17214: (Craig) Article: CDC Prevention News Update (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: Dan Craig <dgcraig@att.net>

CDC HIV/STD/TB Prevention News Update
Monday, November 10, 2003

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                          MEDICAL NEWS
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HAITI:
"The Feasibility, Demand, and Effect of Integrating Primary Care
Services with HIV Voluntary Counseling and Testing"
Journal of Acquired Immune Deficiency Syndromes (08.01.03) Vol.
33: P.470-475::Robert Peck; Daniel W. Fitzgerald; Bernard
Liautaud; Marie Marcelle Deschamps; Rose Irene Verdier; Marie
Eugene Beaulieu; Reynold GrandPierre; Patrice Joseph; Patrice
Severe; Francine Noel; Peter Wright; Warren D. Johnson Jr.; Jean
William Pape
      The researchers hypothesized that HIV voluntary counseling
and testing (VCT) and primary care services have synergistic
benefits, and that integrating the two could be an effective
strategy against HIV transmission in developing countries.
      "We hypothesize that primary care services and HIV VCT are
synergistic; the on-site availability of primary care services
attracts people to VCT, and VCT attracts people in need of
primary care services for other transmissible diseases," the
scientists wrote. "The goal of the current study is to
demonstrate the feasibility, demand, and effect of integrating
primary care services into VCT in a developing country."
      From 1985-2000, services for HIV care, TB care, treatment of
STDs, reproductive health, nutrition and prenatal care for HIV
mothers were sequentially integrated into HIV VCT at Groupe
Haitien d'Etude du Sarcome de Kaposi et des Infections
Opportunistes (GHESKIO) in Port au Prince, Haiti. This study
examines the effects such integration had on the client
population.
      In 1985, GHESKIO counseled and tested 142 people, mostly
male clients with AIDS, referred from Port au Prince medical
clinics. By the end of 1999, the number of people tested annually
for HIV increased to 8,175, with increasing percentages of women
of reproductive age, adolescents, symptom-free clients and self-
referred clients. Of the 2,013 adults who tested HIV positive at
the GHESKIO VCT center in 1999, 55 percent received medical care
at the center's adult HIV clinic. Twenty-one percent of those
adults referred a sexual partner for HIV testing and counseling.
Of the 121 children who tested positive, 72 percent received care
at the pediatric HIV clinic.
      Of 6,709 adults who were tested in 1999, 1,274 (19 percent)
became new users of a contraceptive method. Seventy percent of
clients who came in for family planning counseling chose to use
condoms alone, while 372 women (30 percent of family planning
users) chose a highly effective method of birth control. Of those
women, 50 percent (186) also used condoms regularly.
     Eighteen percent of clients (1,196) were given syndromic STD
management (including counseling, condoms, and syndromic
treatment with free medications), and 398 (6 percent) were
diagnosed and treated for active TB.  Nine percent (599) had a
positive syphilis serology and received management for latent
syphilis; 9 percent (597) received management for symptomatic
STDs.
      Follow-up data on the first 62 children born to women
participating in the program to prevent mother-to-child HIV
transmission show seven infected with HIV during an 18-month
follow-up, for a rate of 11 infections/100 live births.
Historical controls in Haiti estimate the infection rate at
22/100 live births.
      "This report demonstrates the feasibility, demand, and
effective synergy of integrated on-site primary care services and
HIV VCT in Haiti," the authors concluded. "It is important to
note that people diagnosed with HIV/AIDS in Haiti still risk
tremendous social stigmatization; therefore, if thousands of
people come for HIV testing, then they must believe that the
benefits of VCT and integrated services outweigh the risk of
stigmatization. We believe that the availability of on-site
patient services is an important variable in this personal
risk/benefit calculation."
      "While some view HIV care and HIV prevention as opposing
programs vying for limited resources," the researchers stated,
"we believe that prevention and care are synergistic and forged
together will be a powerful weapon in the fight against AIDS in
Haiti and in many other developing countries."

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