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HIV-challenges and controversies
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Methods: A randomized controlled trial in 12 schools in Edo State was conducted to evaluate an intervention to improve STD treatment-seeking and STD treatment provision. The intervention, consisted of community participation, peer education, public lectures, health clubs in high schools, and training of STD treatment providers including those with no formal training. A questionnaire measured outcomes before and 10 months into the intervention. The effect of the intervention among 4 randomly-selected intervention schools compared to 8 randomlyselected control schools was assessed using multiple logistic regression with Huber’s formula to account for school clusters. Results: 1896 and 1858 youth 14-20 years of age were enrolled in the pre and post-intervention surveys. Youths in the intervention schools compared to control schools reported statistically significant improvements in knowledge of STDs, condom use, partner awareness that the youth had a STD, and treatment-seeking behavior. Treatment by private physicians increased (OR=2.1, 95% CI = 1.1-4.0) and by patent medicine dealers or pharmacists decreased (OR =0.44, 95% CI = 0.22. 0.88). The reported prevalence of STD symptoms in the past 6 months was significantly reduced in the intervention compared to control schools (OR = 0.68%, 95% CI=O.48-0.95). Conclusion: Significant improvements in treatment seeking for STD symptoms can be effected among Nigerian youth. The prevalence of reported STD symptoms can be decreased by a peer educational program to improve treatment-seeking for STD.
FC4.04.09 PREVALENCE OF GYNAECOLOGICAL RISK FACTORS FOR HETEROSEXUAL TRANSMISSION OF HIV AMONG WOMEN ATTENDING CENTERS FOR COUNSELLING AND SEROLOGIC TESTING IN BRAZIL A.D. J.R.Gabiatti, P.C. Giraldo, State University of Campinas - UNICAMP, National Health Ministry Brazil Objectives: To determine the prevalence of gynaecological risk factors among women once exposed to HIV transmission. To stablish a possible correlation between behavioral and gynaecological risk factors for HIV heterosexual transmission. Study Methods: Among women visiting a Center for counselling and serologic testing in Brazil during a six month period, 253 accepted a gynaecological consultation where a questionary defined their behavioral risks and a gynaecological and complementary exams defined their biological risk to heterosexual transmission of HIV. Statistical analisis were used to search any correspondence between those risk factors. Results: Overall prevalence of gynaecological risk factors for HIV heterosexual transmission among the sample were 62,7%, most of them assymptomatic. Statisticaly, it was not possible to determine a greater risk of having a gynaecological risk factor for HIV transmission by analising only the behavioral risk through a standart questionary. Conclusions: Any effort to diminish risk among women exposed to HIV transmission should include not only advertising and counselling but also a gynaecological check up even if assymptomatic. Teatching the importance of genital health on fighting agains heterosexual transmission of HIV should be part of the speach of every profissional at Centers for counselling and serologic testing in Brazil and all over the world.
FC4.04.10 HIV-CHALLENGES AND CONTROVERSIES A. Patil, H. Divakar, Divakars Hospital, BTM Layout, Bannerghatta Road, Bangalore, Karnataka, India, 560076. This paper aims at presenting the management of ‘8’pregnant patients who were referred to our hospital due to seropositivity to HIV, Our hospital being one of the first private institutions accepting management of HIV seropositive cases. Of the ‘8’HIV +ve pregnant patients, 4 patients opted for termination of pregnancy at 10 weeks, 14 weeks, 28 weeks and 30 weeks of gestation. The patients who continued pregnancy were appropriately counselled and started on AZT Ziduvidine.One patient delivered vaginally and three patients underwent elective casearean sections. The neonatal outcomes & followups will be presented. At present, we have two ongoing HIV +ve pregnancies, both of whom are on AZT.
THURSDAY,
SEPTEMBER
The paper will also highlight the alarming numbers of HIV epidemic in India & the rest of the developing world, the testing policies, the preventive strategies and the various anti retroviral drug regimens. As obstetricians, our concern of vertical transmission to the foetus and the controversies regarding mode of delivery, breast feeding recommendations and drug therapy will be discussed. HIV is grossly underdiagnosed and health care community is reluctant to manage the infected persons in the developing world. Our Hospital is one of the premier institutes in southern India who has taken the first step towards treating HIV +ve patients and embarking on the goal of prevention of vertical transmission.
FC4.05 OBSTETRICS:
LABOR
FC4.05.01 MISOPROSTOL VERSUS OXYTOCIN FOR LABOR INDUCTION: RANDOMIZED CONTROLLED TRIAL J.G. Cecatti (l), M.M.A. Aquino (l), G.M. Garcia (2), T.M.C. Rodrigues (2) (1) Dept. OBIGYN, Universidade Estadual de Campinas, SBo Paula, Brazil. (2) Dept. OBIGYN, Hospital-Maternity Leonor Mendes de Barros, SBo Paula, Brazil. Objective: To compare the effectiveness and safety of intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. Study Methods: It was a randomized controlled trial, performed at Hospital-Maternity Leonor Mendes de Barros (HMLMB), SBo Paula, Brazil, from November 1998 to August 1999. 106 term pregnant women with intact membranes and with indication for labor induction were selected. They randomly received 25 pg of vaginal misoprostol every 4 hours, not exceeding 8 doses (53 women) or oxytocin in a continuous infusion (53 women). The main outcome variables were: latent period, time from onset of induction to vaginal deilvery, route of delivery and occurrence of hyperstimulation syndrome. To verify the statistical significance of the differences among the groups, xz, Student t and Mann-Whitney tests were used. Results: There were no significant differences between the groups concerning age, parity, race, literacy, initial Bishop Index and delivery route, although twice the amount of cesareans occurred in the oxytocin group (39.6% against 20.7% for misoprostol). The latent period and the period from the onset of induction to vaginal delivery were significantly lower for the misoprostol group (p
FC4.05.02 A COMPARISON OF ORAL AND VAGINAL MISOPROSTOL TABLETS IN THE INDUCTION OF LABOR AT TERM A. Shetty, P. Danielian, A. Templeton, Dept. OBIGYN, Aberdeen Maternity Hospital, Aberdeen, UK. Objectives: The aim of the study was to compare the efficacy of equivalent doses of orally administered with vaginally administered misoprostol in the induction of labor at term. Study Methods: Two hundred and forty five pregnant women at term, with indications for labor induction were randomly assigned to receive 50pgms of misoprostol tablets orally or vaginally four hourly to a maximum of 5 doses, if required. The main outcome measure was the interval from induction to vaginal delivery. Results: The mean induction to vaginal deliver interval was significanly shorter in the vaginal group as compared to the oral group (14.3hrs Vs 25.lhrs;p<0.0001). There was no difference in the mode of delivery, analgesic requirements or neonatal outcomes in the two groups. There was, however, a higher incidence of uterine hyperstimulation in the vaginal group (4.9% Vs 0.8%) although this was not statistically significant (P=O.12), and more operative deliveries were indicated for fetal distress in this group (23.8% Vs 9.8%, P=O.OOS). Patient questionnaire analysis revealed that a significant number preferred the
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Methods: A randomized controlled trial in 12 schools in Edo State was conducted to evaluate an intervention to improve STD treatment-seeking and STD treatment provision. The intervention, consisted of community participation, peer education, public lectures, health clubs in high schools, and training of STD treatment providers including those with no formal training. A questionnaire measured outcomes before and 10 months into the intervention. The effect of the intervention among 4 randomly-selected intervention schools compared to 8 randomlyselected control schools was assessed using multiple logistic regression with Huber’s formula to account for school clusters. Results: 1896 and 1858 youth 14-20 years of age were enrolled in the pre and post-intervention surveys. Youths in the intervention schools compared to control schools reported statistically significant improvements in knowledge of STDs, condom use, partner awareness that the youth had a STD, and treatment-seeking behavior. Treatment by private physicians increased (OR=2.1, 95% CI = 1.1-4.0) and by patent medicine dealers or pharmacists decreased (OR =0.44, 95% CI = 0.22. 0.88). The reported prevalence of STD symptoms in the past 6 months was significantly reduced in the intervention compared to control schools (OR = 0.68%, 95% CI=O.48-0.95). Conclusion: Significant improvements in treatment seeking for STD symptoms can be effected among Nigerian youth. The prevalence of reported STD symptoms can be decreased by a peer educational program to improve treatment-seeking for STD.
FC4.04.09 PREVALENCE OF GYNAECOLOGICAL RISK FACTORS FOR HETEROSEXUAL TRANSMISSION OF HIV AMONG WOMEN ATTENDING CENTERS FOR COUNSELLING AND SEROLOGIC TESTING IN BRAZIL A.D. J.R.Gabiatti, P.C. Giraldo, State University of Campinas - UNICAMP, National Health Ministry Brazil Objectives: To determine the prevalence of gynaecological risk factors among women once exposed to HIV transmission. To stablish a possible correlation between behavioral and gynaecological risk factors for HIV heterosexual transmission. Study Methods: Among women visiting a Center for counselling and serologic testing in Brazil during a six month period, 253 accepted a gynaecological consultation where a questionary defined their behavioral risks and a gynaecological and complementary exams defined their biological risk to heterosexual transmission of HIV. Statistical analisis were used to search any correspondence between those risk factors. Results: Overall prevalence of gynaecological risk factors for HIV heterosexual transmission among the sample were 62,7%, most of them assymptomatic. Statisticaly, it was not possible to determine a greater risk of having a gynaecological risk factor for HIV transmission by analising only the behavioral risk through a standart questionary. Conclusions: Any effort to diminish risk among women exposed to HIV transmission should include not only advertising and counselling but also a gynaecological check up even if assymptomatic. Teatching the importance of genital health on fighting agains heterosexual transmission of HIV should be part of the speach of every profissional at Centers for counselling and serologic testing in Brazil and all over the world.
FC4.04.10 HIV-CHALLENGES AND CONTROVERSIES A. Patil, H. Divakar, Divakars Hospital, BTM Layout, Bannerghatta Road, Bangalore, Karnataka, India, 560076. This paper aims at presenting the management of ‘8’pregnant patients who were referred to our hospital due to seropositivity to HIV, Our hospital being one of the first private institutions accepting management of HIV seropositive cases. Of the ‘8’HIV +ve pregnant patients, 4 patients opted for termination of pregnancy at 10 weeks, 14 weeks, 28 weeks and 30 weeks of gestation. The patients who continued pregnancy were appropriately counselled and started on AZT Ziduvidine.One patient delivered vaginally and three patients underwent elective casearean sections. The neonatal outcomes & followups will be presented. At present, we have two ongoing HIV +ve pregnancies, both of whom are on AZT.
THURSDAY,
SEPTEMBER
The paper will also highlight the alarming numbers of HIV epidemic in India & the rest of the developing world, the testing policies, the preventive strategies and the various anti retroviral drug regimens. As obstetricians, our concern of vertical transmission to the foetus and the controversies regarding mode of delivery, breast feeding recommendations and drug therapy will be discussed. HIV is grossly underdiagnosed and health care community is reluctant to manage the infected persons in the developing world. Our Hospital is one of the premier institutes in southern India who has taken the first step towards treating HIV +ve patients and embarking on the goal of prevention of vertical transmission.
FC4.05 OBSTETRICS:
LABOR
FC4.05.01 MISOPROSTOL VERSUS OXYTOCIN FOR LABOR INDUCTION: RANDOMIZED CONTROLLED TRIAL J.G. Cecatti (l), M.M.A. Aquino (l), G.M. Garcia (2), T.M.C. Rodrigues (2) (1) Dept. OBIGYN, Universidade Estadual de Campinas, SBo Paula, Brazil. (2) Dept. OBIGYN, Hospital-Maternity Leonor Mendes de Barros, SBo Paula, Brazil. Objective: To compare the effectiveness and safety of intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. Study Methods: It was a randomized controlled trial, performed at Hospital-Maternity Leonor Mendes de Barros (HMLMB), SBo Paula, Brazil, from November 1998 to August 1999. 106 term pregnant women with intact membranes and with indication for labor induction were selected. They randomly received 25 pg of vaginal misoprostol every 4 hours, not exceeding 8 doses (53 women) or oxytocin in a continuous infusion (53 women). The main outcome variables were: latent period, time from onset of induction to vaginal deilvery, route of delivery and occurrence of hyperstimulation syndrome. To verify the statistical significance of the differences among the groups, xz, Student t and Mann-Whitney tests were used. Results: There were no significant differences between the groups concerning age, parity, race, literacy, initial Bishop Index and delivery route, although twice the amount of cesareans occurred in the oxytocin group (39.6% against 20.7% for misoprostol). The latent period and the period from the onset of induction to vaginal delivery were significantly lower for the misoprostol group (p
FC4.05.02 A COMPARISON OF ORAL AND VAGINAL MISOPROSTOL TABLETS IN THE INDUCTION OF LABOR AT TERM A. Shetty, P. Danielian, A. Templeton, Dept. OBIGYN, Aberdeen Maternity Hospital, Aberdeen, UK. Objectives: The aim of the study was to compare the efficacy of equivalent doses of orally administered with vaginally administered misoprostol in the induction of labor at term. Study Methods: Two hundred and forty five pregnant women at term, with indications for labor induction were randomly assigned to receive 50pgms of misoprostol tablets orally or vaginally four hourly to a maximum of 5 doses, if required. The main outcome measure was the interval from induction to vaginal delivery. Results: The mean induction to vaginal deliver interval was significanly shorter in the vaginal group as compared to the oral group (14.3hrs Vs 25.lhrs;p<0.0001). There was no difference in the mode of delivery, analgesic requirements or neonatal outcomes in the two groups. There was, however, a higher incidence of uterine hyperstimulation in the vaginal group (4.9% Vs 0.8%) although this was not statistically significant (P=O.12), and more operative deliveries were indicated for fetal distress in this group (23.8% Vs 9.8%, P=O.OOS). Patient questionnaire analysis revealed that a significant number preferred the
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