In the final installment of abstracts from the Toronto conference, we look at what are called ‘cross-border approaches’. Low, low numbers here.

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Epidemiological and clinical profile of PLWHAs in Chittagong, Bangladesh CDC0043

A.Q.M.S. Islam1, R. Aziz2, S. Begum3, F. Ahsan4, N. Begum5, M. Chowdhuri61Professor of Dermatology & STDs, Chittagong, Bangladesh, 2Chittagong Medical College, Asstt. Prof. of Biochemistry, Chittagong, Bangladesh, 3Clinical Care of HIV, Family Health International (FHI), Consultant,, Dhaka, Bangladesh, 4Central Skin & Social Hygeine Centre, Consultant, Chittagong, Bangladesh, 5Ashar Alo Society, Divisional Co-ordinator, Chittagong, Bangladesh, 6Ashar Alo Society, Counsellor, Chittagong, Bangladesh

Background: HIV prevalence is still low in Bangladesh, but it is increasing day by day. Chittagong is the main port city of Bangladesh and have border with Myanmar. There is frequent cross border Rohinga refugee influx and a lot of people from this region are overseas migrant workers. All these factors made Chittagong a high-risk zone for HIV. The purpose of this study is to characterize HIV-infected person in this region, including demographic features, probable mode of transmission, risk factors and clinical status of PHAs at the time of study.

Methods: A retrospective study was conducted on 60 HIV-infected individuals who reported to a PHA-clinical care center (Ashar Alo Society) and the private chamber of a HIV Physician (1st Author) in Chittagong from July 2003 to December 2005.

Results: The mean age of PHAs was 32 years with a range of 2 to 65 years. Among them 41 (68.33%) male, 14 (23.33%) female and 5 (8.33%) children. Mode of transmission was mostly heterosexual 54 (90.0%), 1 (1.66%) through blood transfusion and 5 (8.33%) mother- to- child transmission. Identified risk factors included - working overseas 40 (66.66%), being wife of HIV-infected man 14 (23.33%) and having a history of blood transfusion 1 (1.66%). Of the PHAs 48% were a symptomatic and 52% had sign/symptoms suggesting of immunodeficiency with common OIs like diarrhea, fever, pneumonia, TB, oral thrush, skin infections and herpes. A total of 15 (25.0 %) patients died during the study period.

Conclusions: The predominant mode of transmission was heterosexual contact and the majority of the reported cases were overseas migrant workers. Most of the cases were identified very late as they develop advanced AIDS defining illness. Efforts are urgently needed to identify the HIV-infected cases at earlier stages to interrupt the further spread of infection.

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Chiang Saen cross border ART (model I): a pilot programme at a Thai border site CDD0151

ChaitaChiang Saen Hospital, Ministry of Public Health Thailand, Chiang Rai, Thailand

Issues: Chiang Saen Hospital has provided ART to Laotian and Burmese migrants since 2004, with support from the EU, MSF and a Community Programme from the 15th International AIDS Conference. The programme has strengthened and progressed after being presented in Gobe at the 7th ICAAP last year.

Description: Guidelines of the country programme were applied. The Buddy programme and soft loans are available to them. The programme established a workable referral system and networks, and promoted VCT counseling. NCA supports alternative care using Thai traditional medicine and spiritual care. Of the 41 cases in the programme, 30 reside in Chiang Saen, 2 reside in Lao and 9 in Myanmar. One case is pregnant and receiving care to prevent mother to child transmission. One infant is receiving nutritional support. All of them have more than 90 % adherence and an improved quality of life. Eight PLWHA were trained as migrant health volunteers. 50 families, 7 employers, and 6 communities have joined the programme to fight discrimination.

Lessons learned: Three cases died because they came too late and suffered adverse effect from ART. A comparison of the unit cost for care found the group receiving ART have an average monthly cost of US$30 while the cost of care for cases not receiving ART is US$120. Addressing the public health needs of this population is challenging due to political, financial, cultural and language barriers. The work is more difficult and complicated than working with the Thai group, especially with illegal migrants.

Recommendations: Culture, language and workload problems can be party solved by non-Thai PLWHA volunteers. The programme’s effectiveness and sustainability still need to be considered. Strict criteria to recruit cases for the programme are necessary for an effective outcome. Good relations between patients/families and health providers, and collaboration between multi-sectors should be developed

Chiang Saen cross border ART (model II) joint programme between twin cities: Chiang Saen-Tonpeung and Chiang Saen-Myanmar border village W. Chaitha CDD1286

Chiang Saen Hospital, Ministry of Public Health Thailand, Chiang Rai, Thailand

Issues: Chiang Saen Hospital, Thailand, provides ART to PLWHA in Lao and Myanmar border areas along the Mekong River, sharing lessons learned from the Chiang Saen pilot programme, and jointly caring for PLWHA receiving ART together with Tonpeung Hospital in Lao and a Christian group in Myanmar. Description: Two PLWHA in Lao and Nine in Myanmar have joined this programme. MSF supports ART and OI drugs. NCA provides psychosocial and nutritional support, as well as for activities that share lessons learned. PLWHA travel to Chiang Saen Hospital twice monthly to receive the drugs and join activities. Thai PLWHA volunteers cross borders to visit patients monthly. Setting up joint activities include establishing a referral system, training health teams and volunteers from border countries to network with Thai PLWHA volunteers, and creating a multi-sectored collaboration between countries.

Lessons learned: Two PLWHA died because they arrived too late, due to travel difficulties and costs, and had adverse reactions from ART. Communities and schools in these countries still discriminate against PLWHA. Language, cultural, political and religious differences mean the strategy for provision of ART in the two countries differs. Trainings and home visits in Myanmar are more complicated than in Lao. Programme participants and the Christian group has an important role as volunteer in following up and caring for PLWHA in Myanmar.

Recommendations: Strict criteria for programme applicants are necessary for an effective outcome. The socio-economic problems cannot be avoided. The effectiveness and sustainability of the programme still needs consideration. Sharing knowledge will facilitate the learning process in the two countries. Preparedness for workload mobility, a referral system, promoting a positive attitude and relationships between patients/families, health providers, and communities, and collaboration between multi-sectors of the countries, both GO and NGO, should be developed. MOUs on HIV/AIDS collaborations between both countries will be good for the local team.