What is known from the existing literature about how sleep is measured in HIV care? A scoping review.

The HIV care landscape has significantly altered over the past 30 years with advances in HIV medical treatment. Despite these medical advances, people living with HIV experience a significant number of issues that affect their health-related quality of life, including sleep. Although poor sleep quality is common, there remains a lack of understanding of how to identify sleep issues in order to improve outcomes for people living with HIV. A scoping review of three databases as well as the grey literature yielded 2932 articles, of which 60 met the inclusion criteria. The following themes were identified: range of methods used to assess sleep, self-reported sleep measures and objective measures of sleep. The review found that a number of different measures of sleep were used within the research, the most commonly used being the Pittsburgh Sleep Quality Index. Due to the variety of approaches being used to measure sleep (n=18) there was a lack of consistency in what aspects of sleep were being explored, and in many cases why the measure of sleep was chosen. Furthermore, there was a lack of meaningful clinical recommendations as to how these findings could be used to improve outcomes for people living with HIV.

HIV Matters: an educational podcast series to improve outcomes for people living with HIV.

The growth of podcasting since its development in 2004 has been phenomenal. Within health education, it has become an innovative way of broadcasting information on a wide range of subjects. Podcasting offers creative ways to support learning and share best practice. The aim of the article is to explore the use of podcasting as an educational tool to improve outcomes for people living with HIV.

Becoming an inner ally: the compassionate minds approach to self-compassion - an online programme.

A rapidly growing body of evidence indicates the enormous psychological burden of working in health care on nurses and other health professionals that is resulting in high levels of psychological problems. These will have profound effects on individuals and long-term ramifications for healthcare systems. Effective interventions that can counter the adverse psychological effects of caring during the COVID-19 pandemic and beyond are urgently required. With this in mind, the authors have created an online self-compassion programme to advance the health and wellbeing of the nursing workforce through developing proactive evidence-based preventive teaching and learning strategies to promote compassion satisfaction and prevent compassion fatigue by improving self-compassion. The online programme is underpinned by compassionate minds theories and research.

HIV at 40: reflections on and development of interdisciplinary working in HIV care.

This article reflects on 40 years of HIV and the growing need to work collaboratively to improve outcomes for people living with HIV. It reflects on the history of interdisciplinary working in HIV care in the UK and discusses the development of links between the professions of nursing and clinical psychology. Both professions had contributed to the development of the Standards for Psychological Support for Adults Living with HIV. One of the authors, who was chair of the National HIV Nurses Association, initiated an audit of the use of the standards within UK HIV clinics and invited local British Psychological Society members to participate in the development of the audit process. The audit results identified gaps in the provision of care that led to further close working relationships. In an era of highly effective antiretrovirals that address the medical aspects of HIV care, the focus of care has shifted to the management of psychosocial factors that contribute to poor outcomes in of HIV. Interdisciplinary work and cooperation is the most effective way to address those complex issues.

Resurrecting the 'fourth 90': towards a definition of health-related quality of life in HIV care.

Medical advancements in the treatment of HIV continue to return ever more impressive medical results; increasing life expectancy and reducing negative symptoms (either disease-related or medically-induced). Physical wellness, however, is only one of the many facets of human life. It has been 5 years since Lazarus et al proposed we should be looking towards a fourth 90-good health-related quality of life (QoL)-yet little has been done to take up this task within a coherent approach. We suggest that one of the barriers to this is a lack of definition about what we mean by 'good health-related quality of life' (HRQoL) for people living with HIV. This article considers existing definitions of this, and related terms, and the difficulties in finding a universal definition. It goes on to suggest a way to a conceptual HRQoL in people living with HIV based on the biopsychosocial model. It is proposed that by doing it this way, practitioners can assess HRQoL in a comprehensive way, and focus on the things that matter to the individual.

Developing therapeutic relationships with people living with HIV: exploring the nurse-patient relationship.

BACKGROUND: The care paradigm for HIV has changed from one of an infectious, life-limiting disease to that of a chronic manageable condition. This shift poses challenges for practitioners working in this area when providing care that is both person centred and reflective of the demands placed on an evolving disease area. OBJECTIVES: The overall aim of this study was to explore how therapeutic relationships are developed and their subsequent use within person-centred care. DESIGN: An interpretative phenomenological analysis research design was used to collect data from 10 purposively recruited HIV specialist nurses in the north-west region of the UK. In-depth, semistructured interviews were used to collect the data. RESULTS: Data analysis revealed three themes that captured person-centredness in HIV care. These were: ways of being; the nurse-patient relationship; and the influence of stigma. CONCLUSION: The research illuminates key features that are important when developing therapeutic relationships and offers a framework to explain how these features were also key elements of person-centred care.

Psychological impact of caring during the COVID-19 pandemic on HIV nurses.

The COVID-19 pandemic has created a set of unprecedented challenges for healthcare services and staff. The authors conducted a national online survey of nurses employed to work in HIV services in England, Wales, Scotland, Northern Ireland and the Republic of Ireland to establish how the COVID-19 pandemic has impacted on the professional quality of life of HIV nurses. Professional quality of life was assessed using the ProQOL scale; 132 nurses completed the survey, 99 of whom completed the ProQOL scale. Just over 1 in 3 were redeployed in the first pandemic wave, dropping to 1 in 6 in subsequent waves. In multivariate analysis, redeployment in both waves increased burnout scores by nearly 10 points and decreased compassion satisfaction scores by nearly 5 points, with no effect on secondary traumatic stress scores. A supportive workplace environment will have a key role in supporting the path to recovery.

What are the current factors that impact on health-related quality of life for women living with HIV?

Since the start of the HIV epidemic, care has often had a strong focus on quality of life. In the early days, this was in part due to the limited treatment options available for people living with HIV, alongside the strong humanistic desire of those working in the specialty to provide optimum care. Advances in HIV treatments have led to care having more of a medical focus, with national and international targets concentrating on the prevention of new infections. Despite medical progress, the impact of being diagnosed and living with HIV has a significant impact on many people, across all aspects of their life. Factors that impact on health-related quality of life for women living with HIV are often poorly understood and under-explored in healthcare settings.

Use of the wellness thermometer to improve consultations for patients with human immunodeficiency virus.

The care paradigm for patients with human immunodeficiency virus (HIV) has changed from managing an infectious condition with a suboptimal prognosis, to managing a long-term chronic disease. The wellness thermometer is a tool that was developed to assist with monitoring the biological, psychological, social and spiritual well-being of patients with HIV. Aim To evaluate the effectiveness of using the wellness thermometer in healthcare consultations with patients with HIV. Method This was a service evaluation that was undertaken in three UK HIV clinics in 2014. After using the wellness thermometer, patients and healthcare professionals completed a survey to indicate whether they felt the tool improved their consultations. Results A total of 231 patients completed the survey. It was found that 80% (n=185) of patients felt the wellness thermometer helped to identify their concerns, while 79% (n=182) of patients felt the wellness thermometer improved their conversation with the healthcare professional. Of the 12 healthcare professionals who completed the survey, most felt that the tool helped patients to identify their concerns (n=10) and that it was easy to use (n=11). Conclusion There are several benefits associated with using the wellness thermometer in healthcare consultations, and it may support patients with HIV to report any concerns they have in relation to their treatment and quality of life. The authors envisage that the tool will become a routine part of the care of these patients.

HIV: an integrated approach.

Last month, the National HIV Nurses Association (NHIVNA) produced guidelines on advanced nursing practice in HIV care, endorsed by the RCN.

The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

BACKGROUND: Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. OBJECTIVES: The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. TYPES OF PARTICIPANTS: All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). CONTEXT: The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. SEARCH STRATEGY: A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. METHODOLOGICAL QUALITY: Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. DATA EXTRACTION: Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. RESULTS: This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues. CONCLUSIONS: This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling. IMPLICATIONS FOR PRACTICE: The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework. Nurses/midwives undertaking provider-initiated HIV testing and counseling require management support, ongoing training and adequate infrastructure/resources. Additional guidance is required on legal/ethical issues in testing of children and in third party disclosure. IMPLICATIONS FOR RESEARCH: Operational research is required to determine an optimal skill mix and optimal methods of integrating provider-initiated HIV testing and counseling into existing work routines.

"In reality, it is complex and difficult": UK nurses' perspectives on "treatment as prevention" within HIV care.

Globally, clinical guidelines for HIV treatment are being altered to reflect new research showing that successful treatment with antiretroviral therapies (ART) can prevent the onward transmission of HIV. As a result, health care services are being challenged to find ways to roll out "treatment as prevention" (TasP) as a public health measure. In theory, TasP requires individuals to start ART as soon as they are diagnosed - for public health reasons - which may be some time before ART for that individual is required for clinical reasons. There is currently little research on the acceptability of TasP from a patient or provider perspective. This paper reports findings from a qualitative study that sought to explore UK nurses' views and experiences of TasP in HIV care. Ten HIV specialist nurses, purposively selected from across the country, were interviewed. Results suggest that, although positive about TasP in principle, nurses hold several reservations about its implementation in practice. Perceived benefits of TasP include reassurance for patients that their loved ones are protected and that immediate care is available. Concerns include the possibility of sexual dis-inhibition or coercion within sexual relationships. In the UK context, decisions around TasP are still being made on a highly individualised patient by patient basis, within a philosophy of holistic care and partnership working. As such, the research participants called for more resources to support information giving, risk assessment and decision-making. The results show that translating a public health treatment approach into individual patient care is complex, potentially time-consuming and may alter traditional provider-patient dynamics. The findings from this study suggest that in-depth research is needed to understand better the patient, community and provider experience as TasP becomes more widely rolled out.

HIV-associated neurocognitive disease: case studies and suggestions for diagnosis and management in different patient subgroups.

The incidence of HIV-associated dementia has decreased significantly with the introduction of combination antiretroviral therapy; however, milder or more subtle forms of neurocognitive disorders associated with HIV appear to remain common. There is a lack of consensus on when to screen and on which methods are most appropriate for identifying patients at risk of neurocognitive impairment. Multiple factors (demographic, social, genetic, psychological and medical) can play a role in its aetiology and progression, including potential central nervous system toxicity of antiviral therapy. It is important to identify these factors in order to apply relevant management strategies. In this review, we discuss a series of case studies that address some of the challenges presented by the diagnosis and management of HIV-associated neurocognitive impairment in different patient types.