The mounting medical care cost for adult AIDS patients at the Faculty of Medicine, Siriraj Hospital: consideration for management.

From January 1993 to December 1995, case records of adult AIDS and HIV symptomatic patients admitted in the Department of Medicine, observation room and HIV Counseling Clinic were reviewed for the medical care cost of the patients based on the 1995 value of the Thai baht. In the three years, a total of 196, 227 and 182 adult AIDS case were admitted as in-patients respectively. The median duration of admission was 14 days. The leading causes of admission were tuberculosis, cryptococcal meningitis, Pneumocystis carinii pneumonia, diarrhea, salmonellosis and toxoplasmosis. An increase in the number of AIDS patients in the observation room was observed: from 572 cases in 1993 to 1,205 cases in 1995. In addition, approximately 600 AIDS cases were followed up at four to eight week intervals. The analysis of the data found an average medical care cost for hospitalized patients to be 1,452 baht per day while in the observation room it was 1,509 baht per day and 1,132 baht per month for the patients attending the HIV and Counseling Clinic. Because of the higher number of cases and the limited number of admission beds, only 15 per cent of AIDS patients in the observation room could be admitted as hospitalized patients. At present, it is urgent that a referral network be established among all university hospitals, all government hospitals and health centers. In this way, the more advanced medical facilities can serve as a primary diagnostic center which can refer patients for care and follow-up based on an established referral system. In addition, the development of a hospice service and community care is needed for cases in the terminal stage of the illness.

The prevalence of HIV infection and the knowledge of AIDS among Thai labourers at Siriraj Hospital between 1994 and 1995.

From January 1994 to December 1995, a total of 71,249 patients (37,167 in 1994 and 34.082 in 1995) attended the clinic for labourers going abroad at Siriraj Hospital for a pre-assignment physical exam and mandatory blood screen for HIV antibody Of this total, 300 tested positive for HIV antibody (0.8 per cent) in 1994 and 244 (0.7 per cent) in 1995 respectively. The largest proportion of HIV positive persons were from the upper northern provinces of Thailand, Bangkok and Samutprakran (0.8 to 3.0 per cent). Of 614 labourers who volunteered to participate in an interview on the level of knowledge about AIDS, which was conducted by a clinic nurse, 13.6 per cent of the participants accepted that they were more likely to have had sexual intercourse with female commercial sex workers or other women, rather than their wives. Sexual intercourse appears to be the most plausible mode of HIV transmission for those Thai labourers who tested HIV transmission for those Thai labourers who tested HIV –positive, as none had history of injecting drugs. Therefore it is imperative to continue efforts to promote 100 per cent condom use in commercial sex as the norm. In addition, a notification link should be established between the Ministry of Labour and Social Welfare, job placement agencies, the AIDS division and the nearest provincial medical authority, in to provide post-test counseling and follow-up on regular basis to this group of Thai labourers as those who are infected may transmit HIV to others in their home provinces.

Seroprevalence of anti-HCV among HIV-infected persons and general population.

From November 1993 to December 1994, the seroprevalence of anti-HCV, HBsAg was studied among 346 HIV-infected persons (asymptomatic HIV-infected persons and AIDS patients) and 1,023 subjects from the general population (including 119 cord blood samples). The prevalence of anti-HCV, HBsAg among HIV-infected patients aged 15-45+ years was 11.0 and 11.6 per cent respectively which is significantly higher than the comparable levels for the general population (1.9% and 4.7%) in the age group 15-44 years. There was no statistically significant association of anti-HCV and HBsAg prevalence among 200 asymptomatic HIV-infected carriers and 146 AIDS patients. Assays for anti-HCV among blood donors are highly recommended to reduce the development of liver disease or cirrhosis in the immediate future.

HIV-1 infection among low income women attending a Siriraj sexually transmitted disease clinic: sociodemographic differentials.

From August 1993 to October 1994, 322 women attended or were referred to a female sexually transmitted disease clinic, were studied for the prevalence of HIV infection. No subject had a history of commercial sex work, injection drugs use or blood transfusion within the past 8 years. The majority of women belonged to the low socioeconomic stratum. HIV-1 antibody was found in the sera of 38 women (11.8%). HIV-1 seropositivity was not associated with any type of current sexually transmitted disease such as genital ulcers, serologic markers of syphilis or other sexually transmitted disease as well as history of past sexually transmitted disease within the past 2 years. Significant differential factors were found between the HIV-1 seropositive and seronegative women for self risk assessment and ability to communicate concerns with the husband or partner regarding HIV infection/AIDS. Programs are urgently needed for HIV/AIDS prevention and control to low-income communities and to determine what factors enable the HIV-1 seronegative women to be more assertive in their relationship and whether these skills can be enhanced to eliminate future episodes of STD and transfer these skills to the more vulnerable low-income women. Early diagnosis and prevention of HIV infection among women is a priority for public health interventions both in industrialized and in developing countries.

Septicemia in the elderly.

The epidemiologic study regarding septicemia in the elderly was done in general medical wards and intensive care units of Department of Medicine, Siriraj Hospital. The average age of the 100 patients recruited was 70.6 + 8.2 years old with the prevalence of community-acquired septicemia and nosocomial septicemia being 52% and 48% respectively. Sex, the ratio of infection from gram-negative and gram-positive organisms and the mortality rate were not significantly different between those two groups of patients. Gram-negative septicemia constituted 70% of all infections i.e. 2-2.5 time of gram-positive septicemia. The most frequent causative organisms were E. coli (19%) and nonfermentative gram-negative rod (18-%) whereas Staphylococcus aureus was found in greatest number among gram-positive organisms (10%). The mortality rate of septicemia was 49% but only 28% could be discharged alive due to the fact that another 23% of the patients died from other causes such as from the complications of their own underlying diseases as only 2% had no any underlying disease. Cirrhosis was found to be the most serious underlying disease with the mortality rate of 1%. The most common identified site of infection was urinary tract infection (16%), however, intravascular catheter was responsible for nosocomial septicemia in the greatest extent. Serum albumin nonspecific prognostic in elderly patients with the average value of 3.01 + 0.78 gm% among the survivors and 2.55 + 0.97 gm% among the victims. Multiple logistic regression analysis showed that septic shock, hypothermia and consciousness were the independent risk factors of the mortality rate of septicemia in the elderly.

Risk factors for HIV infection among Thai laborers during 1992-1993.

From June 1992 to May 1993, 39,939 Thai men attended the clinic for laborers going abroad at Siriraj Hospital in Bangkok for a pre-assignment physical exam and mandatory blood screen for HIV and syphylis. Of this total, 438 tested positive for HIV antibody (1.1%). Of these, 215 men returned for post test interview and physical exam and were compared with 1,348 men randomly selected HIV-1 seronegative men. None of the HIV-1 seropositive had a history of injecting drug use or had received blood transfusion in the past seven years. HIV-1 seropositivity was associated with the TPHA serological marker for syphylis > 1.160 (p = 0.015, odd ratio 1.8), history of urethritis (p = 0.009, odd ratio 1.92) (Table 4). This study found that HIV-1 seropositive men were mostly single, were likely to be from the rural northern provinces of Thailand or Bangkok. History of purchase of low-fee commercial sex and less condom use were significantly associated with HIV-1 seropositivity as was a history of STD in the year prior to interview. Information on HIV disease and pre-test/post test counselling is needed for Thai laborers who are applying for work abroad to countries which require HIV and syphylis screening. In this effort, the Ministry of Labor and Social Welfare, the Ministry of Public Health and the clinic for laborers going abroad should join forces to provide this service. This will serve to increase awareness and self-determination among an increasingly vulnerable segment of the population who also have the potential to spread HIV infection to their spouse and other sex partners.(ABSTRACT TRUNCATED AT 250 WORDS)