Care of the Transgender Person Living with Human Immunodeficiency Virus.

This article explores HIV care for transgender individuals; in particular, the barriers to early diagnosis of HIV, access and engagement in care, and disease complications. The article also examines how Advanced Practice Nurse Practitioners and other health care providers are well-positioned to mitigate these obstacles to wellness.

HIV Nursing.

These nurses provide compassionate care to patients with HIV and AIDS.

A nurse-led intervention to improve management of virological failure in public sector HIV clinics in Durban, South Africa: A pre- and post-implementation evaluation.

BACKGROUND: Identification of patients on antiretroviral therapy (ART) with virological failure (VF) and the response in the public health sector remain significant challenges. We previously reported improvement in routine viral load (VL) monitoring after ART commencement through a health system-strengthening, nurse-led 'VL champion' programme as part of a multidisciplinary team in three public sector clinics in Durban, South Africa. OBJECTIVES: To report on the impact of the VL champion model adapted to identify, support and co-ordinate the management of individuals with VF on first-line ART in a setting with limited electronic-based record capacity. METHODS: We evaluated the VL champion model using a controlled before-after study design. A paper-based tool, the 'high VL register', was piloted under the supervision of the VL champion to improve data management, monitoring of counselling support, and enacting of clinical decisions. We abstracted chart and electronic data (TIER.net) for eligible individuals with VF in the year before and after implementation of the programme, and compared outcomes for individuals during these periods. Our primary outcome was successful completion of the VF pathway, defined as a repeat VL <1 000 copies/mL or a change to second-line ART within 6 months of VF. In a secondary analysis, we assessed the completion of each step in the pathway. RESULTS: We identified 60 and 56 individuals in the pre-intervention and post-intervention periods, respectively, with VF who met the inclusion criteria. Sociodemographic and clinical characteristics were similar between the periods. Repeat VL testing was completed in 61.7% and 57.8% of individuals in these two groups, respectively. We found no difference in the proportion achieving our primary outcome in the pre- and post-intervention periods: 11/60 (18.3%; 95% confidence interval (CI) 9 - 28) and 15/56 (22.8%; 95% CI 15 - 38), respectively (p=0.28). In multivariable logistic regression models adjusted for potential confounding factors, individuals in the post-intervention period had a non-significant doubling of the odds of achieving the primary outcome (adjusted odds ratio 2.07; 95% CI 0.75 - 5.72). However, there was no difference in the rates of completion of each step along the first-line VF cascade of care. CONCLUSIONS: This enhanced intervention to improve VF in the public sector using a paper-based data management system failed to achieve significant improvements in first-line VF management over the standard of care. In addition to interventions that better address patient-centred factors that contribute to VF, we believe that there are substantial limitations to and staffing requirements involved in the ongoing utilisation of a paper-based tool. A prioritisation is needed to further expand and upgrade the electronic medical record system with capabilities for prompting staff regarding patients with missed visits and critical laboratory results demonstrating VF.

A Review of the State of HIV Nursing Science With Sexual Orientation, Gender Identity/Expression Peoples.

ABSTRACT: Throughout the HIV pandemic, nurses have contributed to or led approaches to understanding the effects of HIV disease at individual and societal levels. Nurses have advocated for socially just care for more than a century, and our efforts have created a foundation on which to further build the state of HIV nursing science with sexual orientation and gender identity/expression (SOGI) Peoples. Nurses have also participated in the development of approaches to manage HIV disease for and in collaboration with populations directly affected by the disease. Our inclusive approach was guided by an international human rights legal framework to review the state of nursing science in HIV with SOGI Peoples. We identified articles that provide practice guidance (n = 44) and interventions (n = 26) to address the health concerns of SOGI Peoples and our communities. Practice guidance articles were categorized by SOGI group: SOGI People collectively, bisexual, transgender, cisgender lesbian, women who have sex with women, cisgender gay men, and men who have sex with men. Interventions were categorized by societal level (i.e., individual, family, and structural). Our review revealed opportunities for future HIV nursing science and practices that are inclusive of SOGI Peoples. Through integrated collaborative efforts, nurses can help SOGI communities achieve optimal health outcomes that are based on dignity and respect for human rights.

Understanding the Relationship Between Nursing Home Experience With Human Immunodeficiency Virus and Patient Outcomes.

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.

Nursing Contributions to Ending the Global Adolescent and Young Adult HIV Pandemic.

ABSTRACT: The welfare of adolescents and young adults (AYA) is pivotal for a sustainable future. However, despite worldwide efforts, alarming disparities in HIV morbidity and mortality persist: AYA are disproportionately affected. Specific world regions and key populations particularly warrant increased efforts to improve prevention and treatment via the global 95-95-95 strategy. Although the idiosyncrasies of AYA represent a challenge to a global response, for the past four decades, nurses have initiated and contributed to advances in HIV policy, practice, and research with AYA. Their unique position within the health care system renders success of these initiatives contingent on the collective capacity to leverage the well-established potential of nursing care. In this article, we (a) characterize the global epidemiology of HIV among AYA; (b) discuss important youth-focused HIV nursing achievements and identify nurses' unique competencies compatible with adolescent and young adult needs; and (c) examine the implications for future youth-tailored HIV nursing science and practice.

Effects of Nurse-Delivered Cognitive Behavioral Intervention on Depression and Anxiety for Persons Living With HIV in China: A Clinical Controlled Trial.

ABSTRACT: Depression and anxiety, which may influence antiretroviral therapy (ART) medication adherence, are prevalent among persons living with HIV (PLWH) in China. This parallel two-arm clinical controlled trial aimed to examine the effects of a nurse-delivered cognitive behavioral intervention (CBI) on depression, anxiety, and ART medication adherence in Chinese PLWH. Using in-person and online recruitment, 140 PLWH ages 18 years and older who were undergoing ART and had a Patient Health Questionnaire-4 score of ≥2 were assigned to the 10-week-long CBI group or the routine follow-up group according to their preference. Outcomes were measured at baseline, postintervention, and 6-month follow-up. Results showed significant intervention effects on depression maintained until the 6-month follow-up. Although anxiety and ART medication adherence did not show robust effects between conditions, amelioration trends for these outcomes were also found. Our study demonstrated that the nurse-delivered CBI could help Chinese PLWH ameliorate depression.

Diagnóstico de enfermagem risco de infecção e infecções relacionadas à assistência à saúde em pacientes com aids / Diagnóstico de enfermería Riesgo de Infección e Infecciones Asociadas a la Atención de Salud en pacientes con sida / Nursing diagnosis risk for infection and cross-infections in aids patients

Resumo Objetivo Identificar quais fatores de risco do diagnóstico de enfermagem risco de infecção estão associados a chances maiores de pessoas com HIV/aids hospitalizadas desenvolverem Infecções Relacionadas à Assistência à Saúde. Métodos Estudo caso-controle no qual os casos foram pacientes com aids hospitalizados que apresentaram Infecções Relacionadas à Assistência à Saúde (n = 104) e os controles foram pacientes com aids hospitalizados que não evoluíram para Infecções Relacionadas à Assistência à Saúde (n = 104). Usaram-se o teste qui-quadrado de Pearson e a regressão logística, e calculou-se a odds ratio. Resultados Peristaltismo alterado, tabagismo, nível reduzido de hemoglobina e leucopenia foram significativamente associados com o desfecho estudado. Na regressão logística, a redução na hemoglobina foi considerada um fator preditor da detecção de risco de infecção. Conclusão Os indicadores tabagismo, leucopenia e nível reduzido de hemoglobina foram identificados na regressão como os preditores mais importantes para identificar o risco de infecção em pessoas vivendo com HIV/aids.

Resumen Objetivo Identificar qué factores de riesgo del diagnóstico de enfermería Riesgo de Infección están relacionados con mayores probabilidades de que personas con el VIH/sida hospitalizadas presenten Infecciones Asociadas a la Atención de Salud. Métodos Estudio caso-control, en el cual los casos fueron pacientes con sida hospitalizados que presentaron Infecciones Asociadas a la Atención de Salud (n = 104) y los controles fueron pacientes con sida hospitalizados que no contrajeron Infecciones Asociadas a la Atención de Salud (n = 104). Se utilizó la prueba χ2 de Pearson y la regresión logística y se calculó el odds ratio. Resultados El peristaltismo alterado, el tabaquismo, el nivel reducido de hemoglobina y la leucopenia fueron significativamente asociados al resultado estudiado. En la regresión logística, la reducción de la hemoglobina fue considerada un factor predictor de la detección del riesgo de infección. Conclusión Los indicadores tabaquismo, leucopenia y nivel reducido de hemoglobina fueron identificados en la regresión como los predictores más importantes para identificar el riesgo de infección en personas que viven con el VIH/sida.

Abstract Objective To identify which risk factors of the Nursing Diagnosis Risk of infection are associated with a greater chance of Hospitalized People Living with HIV/AIDS developing Healthcare-associated Infections. Methods This is a case-control study in which the cases were composed by hospitalized AIDS patients who presented Healthcare-associated Infections (n=104) and, the controls by those who did not progress to Healthcare-associated Infections (n=104). The Pearson Chi-square test, Odds Ratio calculations for risk factors and Logistic Regression were used. Results Altered peristalsis, smoking, decreased hemoglobin and leukopenia were significantly associated with the outcome investigated. In logistic regression, the decrease in hemoglobin was considered a predictor factor for the detection of infection risk. Conclusion The indicators smoking, leucopenia and decreased hemoglobin were recognized in the regression as the most important predictors for identifying the risk of infection in People Living with HIV/AIDS.

Geographic distribution of hospice, homecare, and nursing home facilities and access to end-of-life care among persons living with HIV/AIDS in Appalachia.

BACKGROUND: Access to healthcare services, from diagnosis through end of life (EOL), is important among persons living with Human Immunodeficiency Syndrome (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (PLWHA). However, little is known about the availability of hospice services in Appalachian areas. Therefore, the objective of this study is to describe the geographic distribution of hospice, homecare and nursing home facilities in order to demonstrate current existence of and access to resources for EOL care among PLWHA in the Appalachian regions of Tennessee and Alabama. METHODS: This paper reports on the second aim of a larger sequential, mixed methods qualitative-quantitative (qual→quan) study. Data from advance care planning (ACP) surveys were collected by both electronic (n = 28) and paper copies (n = 201) and, among other things, obtained information on zip codes of residence of PLWHA. This enabled assessment of the geographic distribution of residences of PLWHA in relation to the distribution of healthcare services such as hospice and home healthcare services. Hospice and Home Healthcare data were obtained from the Tennessee and Alabama Departments of Health. The street addresses of these facilities were used to geocode and map the geographic distributions of the facilities using Street Map USA. Travel times to Hospice and Home Healthcare facilities were computed and mapped using ArcGIS 10.3. RESULTS: We identified a total of 32 hospice and 69 home healthcare facilities in the Tennessee Appalachian region, while the Alabama Appalachian region had a total of 110 hospice and 86 home healthcare facilities. Most care facilities were located in urban centers. The distribution of care facilities was worse in Tennessee with many counties having no facilities, requiring up to an hour drive time to reach patients. A total of 86% of the PLWHA indicated preference to die at home. CONCLUSIONS: Persons living with HIV/AIDS in Appalachia face a number of challenges at the end of life that make access to EOL services difficult. Although respondents indicated a preference to die at home, the hospice/homecare infrastructure and resources are overwhelmingly inadequate to meet this need. There is need to improve access to EOL care in the Appalachian regions of both Tennessee and Alabama although the need is greater in Tennessee.

Two Nursing Outreach Interventions to Engage Vulnerable Populations in Care.

People experiencing substance use disorders, homelessness, mental health conditions, or poverty often have difficultly engaging in healthcare services particularly prevention services. This brief report describes two nursing interventions implemented by nursing students that aim to empower vulnerable populations and draw them into care using empathetic and patient-centered approaches. The first intervention uses street outreach with naloxone training in an area of Baltimore experiencing a high rate of overdose deaths. The second uses home or street outreach to link people living with HIV to HIV care.

The Effect of FAmily-CEntered (FACE®) Pediatric Advanced Care Planning Intervention on Family Anxiety: A Randomized Controlled Clinical Trial for Adolescents With HIV and Their Families.

Clinicians fear pediatric advance care planning (pACP) for adolescents is too distressing for families. Multisite longitudinal randomized controlled trial of adolescents with HIV tested the effect of FAmily-CEntered (FACE®) pACP intervention on families' anxiety and depression. One hundred five adolescent/family dyads were randomized to FACE® (n = 54 dyads) or control (n = 51 dyads). Families were 90% African American, 37% HIV-positive, and 22% less than high school educated. Families reported lower anxiety 3 months post-FACE® intervention than control (ß = -4.71, 95% confidence interval [CI] = [-8.20, -1.23], p = .008). Male family members were less anxious than female family members (ß = -4.55, 95% CI = [-6.96, -2.138], p ≤ .001). Family members living with HIV reported greater depressive symptoms than HIV-uninfected families (ß = 3.32, 95% CI = [0.254, 6.38], p = .034). Clinicians can be assured this structured, facilitated FACE® pACP model minimized family anxiety without increasing depressive symptoms. Adolescent/family dyads should be invited to have access to, and provision of, evidence-based pACP as part of patient-centered/family-supported care in the HIV continuum of care.

A qualitative evaluation of a stress management programme for HIV and AIDS home-based care workers in Tshwane, South Africa.

The HIV and AIDS pandemic resulted in increased demands on the South African healthcare system and contributed to elevated stress levels among healthcare workers, including home-based care workers. The goal of the study was to evaluate a stress management programme for HIV and AIDS home-based care workers in Tshwane, South Africa. Social constructionism was adopted as the theoretical framework of the study. The study implemented intervention research and adopted a qualitative research approach, specifically the instrumental case study. Non-probability sampling, specifically volunteer sampling was utilised to recruit a group of twelve HIV and AIDS home-based care workers (n = 12). The data were collected through semi-structured interviews and administered before and after exposure to the stress management programme. The research findings, based on thematic analysis, revealed that the programme was effective in mitigating the impact of stress experienced by the HIV and AIDS home-based care workers in Tshwane. Recommendations are proffered for the refinement of the newly developed stress management programme for implementation among HIV and AIDS home-based care workers in similar field settings.

Nursing Considerations for Patients With HIV in Critical Care Settings.

Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed. Antiretroviral therapy is critical for successful management of HIV infection and should be continued when possible during intensive care unit stays. However, many antiretroviral regimens result in drug-drug interactions, adverse drug-related events, and secondary complications such as insulin resistance and prolonged QT intervals. Critical care nurses have unique opportunities to provide safe, unbiased, and compassionate care that promotes health for a population of people who have a history of being stigmatized.

A phenomenographic study: Exploring the variations of registered nurses' perceived roles and experiences as HIV counselors

OBJECTIVES: The study explored the variations of registered nurses' perceived roles and experiences before, during and after HIV counseling. METHODS: The study is anchored on Parse's Human Becoming Theory structured around three abiding themes: meaning, rhythmicity, and transcendence. A qualitative phenomenographical approach was used and the data were collected through semi structured, face-to-face, in-depth interview sessions with ten registered nurses who were eligible under the set criterion: HIV counselors employed in both government and private health facilities with HIV Testing and Counseling facilities and services in Iligan City and Cagayan de Oro City. Verbatim transcriptions were analyzed in iterative process using Jan Larssons and Inger Holmstrom's (2007) seven simple steps of phenomenographic analysis. Triangulation and validation established rigor and trustworthiness of the data. RESULTS: Emergent themes of differences in participants' perceived roles and experiences conveyed in a metaphor: The Employee vs. The Educator; The Professional vs. The Shepherd. CONCLUSION: The variations ascertained the association of perceived roles and experiences of HIV Counselors and posited equally vast challenges as nursing takes the core in collaboration for the care of persons living with HIV toward a dignified death

No disponible

Nursing Leadership Implications for Clinical Placements in Corrections.

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.

Eswatini Nursing Council Regulatory Reforms: Process towards Entry to Practice Examination.

Objective: To identify and to measure entry level competencies (knowledge, skills, attitudes, judgements) for nurses to practice safely and effectively in the Kingdom of Eswatini. Introduction: Eswatini, formerly known as Swaziland, is a small sub-Saharan country between South Africa and Mozambique. There are four nursing programs approved by the Eswatini Nursing Council (ENC) that provide nursing education in the areas of general nursing, midwifery, mental health and community health. The mandate of the ENC is to protect the public and to this end licensed nurses must be able to meet standardized entry level requirements. Methods: We identified gaps in expected competencies of new nurses led to comprehensive strategies by many stakeholders to close the gaps. Nursing competencies were categorized into seven learning domains with specific, measurable indicators included in each domain. Specific clinical skills essential for entry to practice were identified. Results: Provision of Quality Care; Information Management Systems; Emergency/Trauma/Disaster Management; Infection Prevention & Control; Leadership and Management; Ethics/Legal Issues/Professional Conduct; and Prevention/Treatment & Care of HIV, AIDS, TB are the seven competency domains that are measured on a newly developed standardized entry to practice multiple choice examination. Essential clinical skills are also assessed prior to obtaining licensure. Conclusion: Implementing these standards will ensure that nurses in Eswatini have the appropriate skill set to deliver care to their patients, improve their communities' health, and enable the kingdom to make advances towards universal health coverage and attainment of the sustainable development goals.

The role of trust and health literacy in nurse-delivered point-of-care STI testing for pregnant women living with HIV, Tshwane District, South Africa.

BACKGROUND: Sexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization's current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes. METHODS: To engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach. RESULTS: Twenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners. CONCLUSIONS: We recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.