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1.
Med Care ; 59(1): 46-52, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33027238

RESUMO

BACKGROUND: As the population with human immunodeficiency virus (HIV) continues to age, the need for nursing home (NH) care is increasing. OBJECTIVES: To assess whether NH's experience in treating HIV is related to outcomes. RESEARCH DESIGN: We used claims and assessment data to identify individuals with and without HIV who were admitted to NHs in 9 high HIV prevalent states. We classified NHs into HIV experience categories and estimate the effects of NH HIV experience on patient's outcomes. We applied an instrumental variable using distances between each individual's residence and NHs with different HIV experience. SUBJECTS: In all, 5,929,376 admissions for those without HIV and 53,476 admissions for residents with HIV. MEASURES: Our primary outcomes were 30-day hospital readmissions, likelihood of becoming a long stay resident, and 180-day mortality posthospital discharge. RESULTS: Residents with HIV tended to have poorer outcomes than residents without HIV, regardless of the NH they were admitted to. Residents with HIV admitted to high HIV experience NHs were more likely to be readmitted to the hospital than those admitted to NHs with lower HIV experience (19.6% in 0% HIV NHs, 18.7% in 05% HIV NHs and 22.9% in 5%-50% HIV NHs). CONCLUSIONS: Residents with HIV experience worse outcomes in NHs than residents without HIV. Increased HIV experience was not related to improved outcomes.


Assuntos
Infecções por HIV/enfermagem , Revisão da Utilização de Seguros/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Idoso , Feminino , Infecções por HIV/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos
2.
Nurs Leadersh (Tor Ont) ; 33(1): 35-51, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32437320

RESUMO

Clinical placements in correctional settings offer nursing students unique opportunities for learning mental health and community health concepts, including social justice, restorative justice and the impact of poverty and marginalization on health and life choices. Although there is some evidence to suggest that a small number of nursing programs use clinical placements in correctional settings, relatively little scholarly literature addresses nursing education in such settings, or the implications for nursing leadership when students do have an opportunity to learn in correctional settings. In this paper, we examine the literature that is available on this topic and present the findings of a secondary analysis of interviews with undergraduate nursing students at our nursing program in relation to their clinical placements in correctional settings. Drawing on the students' perspectives, we have found that these placements, in particular, have fostered learning about caring for marginalized populations; themes of hope and restorative justice featured prominently in their descriptions of their learning. Students also emphasized that they learned a great deal about the expanded role of nurses and about caring for marginalized populations. With strong administrative and faculty support, these settings offer students exposure to expert registered nurse mentors who work with clients in an expanded role to facilitate their achievement and stabilization of a broad range of health challenges. They are also role models for students, by showing students that nurses can be agents of hope when working with a diverse client population and their families. We offer recommendations on how to maximize student learning in correctional settings, including a reflection on how to support students' integration of their learning experiences in their nursing practice, with the long-term view that these transformative student experiences have the potential to shape our future nurse leaders.


Assuntos
Liderança , Preceptoria/métodos , Prisões/normas , Estudantes de Enfermagem/psicologia , Bacharelado em Enfermagem/métodos , Bacharelado em Enfermagem/normas , Infecções por HIV/enfermagem , Infecções por HIV/psicologia , Hepatite C/enfermagem , Hepatite C/psicologia , Humanos , Preceptoria/tendências , Prisões/tendências , Enfermagem Psiquiátrica/educação , Enfermagem Psiquiátrica/métodos , Pesquisa Qualitativa , Determinantes Sociais da Saúde
4.
Creat Nurs ; 26(1): 9-16, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32024732

RESUMO

Combination antiretroviral therapy (cART) has improved the health and life expectancy of people living with human immunodeficiency virus (HIV). Comorbidities and geriatric syndrome are more prevalent in patients with HIV than in the general population. As a result, people living with HIV may face unique characteristics and needs related to aging. Health-care systems need to prepare to encounter those issues that not only focus on virology suppression and cART management but also chronic non-AIDS comorbidities and geriatric syndrome. However, there are limited data on geriatric assessment among people living with HIV. The purpose of this article is to present findings of a literature search that integrate age-related issues in HIV care management for health-care professionals caring for people living with HIV in Indonesia to consider. Integrating comprehensive geriatric assessment (CGA) into HIV care is essential. However, some critical issues need to be considered prior to implementing CGA in HIV primary care, including social vulnerability, economic inequality, and aging-related stigma. Developing guidelines for implementing CGA in HIV primary clinics remains a priority. Studies of HIV in the aging population in Indonesia need to be conducted to understand the burden of geriatric syndrome.


Assuntos
Atenção à Saúde/organização & administração , Avaliação Geriátrica , Infecções por HIV/enfermagem , Avaliação em Enfermagem , Idoso , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Indonésia/epidemiologia
5.
Curationis ; 42(1): e1-e6, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30843402

RESUMO

BACKGROUND:  Integration of human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) services into primary healthcare (PHC) is a key public health approach to achieving universal access to antiretroviral therapy (ART). Despite the government's efforts of integrating HIV services into PHC, an insufficient number of PHC staff and inadequate infrastructure are challenging when integrating HIV and AIDS services into PHC. This study explored the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. OBJECTIVES:  The aim of the study was to explore the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. METHOD:  An exploratory, descriptive and contextual qualitative research design utilising face-to-face semi-structured interviews was conducted with 12 PHC nurses from selected clinics and health centres in the Vhembe district of Limpopo province. RESULTS:  Two main themes emerged from data analysis which included challenges related to healthcare recipients and challenges related to healthcare providers. CONCLUSION:  Clear policies on the integration of HIV and AIDS services into PHC should be available and should include strategies to promote HIV testing and counselling, adherence to ART and scheduled appointments, disclosure of HIV status as well as revising the human resource policy to reduce workload.


Assuntos
Infecções por HIV/enfermagem , Enfermagem de Atenção Primária/métodos , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Prestação Integrada de Cuidados de Saúde/tendências , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Acessibilidade aos Serviços de Saúde/normas , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , África do Sul
6.
AIDS Care ; 31(2): 243-249, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30146895

RESUMO

With the increase in the US of the number of older adults living with HIV, more research is needed to understand the caregiving and advance care planning needs of this population. This descriptive study examined the relationship between social support and caregiving preferences and advance care planning. Older adults living with HIV were recruited from clinics in Los Angeles, CA and New Orleans, LA to complete cross-sectional surveys (n = 154). Logistic regression analyses were modeled to determine the characteristics associated with 1) preference for formal short-term term care, 2) preference for formal long-term care, 3) having at least one contact for emergency care, 4) having an advance directive or living will, and 5) having a healthcare proxy or agent. The mean age was 56.8 years. The majority of participants indicated a preference for informal support for both short-term (73.4%) and long-term care (66.2%), 13.2% had no one they could call for emergency care, 26.0% had an advance directive/living will, and 30.5% had a healthcare proxy/agent. In adjusted models, greater social support was associated with preference for informal short-term care and with having at least one emergency contact. Findings suggest that older adults living with HIV prefer informal sources of support for their caregiving needs despite having small social networks and individuals with limited social networks are particularly vulnerable due to lack of access to caregivers in sudden or unexpected health situations.


Assuntos
Infecções por HIV/enfermagem , Testamentos Quanto à Vida/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Procurador/estatística & dados numéricos , Idoso , Estudos Transversais , Emergências , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Assistência de Longa Duração , Los Angeles , Masculino , Pessoa de Meia-Idade , Apoio Social
7.
J Assoc Nurses AIDS Care ; 29(2): 220-230, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28974351

RESUMO

Financial reporting represents a critical tool in eliminating HIV across Papua New Guinea (PNG). Using the tenets of the theory of indigenous alternative reporting, this paper considers how the PNG Nursing Council may accommodate nurse-initiated and managed antiretroviral therapy (NIMART) reporting. Textual analysis of indigenous reporting expectations placed on the PNG Nursing Council are examined in a NIMART context to examine levels of reporting compliance exercised by council administrators from year-end reports (1980 to 2016) to accommodate NIMART reporting. The study revealed that the 2014 annual report of the PNG Nursing Council generated a 40% NIMART compliance rate, offering encouraging signs of financial reporting that could make room for NIMART reporting. The study suggested that local mechanisms could be used to meet local indigenous reporting expectations in order to adopt NIMART reporting. The study also has far-reaching implications for other developing country nursing councils wanting to develop NIMART reporting.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/economia , Custos de Cuidados de Saúde , Papel do Profissional de Enfermagem , Padrões de Prática em Enfermagem/organização & administração , Atenção Primária à Saúde/organização & administração , Antirretrovirais/economia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/enfermagem , Humanos , Liderança , Programas Nacionais de Saúde/economia , Papua Nova Guiné
8.
Ann Emerg Med ; 72(1): 41-53.e9, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29092761

RESUMO

STUDY OBJECTIVE: This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. METHODS: In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis. RESULTS: During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was €1,324 per additional new diagnosis. CONCLUSION: The combined strategy of targeted screening and diagnostic testing was effective.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/enfermagem , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Adulto , Análise Custo-Benefício , Estudos Cross-Over , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Inquéritos e Questionários , Adulto Jovem
9.
Rev Med Suisse ; 13(558): 787-791, 2017 Apr 12.
Artigo em Francês | MEDLINE | ID: mdl-28727327

RESUMO

Despite the improvements in antiretroviral therapy, the psychosocial management of persons living with HIV remains complex and requires a multidisciplinary approach. An auto-evaluation scale of psychosocial difficulties and needs was used by a team of nurses working in an HIV outpatient clinic. After 3 years of experience, this well-accepted tool revealed a high prevalence of psychosocial difficulties within this population, including psychological health, financial situation and sexual life. This instrument also allowed implementing a number of targeted nurse interventions to improve the management of these patients.


Malgré les progrès effectués dans le domaine des traitements antirétroviraux, la prise en charge psychosociale des patients vivant avec le VIH reste complexe et nécessite une approche multidisciplinaire. Une échelle d'auto-évaluation des difficultés et besoins d'aides psychosociaux a été utilisée par une équipe d'infirmières travaillant dans une consultation ambulatoire VIH. Après 3 ans d'expérience, cet outil, très bien accepté par les patients, a permis de révéler une prévalence importante de difficultés psychosociales dans cette population, touchant notamment la santé psychique, la situation financière et la sexualité. Cet outil a permis en outre de mettre en place un certain nombre d'interventions infirmières ciblées pour améliorer la prise en charge des patients.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Infecções por HIV/psicologia , Enfermeiras e Enfermeiros/organização & administração , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/enfermagem , Infecções por HIV/terapia , Necessidades e Demandas de Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
10.
Rev Gaucha Enferm ; 38(2): e67712, 2017 Jul 13.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28723987

RESUMO

OBJECTIVE: To verify the inference of Nursing Diagnoses, Impaired religiosity and Spiritual distress in people living with HIV/AIDS. METHODS: This is a cross-sectional study with a quantitative approach, performed in a specialized Service CenteR of Recife, Pernambuco, from June to November 2015. The results related to 52 people living with HIV/AIDS and that were interviewed were analyzed by three nurse judges. RESULTS: Spiritual distress was estimated at 73.1% (38), Impaired religiosity at 36.5% (19), with an average number of defining characteristics of 3.88 ± 2.05 and 2.55±0.69. The main defining characteristic for Impaired religiosity was: "reports a need to reconnect with previous beliefs" (92.3%); and for Spiritual distress, it was: "Expresses a lack of purpose in life/expresses lack of meaning in life" (86.5%). CONCLUSIONS: The results point to the need to consider the religious-spiritual dimension in care protocols and research in nursing.


Assuntos
Infecções por HIV/psicologia , Religião , Síndrome da Imunodeficiência Adquirida/psicologia , Adulto , Estudos Transversais , Feminino , Infecções por HIV/enfermagem , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Diagnóstico de Enfermagem , Espiritualidade
11.
Worldviews Evid Based Nurs ; 14(6): 492-498, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28755393

RESUMO

BACKGROUND: Practice guidelines aim to improve the standard of care for people living with HIV/AIDS. Successfully implementing guidelines requires tailoring them to populations served and to social and organizational influences on care. AIMS: To examine dimensions of context, which nurses and midwives described as having a significant impact on their care of patients living with HIV/AIDS in Kenya, Uganda, South Africa, and Jamaica and to determine whether HIV/AIDS guidelines include adaptations congruent with these dimensions of context. METHODS: Two sets of data were used. The first came from a qualitative study. In-depth interviews were conducted with purposively selected nurses, midwives, and nurse managers from 21 districts in four study countries. A coding framework was iteratively developed and themes inductively identified. Context dimensions were derived from these themes. A second data set of published guidelines for HIV/AIDS care was then assembled. Guidelines were identified through Google and PubMed searches. Using a deductive integrative analysis approach, text related to context dimensions was extracted from guidelines and categorized into problem and strategy statements. RESULTS: Ninety-six individuals participated in qualitative interviews. Four discrete dimensions of context were identified: health workforce adequacy, workplace exposure risk, workplace consequences for nurses living with HIV/AIDS, and the intersection of work and family life. Guidelines most often acknowledged health human resource constraints and presented mitigation strategies to offset them, and least often discussed workplace consequences and the intersections of family and work life. LINKING EVIDENCE TO ACTION: Guidelines should more consistently acknowledge diverse implementation contexts, propose how recommendations can be adapted to these realities, and suggest what role frontline healthcare providers have in realizing the structural changes necessary for healthier work environments and better patient care. Guideline recommendations should include more explicit advice on adapting their recommendations to different care conditions.


Assuntos
Atitude do Pessoal de Saúde , Guias como Assunto/normas , Infecções por HIV/psicologia , Enfermeiras e Enfermeiros/psicologia , Padrão de Cuidado/normas , Adulto , Feminino , Infecções por HIV/enfermagem , Infecções por HIV/prevenção & controle , Humanos , Jamaica , Quênia , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/normas , Pesquisa Qualitativa , África do Sul , Uganda , Precauções Universais/economia , Precauções Universais/instrumentação , Local de Trabalho/psicologia
12.
Lancet Infect Dis ; 17(6): 595-604, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28262598

RESUMO

BACKGROUND: No high-quality trials have provided evidence of effectiveness and cost-effectiveness of HIV treatment adherence intervention strategies. We therefore examined the effectiveness and cost-effectiveness of the Adherence Improving self-Management Strategy (AIMS) compared with treatment as usual. METHODS: We did a pragmatic, multicentre, open-label, randomised controlled trial in seven HIV clinics at academic and non-academic hospitals in the Netherlands. Eligible participants were patients with HIV who were either treatment experienced (ie, with ≥9 months on combination antiretroviral therapy [ART] and at risk of viral rebound) or treatment-naive patients initiating their first combination ART regimen. We randomly assigned participants (1:1) to either AIMS or treatment as usual (ie, containing a range of common adherence intervention strategies) using a computer-generated randomisation table. Randomisation was stratified by treatment experience (experienced vs naive) and included block randomisation at nurse level with randomly ordered blocks of size four, six, and eight. 21 HIV nurses from the participating clinics received three training sessions of 6 h each (18 h in total) on AIMS and a 1·5 h booster training session at the clinic (two to three nurses per session) after each nurse had seen two to three patients. AIMS was delivered by nurses during routine clinic visits. We did mixed-effects, intent-to-treat analyses to examine treatment effects on the primary outcome of log10 viral load collected at months 5, 10, and 15. The viral load results were exponentiated (with base 10) for easier interpretation. Using cohort data from 7347 Dutch patients with HIV to calculate the natural course of illness, we developed a lifetime Markov model to estimate the primary economic outcome of lifetime societal costs per quality-adjusted life-years (QALYs) gained. This trial is registered at ClinicalTrials.gov (number NCT01429142). FINDINGS: We recruited participants between Sept 1, 2011, and April 2, 2013; the last patient completed the study on June 16, 2014. The intent-to-treat sample comprised 221 patients; 109 assigned to AIMS and 112 to treatment as usual. Across the three timepoints (months 5, 10, and 15), log viral load was 1·26 times higher (95% CI 1·04-1·52) in the treatment-as-usual group (estimated marginal mean 44·5 copies per mL [95% CI 35·5-55·9]) than in the AIMS group (estimated marginal mean 35·4 copies per mL [29·9-42·0]). Additionally, AIMS was cost-effective (ie, dominant: cheaper and more effective) since it reduced lifetime societal costs by €592 per patient and increased QALYs by 0·034 per patient. INTERPRETATION: Findings from preparatory studies have shown that AIMS is acceptable, feasible to deliver in routine care, and has reproducible effects on medication adherence. In this study, AIMS reduced viral load, increased QALYs, and saved resources. Implementation of AIMS in routine clinical HIV care is therefore recommended. FUNDING: Netherlands Organisation for Health Research and Development.


Assuntos
Análise Custo-Benefício , Infecções por HIV/enfermagem , Adesão à Medicação , Papel do Profissional de Enfermagem , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Anos de Vida Ajustados por Qualidade de Vida , Autocuidado/métodos , Resultado do Tratamento , Carga Viral
13.
J Assoc Nurses AIDS Care ; 27(6): 755-767, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27405660

RESUMO

HIV-related criminal laws in some jurisdictions may hamper population health efforts to manage HIV and bring about an AIDS-free generation. HIV care nurses have an instrumental role to play in ensuring equitable care and health for all in a context of HIV. The purpose of our study was to determine HIV care nurses' knowledge of HIV-related criminal laws. Ecosocial theory and content expert opinion guided development of a questionnaire to assess nurses' knowledge of HIV-related criminal laws. A total of 174 HIV care nurses from Canada (n = 23) and the United States (n = 151) completed the questionnaire. Knowledge gaps were observed in several aspects of HIV-related criminal laws that can influence nursing clinical practices. Nurses should increase their knowledge of HIV-related criminal laws to ensure the success of population health initiatives and to reduce stigma and discrimination experienced by people living with HIV.


Assuntos
Atitude do Pessoal de Saúde , Direito Penal , Infecções por HIV/enfermagem , Equidade em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/psicologia , Adulto , Idoso , Canadá , Discriminação Psicológica , Estudos de Viabilidade , Feminino , Infecções por HIV/psicologia , Direitos Humanos , Humanos , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Estigma Social , Inquéritos e Questionários , Revelação da Verdade , Adulto Jovem
14.
Curationis ; 39(1): 1583, 2016 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-27246792

RESUMO

BACKGROUND: This article assessed maternal and neonatal outcomes amongst users of prevention of mother-to-child transmission (PMTCT) of HIV services in Addis Ababa, Ethiopia. OBJECTIVES: The study aimed to assess the health outcomes (antiretroviral prophylaxis versus antiretroviral treatment, CD4 counts, World Health Organization (WHO) stages of illness, other illnesses) of women who had used these services, as well as the HIV status of their babies and the infant feeding method adopted. METHODS: A quantitative, cross sectional, retrospective cohort design was used. Document reviews were conducted with a sample of 384 mother-infant pairs (out of a population of 796) who had used PMTCT services. RESULTS: All respondents were using prophylactic antiretrovirals or antiretroviral therapy, but some were on the wrong treatment based on their CD4 counts. The CD4 counts increased four times more for women on antiretroviral treatment than for those on prophylactic antiretrovirals. The WHO's stages of HIV illness did not improve but deteriorated in some cases, and 52 other illnesses were recorded. Out of the 384 infants, 6.0% (n = 23) were HIV-positive. Most respondents opted for exclusive breast feeding but some used mixed feeding during the first six months of their infants' lives, despite having received health education related to infant feeding options. CONCLUSION: The respondents' improved CD4 counts were inadequate to improve their World Health Organization stages of HIV illness. Some babies received mixed feeding during the first six months of their lives and 6% of the babies were HIV-positive despite their mothers' utilisation of PMTCT services.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Contagem de Linfócito CD4 , Estudos de Coortes , Estudos Transversais , Etiópia , Feminino , Infecções por HIV/sangue , Infecções por HIV/enfermagem , Humanos , Recém-Nascido , Serviços de Saúde Materna , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/enfermagem , Resultado da Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
15.
J Assoc Nurses AIDS Care ; 27(3): 322-30, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27086191

RESUMO

Given the burden of HIV and the critical shortage of health workers in Kenya, in 2011 the National AIDS and STI Control Program recommended shifting HIV care and treatment tasks to nurses in settings without physicians and clinical officers in order to decentralize and scale-up HIV services. In September 2013, ICAP at Columbia University conducted a survey with nurses in four health facilities in eastern Kenya to assess preparedness for task shifting. Findings indicated gaps in nurses' training, perceived competency, and practice in HIV care and treatment. Further investment in nurse capacity building is needed to bridge the gaps and prepare more nurses to provide high-quality, comprehensive HIV care and treatment services to curb the epidemic in Kenya.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Competência Clínica , Infecções por HIV/tratamento farmacológico , Infecções por HIV/enfermagem , Recursos Humanos de Enfermagem/educação , Padrões de Prática em Enfermagem , Estudos Transversais , Humanos , Capacitação em Serviço , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde , Avaliação de Processos em Cuidados de Saúde , Recursos Humanos
16.
J Acquir Immune Defic Syndr ; 72(2): e32-6, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-27003494

RESUMO

INTRODUCTION: Improving HIV outcomes among severely immunocompromised HIV-infected persons who have increased morbidity and mortality remains an important issue in sub-Saharan Africa. We sought to evaluate the impact of targeted clinic-based nurse care on antiretroviral therapy (ART) initiation and retention among severely immunocompromised HIV-infected persons. METHODS: The study included ART-naive patients with CD4 counts <100 cells per microliter registered in seven urban clinics in Kampala, Uganda. Data were retrospectively collected on patients enrolled from July to December 2011 (routine care cohort). Between July 2012 and September 2013, 1 additional nurse per clinic was hired (nurse counselor cohort) to identify new patients, expedite ART initiation, and trace those who were lost to follow-up. We compared time to ART initiation and 6-month retention in care between cohorts and used a generalized linear model to estimate the relative risk of retention. RESULTS: The study included 258 patients in the routine care cohort and 593 in the nurse counselor cohort. The proportion of patients who initiated ART increased from 190 (73.6%) in the routine care cohort to 506 (85.3%) in the nurse counselor cohort (P < 0.001). At 6 months, 62% of the routine care cohort were retained in care versus 76% in the nurse counselor cohort (P = 0.001). A 21% increase in the likelihood of retention in the nurse counselor cohort (relative risk: 1.21, 95% CI: 1.09 to 1.34) compared with the routine care cohort was observed. CONCLUSIONS: Implementation of targeted nurse-led care of severely immunocompromised HIV-infected patients in public outpatient health care facilities resulted in decreased time to ART initiation and increased retention.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Estudos Controlados Antes e Depois , Infecções por HIV/tratamento farmacológico , Infecções por HIV/enfermagem , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospedeiro Imunocomprometido , Pesquisa Operacional , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , Atenção à Saúde/organização & administração , Atenção à Saúde/estatística & dados numéricos , Feminino , Infecções por HIV/imunologia , Serviços de Saúde , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Padrões de Prática em Enfermagem , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/organização & administração , Resultado do Tratamento , Uganda/epidemiologia , População Urbana , Recursos Humanos
17.
SAHARA J ; 13: 35-40, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26831832

RESUMO

This study examined the relative efficacy of social support seeking (SSS) and self-efficacy building (SEB) in the management of emotional well-being of caregivers of people suffering from HIV/AIDS. It was based at the United States President's Emergency Plan for AIDS Relief (PEPFAR) center in the University College Hospital, Ibadan, Oyo state, being the first and the largest teaching hospital in Nigeria. A 3 × 2 factorial design consisting of treatment and a control group was used. The columns have two levels of gender being male and female caregivers. One-hundred and sixty-five (165) caregivers who were taking care of people that are suffering from HIV/AIDS were purposively selected and randomly assigned to the treatment groups and control. The treatment was carried out for a period of eight weeks. Two null hypotheses were tested, both at .05 levels of significance. Data were collected with the use of standardized intruments rating scale; social support scale, general self-efficacy scale and emotional well-being scale. ANCOVA was used to establish significant treatment effects with the pretest as covariate. Even though SSS and SEB were both found to be effective in enhancing the emotional well-being of informal caregivers in this study when compared to the controls, SSS was significantly more effective than SEB in achieving this goal. Since the HIV/AIDS patients cannot be adequately cared for in the hospital settings due to severe shortages of material, personnel and time, serious efforts should be made by the three levels of the health care system viz: the primary, secondary and tertiary health care systems, to encourage the employment of the psychological management of caregivers of people suffering from HIV/AIDS. Also, the psychologists, clinical psychologists and the significant others should be encouraged to employ this psychological management in the care of HIV/AIDS informal caregivers.


Assuntos
Cuidadores/psicologia , Emoções , Infecções por HIV/enfermagem , Autoeficácia , Apoio Social , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Nigéria/epidemiologia , Qualidade da Assistência à Saúde , Qualidade de Vida , Resultado do Tratamento
18.
J Assoc Nurses AIDS Care ; 27(3): 274-84, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26644019

RESUMO

We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Atenção à Saúde , Mentores , Relações Enfermeiro-Paciente , Adulto , Fármacos Anti-HIV/uso terapêutico , Canadá , Serviços de Saúde Comunitária/organização & administração , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/enfermagem , Humanos , Entrevistas como Assunto , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Recursos Humanos
19.
Afr J AIDS Res ; 14(2): 159-67, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26223333

RESUMO

The objective of this study was to examine gender roles in the provision and receipt of care among older Ugandans. Survey data on care work were collected in 2009-2010 from 510 older people infected or affected by HIV/AIDS, at one rural and one semi-urban site. The questionnaire was adapted from the WHO Study on global AGEing and adult health survey. The type of care work done by older men and women for children in their households differs, yet, both men and women are taking on various types of care work. Women were more likely to report taking part in health/personal and physical care, whereas men were more likely to report providing financial assistance. Some older people, particularly women, were providing care at the same time as needing care. The finding on reciprocity of care suggests the need for further studies focused on how the reciprocity of care may affect health and well-being in older age.


Assuntos
Cuidadores/estatística & dados numéricos , Infecções por HIV/enfermagem , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Cuidadores/psicologia , Feminino , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Saúde da População Rural/economia , Saúde da População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Uganda/epidemiologia , Saúde da População Urbana/economia , Saúde da População Urbana/estatística & dados numéricos
20.
PLoS One ; 10(4): e0124416, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25879442

RESUMO

BACKGROUND: Health care providers are at risk of acquiring human immunodeficiency virus (HIV) infection from occupational exposure, with nurses being the most vulnerable. There is no data on the awareness of post-exposure prophylaxis (PEP) among nurses in Cameroon. This study aimed to assess the knowledge, practices of nurses regarding PEP for HIV and their determinants in Cameroon. METHODS: A cross-sectional study was conducted between April and July 2013, and involved 80 nurses in a rural health district in the North West Region of Cameroon. Data was collected using a structured questionnaire and analysed using the SPSS software version 20. RESULTS: In all, 73.7% of the participants had poor knowledge about PEP for HIV. Though many (83.8%) had heard about PEP, just 10 (12.5%) had received formal training on PEP for HIV. Only 24 (30%) and 20 (25%) knew the correct drug regimen and duration of treatment respectively. The majority (85%) considered themselves to be at risk of acquiring HIV at work, with 54 (67.5%) having experienced an exposure in the past, mainly while setting up intravenous lines (57.4%), recapping needles (37.0%) and during delivery (24.1%). Of those exposed, ten (18.9%) received PEP, which was started after 24 hours in 50%. In multivariable regression analyses, awareness of hospital policy [OR: 0.043 (0.005-0.404), p-value = 0.006] was associated with Good knowledge on PEP for HIV. CONCLUSIONS: The knowledge and practice of nurses on PEP for HIV in Cameroon is low. There is urgent need for training programmes and workshops to increase awareness, improve practice, and reduce the risk of HIV acquisition from work related activities among health care providers.


Assuntos
Infecções por HIV/prevenção & controle , HIV/patogenicidade , Conhecimentos, Atitudes e Prática em Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Enfermeiras e Enfermeiros/psicologia , Exposição Ocupacional , Profilaxia Pós-Exposição , Adulto , Camarões , Estudos Transversais , Feminino , Infecções por HIV/enfermagem , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
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