Improving Sleep in People with HIV and Chronic Pain: A Pilot Study of Brief Behavioral Treatment for Insomnia.

OBJECTIVES: Insomnia and chronic pain are common symptoms in people with HIV. Poor sleep has been associated with chronic pain. While cognitive behavioral therapy for insomnia improves insomnia in clinical populations, there are barriers to people with HIV accessing treatment including the lack of trained providers and lengthy sessions. Only one study has examined the efficacy of brief behavioral treatment for insomnia (BBTI) in people with HIV. This study examined BBTI effects on sleep and pain in people with HIV. METHODS: Ten adults with HIV and chronic pain completed a 4-week, telephone-delivered BBTI treatment. A control group (n = 10) completed a brief mindfulness training (BMT). The Insomnia Severity Index and Brief Pain Inventory were used to assess insomnia severity and pain outcomes, respectively. RESULTS: There was a significant interaction between intervention and time on insomnia severity, F (2,14) = 5.7, p = .02, partial η2 = 0.45). The BBTI group demonstrated significant improvements in insomnia severity from pre- to post-intervention (p < .001) and from pre-intervention to one-month post-intervention (p = .001) compared to the BMT group. There was a significant interaction between intervention and time on pain interference, F (1,18) = 4.9, p = .02, partial η2 = 0.27). The BBTI group demonstrated a significant decrease in pain interference from pre- to post-intervention (p < .001) compared to the BMT group. CONCLUSIONS: This pilot study demonstrated that BBTI improved insomnia in people with HIV for up to one-month post-treatment. Novel preliminary evidence suggests that BBTI may also improve pain outcomes in people with HIV.

A Practical Guide to Implementing an Evidenced-Based Hands-On Naloxone Training.

Synthetic opioids contribute to the majority of opioid overdose-related deaths in the United States. Expansion of naloxone training to community laypersons is one strategy to mitigate opioid overdose-related deaths. A hands-on naloxone training demonstrated efficacy in improving opioid knowledge and overdose response in baccalaureate nursing students, Greek-affiliated students, and rural clinicians and staff post-training. The purpose of this practical guide is to provide detailed steps to implement an evidence-based hands-on naloxone training for laypersons in community settings. The hands-on naloxone training consisted of five components: evaluator training, a validated pre-post opioid knowledge questionnaire, an opioid lecture, a performance evaluation, and a satisfaction survey. Post-training, trainees demonstrated increased knowledge related to opioids and overdose response, and they felt comfortable administering naloxone to someone experiencing an opioid overdose. Researchers, educators, and community health nurses can adapt this evidence-based practical guide to train peers and acquaintances who are likely to witness an opioid overdose. Virtual training and multi-lingual protocols should be considered to successfully train diverse groups of community laypersons. An active hands-on naloxone training can improve confidence for community health nurses and other health care professionals, and it may reduce delays in response time and naloxone administration. Nurses can use this hands-on training to educate students, families, community members, and stakeholders how to respond to an opioid overdose event.

HIV Knowledge among African Americans Living with HIV in the Rural South: Implications for Improving HIV Prevention and Care Outcomes.

PURPOSE: This study examines the HIV knowledge of people living with HIV (PLWH) and its implications for improved healthcare outcomes. METHODS: The study design was a descriptive cross-sectional study, and a total of 41 PLWH were recruited from a larger faith-based anti-stigma study. Data was collected using a semi-structured self-administered questionnaire and analyzed using SAS. In addition, a literature review was conducted using search engines to gauge existing literature from 2013 to 2022 in areas of HIV knowledge and healthcare outcomes among PLWH. RESULTS: The 41 PLWH enrolled consisted of 51% males and 49% females. Sixteen (39%) were aged ≥ 51 years, 17 (41%) had been living with HIV for > 10 years, 15 (37%) had < high school diploma, and 100% were currently in HIV care. HIV knowledge scores were below average for 20 (49%) of the PLWH. Substantial knowledge deficits were noted in areas of HIV transmission and risk reduction strategies. Lower scores were not significantly associated with the participant's gender, education level, or length of time being HIV-infected. The results of the literature review showed limited research in this area. CONCLUSIONS: The study and literature review results show that HIV knowledge and health literacy may contribute to racial disparities in retention in care leading to poor health outcomes. Healthcare providers and health facilities in rural areas should be equipped with culturally tailored HIV educational tools to strengthen ongoing care for PLWH, foster patient-provider relationships, and eliminate internalized stigma detrimental to improved healthcare outcomes among PLWH.

HIV Knowledge, Risk Factors, and Utilization of Services in the US Rural Deep South.

BACKGROUND: HIV prevalence in the rural South remains high among Black Americans due to limited access to prevention and treatment services and poverty. HIV care inequities for Black Americans living in the rural South are further intensified by high mortality rates, low HIV health literacy, stigma, and discrimination. Few studies have focused on HIV knowledge and risk factors within Black Americans in the rural South. METHODS: This cross-sectional study examined the association between HIV risk factors, HIV knowledge, and utilization of HIV and/or sexually transmitted infection (STI) testing services among Black Americans (N = 200) living in the rural South. HIV knowledge, risk factors, and utilization of testing services were assessed via The HIV Knowledge Questionnaire, The HIV Risk Factor Questionnaire, and three investigator-generated questions, respectively. Linear regression was used to examine the relationship between demographic characteristics, HIV knowledge, utilization of testing services, and HIV risk factors. RESULTS: Among 200 participants, a smaller percentage (37.7%, n = 75) reported using HIV/STI testing services compared to non-users. Controlling for demographic covariates in the model, HIV knowledge (p < .0001) and marital status (p = .010) were significantly associated with HIV risk factors. HIV risk factors decreased as HIV knowledge increased. Individuals who reported being single also reported having fewer risk factors. CONCLUSION: Future research should examine the impact of HIV education tailored for individuals with greater HIV risk factors within rural Black Americans. Studies exploring barriers to the utilization of HIV/STI testing services within Black American rural communities are warranted.

Spirituality and health outcomes within the context of social determinants of health.

ABSTRACT: Spirituality has a significant impact on patients' overall quality of life, however, it is often overlooked in the context of social determinants of health (SDOH). Nurses are well positioned to lead the expansion of SDOH models to include spirituality; however, routine nursing care does not emphasize spiritual assessment knowledge and skills. This article discusses spirituality and how it fits into the SDOH model, nursing education, and interdisciplinary healthcare. Spiritual care training may improve the confidence of nurses to integrate routine mental and spiritual assessments in clinical practice and serve as leaders in promoting spiritual care within interdisciplinary healthcare teams.

Substance use and opioid-related stigma among Black communities in the rural South.

PURPOSE: This study examined perceived substance use, opioid knowledge, and barriers to Black people accessing treatment for substance and opioid use disorder (SUD/OUD). METHODS: Thirty-nine participants completed the community survey and The Brief Opioid Overdose Knowledge questionnaire. Qualitative interviews were conducted with 18 stakeholders and 9 people with SUD/OUD. FINDINGS: Out of 39 participants, <50 % knew where to refer someone for treatment and fewer knew where to access naloxone. Majority of the stakeholders and people with SUD/OUD reported stigma as a treatment barrier. CONCLUSION: Studies related to provider anti-stigma trainings and psychoeducation for Black people living in the rural South are warranted.

Examining the use of geriatric standardized patients with baccalaureate nursing students.

The need for clinical placements for undergraduate nursing programs heightened during the COVID-19 pandemic as nursing schools across the country faced restrictions with the high-risk geriatric client population. Nursing students experienced increased anxiety levels, decreased learning opportunities, and uncertainties about the decision to enter the workforce as healthcare professionals. In turn, this amplified the need for faculty support and feedback imperative for student success. One method for mitigating the gap between didactic content and clinical placement is using simulation-based learning experiences. The purpose of this observational study was to examine the impact of a newly developed home health geriatric simulation on student satisfaction and self-confidence in learning among 133 senior-level Baccalaureate nursing students from a large public university. Study measures included the National League of Nursing's Self-Confidence in Learning Scale (SCLS) and Simulation Design Scale (SDS). The primary outcome was satisfaction and self-confidence in learning. Higher SDS component scores were significantly correlated with higher SCLS scores (all p = <.0001), indicating that high satisfaction among Baccalaureate nursing students in simulation design relates to increased satisfaction and self-confidence in learning. Study findings support using standardized geriatric simulation scenarios to prepare students to communicate and care for older adults.

Preventing Neurocognitive Decline in Adults Aging with HIV: Implications for Practice and Research.

Mild to moderate forms of neurocognitive impairment persist among people living with HIV (PLWH), despite being virally suppressed on antiretroviral therapy. PLWH are disproportionally impacted by physiological and psychosocial comorbidities compared to those without HIV. As adults live longer with HIV, the neurocognitive burden of physiological and psychosocial stressors can impair everyday functioning and may contribute to the development of neurodegenerative diseases such as Alzheimer's disease. This article outlines neurocognitive consequences of everyday stressors in PLWH. While some lifestyle factors can exacerbate inflammatory processes and promote negative neurocognitive health, novel interventions including the use of cannabinoids may be neuroprotective for aging PLWH who are at risk for elevated levels of inflammation from comorbidities. Studies of integrated neurocognitive rehabilitation strategies targeting lifestyle factors are promising for improving neurocognitive health, and may over time, reduce the risk of Alzheimer's disease in PLWH.

An exploratory study of a hands-on naloxone training for rural clinicians and staff.

INTRODUCTION: Since the COVID-19 pandemic, an increase in fentanyl-combined drugs has led to a surge in opioid overdose deaths in the United States. Higher opioid overdose mortality rates are problematic in rural communities, and there are few prevention, treatment, and recovery resources for individuals experiencing opioid use disorder. METHOD: This exploratory project aimed to investigate a hands-on naloxone training for rural clinicians and staff. Rural clinicians and staff at two behavioral health centers were recruited to participate in a 30-min lecture and 30-min hands-on intranasal naloxone training using a low-fidelity mannequin. A pre-post opioid knowledge questionnaire, rubric based on the Substance Abuse and Mental Health Services Administration toolkit, and investigator-generated survey were used to evaluate opioid knowledge and response, demonstration of intranasal naloxone administration, and participants' perceptions of the training. Enrollment characteristics were summarized using descriptive statistics and paired t-tests were used to assess mean differences. RESULTS: Of the nine participants in the project, seven (87.5%) were female and six (75.0%) were Black. Four participants assumed a therapist role, attained a MS or MA degree, and had 5 or more years of experience working in healthcare. The total mean rubric score for all participants was 96.0 (SD = 8.8). No significant pre-post mean differences among opioid knowledge, overdose risk, and overdose response categories were found, all p > 0.05. However, post-intervention mean scores were slightly higher in all categories except overdose risk. Most participants (77.8%) responded that they felt comfortable handling an opioid situation and teaching the training to community members. Open-ended responses indicated that participants liked the demonstrations, examples used, hands-on nature of the training, and the presentation materials. CONCLUSION: A hands-on naloxone training is beneficial for training rural clinicians and staff to respond to opioid overdose. This training may be a promising solution to reduce response time between recognition of opioid symptoms and administration of the life-saving medication, naloxone. Future studies should examine the efficacy of this training in larger samples with the inclusion of rural interdisciplinary teams, trusted community leaders, and family and friends of those impacted by opioid use disorder. CLINICAL RELEVANCE: This innovative hands-on naloxone training is designed for rural clinicians and residents who are most likely to witness individuals experiencing opioid toxicity. The primary goal is to reduce response time between recognition of signs and symptoms and administration of the life-saving medication, Naloxone.

Cognitive differences across ethnoracial category, socioeconomic status across the Alzheimer's disease spectrum: Can an ability discrepancy score level the playing field?

An ability discrepancy (crystallized minus fluid abilities) might be a personally relevant cognitive marker of risk for Alzheimer's disease (AD) and might help reduce measurement bias often present in traditional measures of cognition. In a large national sample of adults aged 60-104 years (N = 14,257), we investigated whether the intersectionality of group characteristics previously shown to pose a risk for AD including ethnoracial category, socioeconomic status, and sex (a) differed in ability discrepancy compared to traditional neuropsychological tests and (b) moderated the relationship between an ability discrepancy and AD symptom severity. In cognitively normal older adults, results indicated that across each decade, fluid and memory composite scores generally exhibited large group differences with sex, education, and ethnoracial category. In contrast, the ability discrepancy score showed much smaller group differences, thus removing much of the biases inherent in the tests. Women with higher education differed in discrepancy performance from other groups, suggesting a subgroup in which this score might reduce bias to a lesser extent. Importantly, a greater ability discrepancy was associated with greater AD symptom severity across the AD continuum. Subgroup analyses suggest that this relationship holds for all groups except for some subgroups of Hispanic Americans. These findings suggest that an ability discrepancy measure might be a better indicator of baseline cognition than traditional measures that show more egregious measurement bias across diverse groups of people.

Olfactory Dysfunction in Aging African American and Caucasian Men With HIV: A Pilot Study.

ABSTRACT: As people age with HIV, olfactory dysfunctions may become more pronounced, especially for African Americans who are predisposed to declines in olfaction. In this cross-sectional study, 34 middle-age and older African American and 17 Caucasian men living with HIV were administered two objective olfactory measures (UPSIT). In the Smell Threshold Test, compared to the HIV-negative age norms, adults living with HIV were significantly less able to detect a lower threshold smell. In the University of Pennsylvania Smell Identification Test, compared to the HIV-negative age norms, adults living with HIV were significantly less able to correctly identify odors; furthermore, using such norms, African Americans with HIV were less likely to correctly identify odors compared to Caucasians with HIV. Since the literature indicates that African Americans have a stronger attraction for salty and sweet foods, such olfactory dysfunction may contribute to poor eating habits, potentially predisposing this population to additional health problems.

Sleep Disturbances and Chronic Pain in People with HIV: Implications for HIV-Associated Neurocognitive Disorders.

Purpose of Review: Antiretroviral therapy has significantly reduced morbidity and mortality in people with HIV. Despite being virally suppressed, sleep disturbances, chronic pain, and neurocognitive impairments persist which can negatively impact quality of life for people with HIV. This article presents relevant literature related to sleep disturbances and chronic pain in people with HIV. The potential impact of these comorbidities on cognition is discussed with implications for managing HIV-associated neurocognitive disorder (HAND). Recent Findings: People with HIV and chronic pain report greater insomnia and depressive symptoms compared to those without chronic pain. The neurotoxic effects of HIV itself and sleep and chronic pain induced inflammation can contribute to poorer cognitive outcomes. Summary: Sleep disturbances and chronic pain are prevalent conditions in people with HIV that may perpetuate the development and exacerbation of HAND. Sleep and pain interventions may preserve cognitive function and improve quality of life for people aging with HIV.

Insomnia severity and depressive symptoms in people living with HIV and chronic pain: associations with opioid use.

Chronic pain commonly occurs in people living with HIV (PLWH). Many PLWH in the United States obtain opioids for chronic pain management. Whether insomnia severity and depressive symptoms are exacerbated by chronic pain and opioid use in PLWH remains to be determined. This study examined insomnia severity and depressive symptoms in 85 PLWH with chronic pain and 35 PLWH without chronic pain. Among PLWH with chronic pain, reported opioid use was examined in relation to insomnia severity and depressive symptoms. PLWH with chronic pain reported significantly greater insomnia severity (p = .033) and depressive symptoms (p = .025) than PLWH without chronic pain. Among PLWH with chronic pain who reported opioid use (n = 36), insomnia severity was greater compared to those who denied opioid use (n = 49), even after controlling for pain severity and number of comorbidities (p = .026). Greater pain severity was significantly associated with greater insomnia severity (p < .001) and depressive symptoms (p = .048) among PLWH with chronic pain who reported opioid use. These associations were not significant among those PLWH with chronic pain who denied opioid use. Findings suggest that PLWH with chronic pain are likely to experience poor sleep and depressed mood. Furthermore, poor sleep was associated with opioid use among PLWH with chronic pain.

An Opioid Education Program for Baccalaureate Nursing Students.

BACKGROUND: Unintentional drug overdose is the leading cause of accidental death in the United States. Previous research identified training health caregivers in the rescue medication naloxone as a strategy to prevent death from opioid overdose. Existing research on naloxone training with nursing students is limited. This educational research project investigated whether training on opioids, opioid toxicity, and overdose response could impact student knowledge, skills, and confidence responding to overdoses. METHOD: Data were collected from baccalaureate nursing students using three sources: the Brief Opioid Overdose Knowledge questionnaire, a rubric based on the Substance Abuse and Mental Health Services Administration opioid overdose prevention toolkit, and a researcher-developed evaluation. RESULTS: Planned repeated-measures analyses of variance conducted on data from 284 baccalaureate students indicated high uptake of knowledge and skills for opioid toxicity and naloxone administration. Results were maintained with slight enhancement at 1 week, and training was highly rated. Cohort analysis suggests efficacy across semesters. CONCLUSION: Education improved student opioid knowledge, skills, and confidence and was relevant across undergraduate nursing curricula.

Nature-Based Therapies for Sleep Disorders in People Living with Human Immunodeficiency Virus.

Following diagnosis of human immunodeficiency virus (HIV), getting adequate sleep may be the farthest thing from the mind of patients or providers. Even further from mind are the potential benefits on both sleep and HIV from nature-based therapy. In developing and developed countries, access to high-quality natural spaces has the potential to support physical and mental health. This article provides a review of sleep disorders, conventional and nature-based therapies, and the potential of nature-based therapy to support the health of people living with HIV through increased restorative sleep and immune function.

Influence of Spirituality, HIV Stigma and Education on HIV Knowledge in Rural African American Congregants in the Deep South: Additional Findings from Project FAITHH.

HIV incidence has shifted racially and geographically in the United States and now represents higher proportions of African Americans living in the Rural South. Lower levels of HIV knowledge may be the culprit behind the increasing HIV rates observed in the Rural South. The purpose of this study was to investigate the individual and joint correlates of HIV knowledge in a sample of rural African Americans. Baseline data from a faith-based anti-stigma intervention (Project FAITHH, N= 210) was used to assess associations between sociodemographic characteristics, spirituality, stigma, and HIV knowledge scores. Associations were examined with recursive partitioning. Statistical significance was determined at P< 0.05 with a two-sided test. Recursive partitioning revealed five distinct groups based on the data. HIV knowledge scores were highest among participants who attended some college (P < 0.001) with lower levels of individual stigma (P < 0.001). HIV knowledge scores were lowest among less educated individuals (P < 0.001) who had lower levels of perceived community stigma (P = 0.002). Future interventions designed to improve HIV knowledge in rural African Americans should consider tailoring content to those who have the greatest deficits in HIV knowledge, which may be based on perceived community stigma and education levels.

The Stigma of Sexually Transmitted Infections.

Evidence-based guidelines have improved diagnosis and treatment of sexually transmitted infections (STI). Social stigma remains a barrier to STI testing and is associated with underutilization of prevention services. Alternatives for STI testing (eg, in-home testing) are convenient. However, some individuals decline follow-up treatment in fear of unintentional disclosure of their diagnosis. This article reviews STI treatment guidelines and examines the impact of stigma and ethical issues on testing, adherence, partner notification, and transmission rates. An understanding of STI-associated ethical issues and controversies is an important step toward eliminating stigma and reducing STI prevalence and morbidity.