Mycobacterium tuberculosis: implications for district nurses.

Despite the belief of many health professionals, tuberculosis is not a disease of the past but is on the increase (Department of Health (DH), 2004) and the UK has seen a year on year increase in the number of new cases (Health Protection Agency, 2008). The DH have made a number of recommendations to combat this increase and one of those recommendations is to raise awareness among health staff (2004). This review has set out to examine district nurses' knowledge about tuberculosis and the consequences of poor knowledge. Five themes emerged from the literature search with the most prominent being the subject of adherence and how this could be addressed. The review has identified that district nurses should have a greater knowledge of tuberculosis and patient treatment could be improved by the nurse having a better understanding about tuberculosis care.

Virologic response using directly observed therapy in adolescents with HIV: an adherence tool.

Virologic response to highly active antiretroviral therapy (HAART) treatment of HIV infection depends on viral sensitivity to antiretrovirals and excellent medication adherence. Adolescents with vertically acquired HIV may require complicated regimens because of significant treatment experience and often have poor medication adherence. A retrospective chart review identified five adolescents with vertically acquired HIV and plasma HIV viral load rebound or nonresponse on a stable HAART regimen followed by a period of directly observed therapy (DOT) in a clinic or hospital setting with serial viral load measurements. Four subjects had a virologic response (mean decline, 1.15 log10) after DOT. A response to HAART can be seen despite antiretrovirals resistance using DOT and treatment-experienced patients seemingly unresponsive to HAART may be nonadherent even with reassuring adherence measures. A period of clinic-monitored DOT may allow diagnosis of nonadherence, discussion of medication barriers, and avoidance of unnecessary medication changes.

HIV risk reduction in a nurse case-managed TB and HIV intervention among homeless adults.

This study evaluated a six-month nurse case-managed intervention against a standard care control program among 295 sheltered homeless adults from Los Angeles, USA. The primary aim of the intervention was encouraging latent tuberculosis infection treatment completion. The secondary aim was reducing HIV risk, the focus of this report. A longitudinal path model revealed that the intervention impacted cognitive factors of AIDS Knowledge, Perceived AIDS Risk and Self-efficacy for Condom Use, but did not impact substance use and risky sexual behaviors. The dual intervention program for HIV and TB provided promising synergistic effects by targeting risk factors common to both infections.

Frontal assault on tuberculosis. Interview by Eileen Fursland.

Nurses working with people who have TB in London battle to reduce the stigma attached to the disease. For many patients, TB is just one of many problems they have to contend with. People living in shared accommodation can face homelessness as a result of their infection. In some countries TB is associated with HIV, increasing the stigma patients face. Some patients are given incentives to encourage concordance with treatment.

Task orientated nursing in a tuberculosis control programme in South Africa: where does it come from and what keeps it going?

Task oriented nursing is associated with traditional hospital ward organisational practice. This paper describes task orientation in a tuberculosis control programme which forms part of the public health system in Cape Town, South Africa. Task oriented practice is illustrated with clinical data from a focused ethnography on the work of nurses in a tuberculosis control programme. The origins of task orientation are traced to the colonial history of nursing in South Africa. The authors explore both the explicit and more functional reasons for maintaining task orientation, as well as the implicit and mostly unconscious socially structured defences which contribute to the continuation of this form of practice. Unless attention is given to the complexities of this phenomenon, initiatives to change task oriented practice may continue to fail.

The use of directly observed therapy in TB: a brief pan-London survey.

AIM: The objective of this study was to investigate issues regarding adherence with tuberculosis therapy and the use of directly observed therapy. METHOD: A small-scale survey of TB nurse specialists at chest clinics in London was carried out to determine the current use of directly observed therapy for patients with tuberculosis in London. RESULTS: Responses to this survey indicate that directly observed therapy is currently used in less than half the available services in London. Many of the specialist TB nurses indicated that lack of resources and time were drawbacks to implementing directly observed therapy. CONCLUSION: Directly observed therapy was found to be a strategy that was infrequently used as a last measure for those people who were previous non-adherers.