European Journal of Medical Research - Deutsche AIDS ...

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June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH 47 A.55 (Vortrag) Children and young people living or working on the streets: the missing face of the HIV epidemic in Ukraine. A research report published by UNICEF Ukraine and AIDS Foundation East-West (November 2006) Teltschik A. 1 1 Free-lance public health consultant (Eastern Europe & Central Asia), Odessa, Ukraine Objectives: 1. To close an existing gap in research and to systematically assess and present: a) Needs and demands of the target group; b) Rights violations; c) National policy and legal frameworks; d) Available resources; e) Service quality and levels of coordination and cooperation. 2. To provide recommendations and to guide the design, implementation and evaluation of an extended, comprehensive and multisectoral national response to prevention, treatment, care and support for this target group. Methods: A comprehensive situation and comparative analysis and a quantitative and qualitative survey among 650 children and young people living or working on the streets in Kiev and Odessa. Results: 1. The phenomenon of children and young people living or working on the streets has been steadily increasing over the past 16 years in Ukraine. 2. Most children run away from home, because of a dysfunctional family, abuse and the fact that there is no adequate social support system in place to address the problems at home and to prevent them from running away. 3. But once the children and young people are living or working on the streets, their needs are also not being adequately met. Key research findings: a) This is a group most likely to be exposed to violence, abuse, discrimination, exploitation, HIV and many other diseases. b) They have a poor health status, very low education levels and their rights are being seriously violated. c) The majority are engaging in risk behaviour. d) They lack protection, as well as the means, skills, knowledge etc. to protect themselves. e) The services provided to them are of low quality. f) There is a lack of official, standardized and reliable data. Conclusions: The target group represents only the ´tip of the iceberg´. ´Below the water´ is a large and growing number of vulnerable children and young people in Ukraine, who are also most-at-risk and most affected by the HIV epidemic, and should therefore be at the centre of policy-making. The research report provides detailed recommendations to the Ukrainian government in key strategic areas on how to extend and improve the national response based on the experience gained in addressing the HIV epidemic over the past years in the country. A.56 (Poster) Knowledge, attitudes and behaviour in regard to HIV and STI among MSM in Austria, Slovak Republic, Italy and Slovenia – a BORDERNET cross border survey Amort F. 1 , Steffan E. 2 , Sokolowski S. 2 , Schnitzer S. 2 1 AIDS-Hilfe Wien, Prävention, Wien, Austria, 2 SPI Forschung gGmbH, Berlin, Germany Objectives: BORDERNET (EU funded) aims to enhance HIV/AIDS and STI-prevention, diagnostic and therapy in regions across the old and the current EC-outer borders. In Western Europe in general over one third (35%) of the HIV infection diagnosed in 2005 occurred through sex between men. The epidemics range in Central Europe remains still small in comparison, but also here sexual contacts between MSM are an important source of infection. Methods: Two BORDERNET model regions (MR 3 – Austria/Slovakia, MR 4 – Italy/Slovenia) decided to make MSM to one of their target groups for a BORDERNET KAB survey with additional questions on mobility. Based on preliminary defined selection criteria of gay friendly venues, a total number of 371 MSM was questionned with a self-administration questionnaire. Results: In regard to cross border mobility, the MSM respondents from Slovenia and Slovakia are the most frequent travellers to the neighbouring countries, whereas the Austrian men are moderate travellers and the Italian travel even more seldom. Leisure time is the most important reason for travelling across the borders. Even though the respondents showed a very high basic knowledge of HIV/AIDS, there are also many insecurities as well as fears to get infected with HIV. A high percentage of MSM have been tested for HIV (Austria: more than 90%), and a high proportion of them stated to have received pre- and post test counselling. Concerning condom use, different patterns of risk management, such as consequent safe sex, being faithful, decrease of number of partners, serosorting, seropositioning and avoidance of risky venues could be identified in all countries. More risky behaviour was stated with steady partners than with casual ones. Over 20% of the men reported an STI diagnosis in the last two years, Italian MSM showed the highest incidence here. Discussion: A main challenge of the combined HIV and STI prevention among MSM is to handle the consequences of the “normalisation” process of HIV. Cross border prevention strategies for MSM might be a possibility to reach synergetic effects and should particularly focus on irrational fears and risk management strategies and help to overcome still existing prejudices and misconceptions. A.57 (Poster) Ansatz der Bewertung einer HIV-Infektion bzw. AIDS-Erkrankung in Österreich, 2006 Schröck T. 1 1 Donauuniversität Krems, Wien, Austria Fragestellung: Behandlungskosten von HIV bzw. AIDS waren in Österreich bislang unbekannt. Daher wurde im Vorfeld der Studie beschlossen, den Ansatz einer Bewertung vorzunehmen.
48 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 Methodik: Auswertung der Gesundheitsstatistik, Experteninterviews mit Ärzten und Vertretern von Pharmaunternehmen, Entwicklung von Modellpatienten, Berechung von Behandlungskosten auf Basis hypothetischer Lebensläufe, diskontiert auf den Barwert. Ergebnisse: HIV bzw. AIDS sind aus ökonomischer Sicht sehr komplexe Erkrankungen. Um diesen Komplexitätsgrad zu reduzieren, wurden mit Experten "Modellpatienten" entwickelt. Nach Berechnung von Arzneimittelkosten, Ambulanzbesuchen, Spitalsaufenthalten und eventueller Pensionierung (letztere beide nur für AIDS-Patienten) ergab sich folgender ökonomischer Kostenbefund: Eine HIV-Infektion in Österreich verursacht (auf den Barwert diskontiert) Kosten von 446.960 Euro bis 563.582 Euro (je nach Lebensalter, Geschlecht und Compliance), eine AIDS-Erkrankung einer 45jährigen Frau belastet das Gesundheitsbudget mit 557.760 Euro, die eines gleich alten Mannes mit 633.284 Euro (auf Grund unterschiedlicher durchschnittlicher Pensionsansprüche). Werden Compliance erhöhende Maßnahmen (z.B. der Einsatz von Adherence Nurses) durchgeführt, reduzieren sich damit die Gesundheitsausgaben pro Patient stark. Durch den vermehrten Besuch der Ambulanz sowie durch höheren Testungsaufwand erhöhen sich bei non-compliant Patienten am Beispiel einer 30jährigen HIV-positiven Frau die diskontierten lebenslangen Kosten der Behandlung um rund 63.000 Euro. Schlussfolgerungen: Für HIV/AIDS-Erkrankungen kann es gesundheitsökonomisch nur folgende sinnvolle Vorgehensweise geben: 1. Prävention und damit Nicht-Ansteckung 2. Wenn eine Ansteckung erfolgt ist: frühzeitige Therapie und ein den Behandlungsrichtlinien des Arztes folgendes Patientenverhalten 3. Jede Verbesserung des Patientenverhaltens ist zu unterstützen und damit besonders der Einsatz von speziell geschulten Pflegekräften („Adherence Nurses“). A.58 (Poster) DAGN-AD improve project part II: National health economic cohort analysis (K3A) Goetzenich A. 1 , Hanhoff N. 1 , Knechten H. 2 , Wasem J. 3 , Neumann A. 3 1 DAGNÄ e.V., Aachen, Germany, 2 PZB, Aachen, Germany, 3 Universität Duisburg-Essen, Lehrstuhl für Medizin- Management, Essen, Germany Background: With ever increasing rates of HIV-infection in Germany, the impact of this condition is not only significant medically but also health economically. Recent nation-wide data on the costs of HIV/AIDS are lacking. Further, data on HIV-infection in Germany and its current management outside the clinical trials setting are needed. Objectives: The objectives of this analysis are: 1) to gather data on the health economics of HIV-infection in Germany, 2) to sub-analyse these data according to stages of the condition, 3) to gather data on clinical parameters and antiretroviral treatment, including reasons for discontinuing or changing therapy. Methods: The DAGN-AD Improve national health economic cohort analysis (K3A) is a prospective, multi-centre evaluation. Continuous health economical and clinical data pertaining to HIV-infection is gathered for each patient for 18 months. The health economical data include both direct (incurred through all HIV-related diagnostic and therapeutic procedures) and indirect costs (incurred through e.g. absence from employment due to illness, etc.). Clinical data include information on routine laboratory parameters (CD4 cell count, HIV-RNA), on AIDS-defining illnesses, on HIV-associated illnesses and co-infections and on antiretroviral therapy use. The latter also includes reasons for any treatment discontinuation or change. Data are obtained via health economic questionnaires and physician clinical documentation. The questionnaires are employed at every patient visit. Results: Calculations based on a statistical power of 90% with a 5% confidence interval indicated that at least 528 cases need to be recruited. Nation-wide, 33 HIV-specialty and ambulatory care centres are participating in this evaluation and have recruited 668 patients. These are representative of the geographical distribution of all HIV-infected individuals in Germany according to epidemiological data published by the RKI. The evaluation is ongoing. A limitation to this study is that intangible costs (a monetary value assigned to pain, decreased quality of life, etc.) are not gathered. A.59 (Poster) Analysis of German costs of full virological suppression for treatment experienced, HIV infected patients in the POWER trials Stoll M. 1 , Hill A. 2 1 Medizinische Hochschule Hannover, Zentrum Innere Medizin, Abt. Klinische Immunologie, Hannover, Germany, 2 University of Liverpool, Pharmacology Research Laboratories, Liverpool, United Kingdom Background: The aim of antiretroviral treatment is long-term suppression of HIV RNA below 50 HIV RNA copies/mL. The POWER 1 and 2 trials evaluated new protease inhibitor treatment – darunavir/ritonavir (DRV/r) 600/100 mg BID versus Control PI (CPI), in treatment experienced patients, where complex and expensive drug combinations are typically required. Methods: Office based German 2007 costs (including tax) were used. Average costs of antiretroviral treatment were calculated from the percentage use of NRTIs, PIs and T-20 in the DRV/r and Control PI arms of the POWER 1 and 2 trials. Rates of HIV RNA suppression
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