Confronting AIDS Directions for Public Health, Health Care, and Research (1986) / Chapter Skim
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Appendix G. PHS Plan for Prevention and Control of AIDS and the AIDS Virus
Appendix G. PHS Plan for Prevention and Control of AIDS and the AIDS Virus
Pages 326-333
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From page 326... ...
Donald Ian Macdonald, MD Acting Assistant Secretary for Health Purpose This document provides a framework for the steps that must be taken in five broad areaspathogenesis and clinical manifestations, therapeutics, vaccines, public health control measures, and patient care and health care needs-to achieve prevention and control of AIDS. The current plan is based on estimated changes in the demographics of AIDS through 1991.
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From page 327... ...
drug abusers, it is clear that this virus does not discriminate by sex, age, race, ethnic group, or sexual orientation. Behaviors which are high risk for the acquisition of HTLV-III/LAV infection include sexual contact or sharing of drug injection equipment with an infected person.
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From page 328... ...
It also includes patients in groups in which epidemiologic studies suggest heterosexual transmission as the major risk factor. By 1991, more than 3,000 cases will have been diagnosed in infants and children.
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From page 329... ...
· Clinical and epidemiologic studies need to be conducted to - Clarify the natural history of infection, including the role which may be played by exogenous or endogenous factors in determining which clinical manifestations occur, and -Continue to expand the spectrum of clinical manifestations. · Basic scientific studies on the virology and immunopathogenesis of HTLV-III/LAV need to be expanded, especially to -Assess target cell susceptibility; - Identify viral and host cell determinants of transmissibility and pathogenicity including portals of viral entry, mechanisms of cytopathic effects, and dysfunction; - Further elucidate mechanisms of viral latency and activation; - identify and assess direct and indirect immunopathogenic mechanisms; - Further delineate the pathogenesis of neurologic and psychiatric abnormalities; and -Ascertain more fully the functions of viral gene products and determine the meaning and mechanisms of genetic heterogeneity.
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From page 330... ...
A vaccine for general use is not anticipated before the next decade, and its use would 'In the absence of a vaccine and therapy, prevention and control of HTL V-III/LA V infection depends largely upon effective approaches to decrease sexual transmission, transmission among I V drug users, and perinatal transmission from infected mothers.' not affect the number of persons infected by that time. The following steps need to be taken: · Vaccines employing recombinant DNA derived .
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From page 331... ...
· With the assistance of appropriate organizations, programs should be implemented to provide culturally sensitive, meaningful information and education to blacks and Hispanics, including homosexuals, IV drug abusers, blood donors, women both at risk; themselves and also at risk for transmitting infection perinatally, and to other segments of the public. · Health care providers need current informa tion and training on the diagnosis, psychosocial counseling, and management of HTLV-III/LAV infected persons.
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From page 332... ...
· Increase the effectiveness of deferral by all persons at increased risk of HTLV-III/LAV infection by: -Collecting demographic and other data from donors found to have confirmed HTLV-III antibody. This will require some type of case reporting and subsequent interviews, but it is essential to the continued evolution of the high-risk donor deferral strategy; -Improving communications to potential donors about self-deferral, taking into consideration their language skills and literacy; -Exploring the usefulness of providing means at the time of donation for blood donors, who do not self-exclude but who have remaining doubts about their suitability, to designate that their donated unit not be used for transfusion; -Implementing the use of a signed donor consent form in all blood banks that clearly indicates the absence of specific risk factors for transmission of infections; · Continue to require that blood and plasma establishments maintain deferral lists of donors who have repeatedly reactive ELISA tests.
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From page 333... ...
To improve care for AIDS patients, all sectors of the health care delivery system should work together to · Develop a coordinated Federal, State, and local response to manage the health services and health financing crisis posed by the escalating AIDS epidemic. This response must reflect the pluralistic character of the American health care system and must involve the coordinated participation of the public, private, and voluntary sectors, as well as ambulatory, in-hospital, and long-term care providers; · Explore the feasibility and need for convening a national, blue-ribbon commission representing the necessary constituencies to canvass needs and resources available and to make recommendations regarding how each sector of our society can help to fill financing and resource needs; · Emphasize the needs of institutional and community-based providers for training, continuing education, and psychosocial support; · Upon request, assist State and local governments and community-based organizations to assess, develop, and implement comprehensive service delivery systems of care for AIDS patients in a cost-effective manner; · Develop organized consortia of service delivery systems responsive to the care of AIDS patients; such consortia should include all the necessary components of care (that is, ambulatory, hospital, mental health, and dental health services, counseling, home health care, and hospice care.)
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