The Social, Mental, and Physical Health Impacts of the COVID-19 Pandemic on People With HIV: Protocol of an Observational International Multisite Study.

ABSTRACT: As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; HIV continuum of care indicators; mental and social health; COVID-19 and vaccination knowledge, attitudes, behaviors, and fears; and overall outcomes. Results of this study will contribute to knowledge that can inform responses to future public health crises to minimize their impacts on vulnerable populations such as PWH.

Everyday ethical challenges of nurse-physician collaboration.

BACKGROUND: Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. RESEARCH QUESTION/AIM: The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels of hospitals in Botswana (referral, district, and primary). ETHICAL CONSIDERATIONS: Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants' written informed consent was obtained. FINDINGS: Respondents' ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse-doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants' views about how their work experiences could be improved. DISCUSSION: Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom-and not a sufficient number of nursing staff. CONCLUSION: Collaboration between physicians and nurses is critical to optimizing patients' health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment.

A qualitative description of service providers' experiences of ethical issues in HIV care.

BACKGROUND: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. PURPOSE: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. RESEARCH DESIGN: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. PARTICIPANTS AND CONTEXT: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. ETHICAL CONSIDERATIONS: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. FINDINGS: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. DISCUSSION: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. CONCLUSION: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members.

Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

The dynamics, dilemmas and complexities of AIDS: the cultural context of Botswana.

AIDS permeates all aspects of the lives of individuals, families and the society at large. In addition, it is beset with dynamics, dilemmas and complexities that have a bearing on people's psychosocial health. However, AIDS presents a wealth of learning opportunities to affected people and to governments. Using Botswana as an exemplar, the author explores the way AIDS has transformed the way of life of a people through the challenges and the opportunities that it presents. The author reflects on the interface of AIDS and mental illness. The paper concludes with recommendations for the way forward.

Impediments for the uptake of the Botswana government's male circumcision initiative for HIV prevention.

Botswana remains one of the countries with high prevalence of HIV infection with a population prevalence rate of 17.6 in 2008. In 2009, the Ministry of Health launched male circumcision as an additional strategy to the already existing HIV preventive efforts. The purpose of this paper is to share what the participants of a survey to evaluate a short-term male circumcision communication strategy in seven health districts of Botswana reported as impediments for the program's uptake. Qualitative data were obtained from 32 key informants and 36 focus group discussions in 2011. Content analysis method was used to analyze data and to derive themes and subthemes. Although male circumcision was generally acceptable to communities in Botswana, the uptake of the program was slow, and participants attributed that to a number of challenges or impediments that were frustrating the initiative. The impediments were organized into sociocultural factors, knowledge/informational factors, and infrastructural and system factors.

The promotion of mental health through cultural values, institutions, and practices: a reflection on some aspects of botswana culture.

Botswana has seen rapid socioeconomic development since the 1970s that has contributed to the erosion of the values, institutions, and practices that are believed to be supportive of mental health. In this paper, the author argues that the aspects of culture that are supportive of mental health have been diluted by the process of urbanization and the interactions of Batswana (the indigenous people of Botswana) with other cultural groups, particularly those from the western hemisphere. The paper further highlights some of the values, institutions, and practices native to Botswana and describes how they promote mental health. Lastly, recommendations for reviving the cultural values, institutions, and practices of Botswana are discussed.

The illness demands of diabetes on couples in Botswana.

This report is part of a larger study that investigated the relationships between illness demands, marital support, and psychological adjustment in the context of diabetes mellitus in rural and urban middle-aged marital couples in Botswana. Ninety-six persons experiencing diabetes and 87 of their spouses participated in the study. This report is based on data from 87 diabetic patients and their spouses. Data were collected through face-to-face interviews. Patients and their spouses were interviewed separately. Three open-ended questions elicited participants' personal experiences of illness demands. The couple participants reported many challenging illness experiences associated with the illness and contextual factors that influenced their perception about the burden of illness and reported that the illness experienced was often a growth-enhancing and maturing process.

HIV/AIDS education, prevention and control course (BNS101): the way forward.

Botswana currently has one of the highest HIV-positive prevalence rates in the world. University students are an important group seriously affected by this pandemic. They represent one of the country's richest resources for the future, and faculty at University of Botswana believe there is a responsibility to educate them in a way that helps them preserve their health and vitality. This article represents a case study of one university faculty's efforts to fight the threat of HIV/AIDS to their student body. This case study reviews the early stages of faculty endeavors beginning with the development of an HIV/AIDS course and continuing through evaluation of the success and failures of the course, as well as current refinements now being made. Because the problem of HIV/AIDS on campus is a common one throughout sub-Saharan Africa, the authors hope that this case study of one faculty's approach may be helpful to those facing the same challenge.

Nursing, healthcare, and culture: a view of the year 2050 from Botswana and Israel.

This column presents a dialogue with nurse scholars Motshedisi B. Sabone from Botswana and Freda DeKeyser Ganz from Israel, who share their respective visions and understanding of each country's vision of nursing, healthcare, and quality of life in the year 2050.

Using qualitative methods for course evaluation: a case study from Botswana.

This article is a report of a qualitative evaluation of a course on human immunodeficiency virus/acquired immunodeficiency syndrome carried out jointly by faculty from Botswana and the United States at a university in Botswana. It demonstrates the importance of both international nurse educator expertise in impacting a major pandemic and the use of qualitative methods for course evaluation.