Integrating HIV-related evidence-based renal care guidelines into adult HIV clinics.

The purpose of this evidence-based practice (EBP) project was to implement research-based, clinic-specific renal care guidelines into two adult HIV clinics. The two main components of the project included (a) implementation of clinic-specific renal care guidelines and (b) initiation of renal and general health patient education by clinic support staff. Overall, statistically significant improvement was shown postguideline implementation in proportion of urinalyses (UA) (p = .01) and estimated glomerular filtration rates (eGFR) (p = .002) completion for patients during initial clinic visits and for those requiring yearly (UA p < .001, eGFR p < .001) or twice-yearly (UA p < .001, eGFR p < .001) renal testing. The rate of renal health education provided to patients by nurses was 60.7%. Results suggest that advanced practice nurse-led EBP change implementation can result in better renal care in outpatient HIV care settings. The process described could be used to implement EBP in other clinic sites.

Self-care management of anxiety and fear in HIV disease.

The purpose of this study is to describe the frequency and correlates of self-reported anxiety and fear and the self-care behaviors used to manage these symptoms. Data were collected in a convenience sample (N = 422) of HIV-positive subjects. Demographic and disease-related variables were compared for those who did and did not report anxiety and fear. Anxiety and fear were the most frequently reported symptoms (17.3%, n = 73). There were significant differences on gender, level of education, and the use of antiretroviral medications. Self-care behaviors (n = 212) for anxiety and fear were grouped into seven categories: using activities for distraction = 25%, talking to others = 21%, using alternative/complementary therapies = 18%, taking prescribed medications = 10%, using self-talk = 9%, using substances = 9%, and using avoidance behaviors = 7%. Anxiety and fear are commonly experienced by people with HIV/AIDS. Self-care strategies are imperative in the management of these clinical manifestations.

HIV and AIDS in people older than 50. A continuing concern.

The proportion of people with AIDS older than age 50 has remained constant since early in the epidemic. Given this fact, in comparison to the decrease in AIDS cases in other risk groups, it is clear that older adults remain a significant risk group. Despite engaging in behavior which puts them at risk for HIV, older adults are less likely to perceive themselves at risk and to adopt safer sexual and needle sharing behaviors. Aging comes with physiological changes, which increase risk for any infection including HIV. Older adults with HIV are more likely to be diagnosed late in disease, experience progression more quickly, and survive for a shorter period than their younger counterparts. Co-morbidities are frequent in older adults with HIV infection and can complicate the disease process and management. Recent treatment and disease monitoring advances are extending the life of individuals with HIV. Therefore, the number of older American with HIV and AIDS may increase even further, clearly defining a need for age-related interventions. Beyond the physiological disease facts, sociological factors have greatly influenced older adult risk behavior, risk-reduction efforts, social response, and health care response to the epidemic. A clear understanding of these sociological factors is necessary in planning interventions for the elderly individual with HIV. Finally, nurses are in a unique position to assist older adults at risk for or with HIV infection. However, a comprehensive understanding of physiological and sociological factors related to older adults is necessary for the most useful and acceptable interventions to be developed.

Complementary therapy use in persons with HIV/AIDS.

The purpose of this study was to describe the frequency and correlates of complementary and alternative medicine (CAM) therapies used by people with HIV/AIDS to manage illness and treatment-related symptoms. Data were collected from a convenience sample (N = 422) of people living with HIV disease. Demographic variables (e.g., education, age, and gender) were compared for those who reported using at least one CAM therapy. There were significant differences for gender (chi2 = 4.003, df = 1, p = .045) and for ethnicity (chi2 = 6.042, df = 2, p = .049). Females and African Americans used CAM more frequently. More than one third of the participants used CAM, and there were a total of 246 critical incidents of nontraditional treatment use. It is possible that these nonallopathic interventions may positively affect health-related quality of life in persons with HIV by ameliorating or reducing the side effects associated with the disease and its treatments.