14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoPeB3238

BACKGROUND: In April 00, MSF opened 3 HIV clinics within primary health care (PHC) facilities in a poor township near Cape Town. Appropriate prophylaxis was provided and opportunistic infections (OIs) and HIV related conditions were diagnosed and treated. The type and frequency of adult OIs according to clinical stage are described.

METHODS: A retrospective survey was conducted on patients attending the clinics from April 00 to December 01. World Health Organization clinical staging was used.

RESULTS: 1,617 patients presented during this period. Patients in stages 3 and 4 presented with 4.8 and 7.2 OIs per year respectively; patients in stages 1 and 2 presented with 0.6 to 1.6 conditions per year respectively. The commonest OIs were: oral candidiasis (629 cases or 27.7% of total new OIs), pulmonary TB (362 or 16%), extrapulmonary TB (83 or 3.7%), recurrent or persistent vaginal candidiasis (378 or 16.7%), oral hairy leucoplakia (234 or 10.3%), recurrent or persistent herpes simplex virus infection (201 or 8.9%), oesophageal candidiasis (168 or 7.4%), extensive or persistent herpes zoster virus infection (111 or 4.9%). The median CD4 cell count was 86 for oral candidiasis, 97 for pulmonary TB, 80 for extrapulmonary TB, 153 for oral hairy leucoplakia, 22 for oesophageal candidiasis. 16% of patients were referred to either secondary or tertiary levels. Referrals to secondary or tertiary levels per patient year by stage were 0.0 for stage 1, 0.1 for stage 2, 0.3 for stage 3 and 1.0 for stage 4. 55.2% of patients were on Cotrimoxazole prophylaxis.

CONCLUSIONS: The management of persons with HIV at PHC level in resource poor settings is feasible, with appropriate training. Acyclovir and Fluconazole should be available together with the drugs on the Essential Drug List for PHC level. Patients in stages 1 and 2, and some in stage 3 can be managed at nurse- based clinics. As TB is very common, there is a need for integration of TB and HIV services.

Presenting author: Francoise Louis

1MSF, PO BOX 27401, Rhine Rd, 8050 Cape Town, South Africa.

2University of Cape Town, Cape Town, South Africa.

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Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.