be
strengthened to handle the increase in services.
Description: This paper describes key issues on operational considerations
that impact the design and implementation of logistics systems for laboratory
services. Particularly, it focuses on logistics system requirements for laboratory
supplies and reagents used in expanding ART services (based on WHO's
recommended minimum tests). Also included are country examples illustrating
challenges associated with countries expanding ART services with weak logistics
systems for laboratory reagents and consumables.
Lessons learned: Designing a well functioning logistics system to support
laboratory services is dependent on clear operational guidelines that provide a
link between clinical decisions, laboratory services, and logistics management
systems for laboratory supplies. Successful expansion of ART services will be
compromised if logistics systems do not ensure quality testing and availability
of laboratory reagents and consumables.
Recommendations: As part of the planning for expansion of ART services,
donors, and countries must include activities to strengthen laboratory services,
particularly operational guidelines and the logistics systems that support
those services to ensure continuous supply of critical laboratory supplies and
reagents.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1