Journal of the Association of Nurses in AIDS Care - Articles in Press

Rapid Oral Fluid Testing for HIV in Veterans With Mental Health Diagnoses and Residing in Community-Assisted Living Facilities - Corrected Proof

2010-08-16

Veterans with a history of mental health and substance abuse diagnoses, residing in assisted living facilities, are more likely to have an undiagnosed HIV infection related to high-risk behaviors. We determined (a) the cross-sectional prevalence of HIV infection among 65 veterans of unknown HIV serostatus with mental health diagnoses who resided in 11 community-assisted living facilities, and (b) whether patients who had not consented to standard physician-initiated blood testing in the previous 5 years would consent to rapid oral fluid HIV testing by nurses familiar to the subjects. We found an HIV prevalence of 3.1% in the subjects who agreed to be tested (n = 64, 98%). High test acceptance, especially in a group with little HIV screening experience, and the identified high prevalence of disease, suggest that this diagnostic method is effective. Patients’ familiarity with the nurses who conducted the testing most likely supported the success of the procedure.

To Engage in Evidence-Based Practice, You Must First Find the Evidence - Corrected Proof

Nancy C. Sharts-Hopko — 2010-08-16

Whenever possible, issues of safety and quality, as well as the cost-effectiveness of health care, have driven the initiative to promote evidence-based practice (EBP). Nurses who work with HIV-infected people may be highly motivated to base their practices on the best scientific evidence, but they may not necessarily know where to find such evidence. This column is intended to provide direction in locating the best evidence available for nursing practice.

Reading and Interpreting the Scientific Evidence - Corrected Proof

Nancy C. Sharts-Hopko — 2010-08-16

Nurses often need to find scientific evidence to help them determine the best practice available in a particular situation or in a periodic review of policies and procedures. Conversely, a nurse may read an article and may assume that it warrants consideration for implementation in the practice setting. It is common for people to find the research literature confusing. A previous column (To Engage in Evidence Based Practice, You Must First Find the Evidence) addressed the issue of locating relevant scientific evidence; this column is intended to demystify research articles.

Barriers and Facilitators to Engagement in HIV Clinical Care in the Deep South: Results From Semi-Structured Patient Interviews - Corrected Proof

Deborah J. Konkle-Parker, K. Rivet Amico, Harold M. Henderson — 2010-08-06

Delayed entry into HIV clinical care and poor retention during care has been associated with increased morbidity and mortality. To characterize the reasons for patients who eventually did enter HIV care after a delay and/or returned to care after a gap of 6 months or more, 130 semi-structured interviews about barriers to and facilitators for prompt entry into and sustained HIV clinical care were conducted in a clinic setting in the Deep South; responses were coded and analyzed quantitatively. Barriers or facilitators were positioned within superordinate categories of personal and structural barriers or facilitators and denial. Personal barriers for entry into care outweighed structural barriers, with denial being reported by 74% of the sample. Barriers to retention in care were more evenly distributed between personal and structural barriers, with denial being a barrier for 24%. Because of the high incidence of denial-based barriers, the role of this barrier and its resolution should be explored further.

Accuracy of Tuberculosis Routine Data and Nurses’ Views of the TB-HIV Information System in the Free State, South Africa - Corrected Proof

2010-07-26

Reliable data are a prerequisite for evidence-based decision making in health care policy (). Accurate measurement is crucial in evaluating epidemic trends, as well as in planning and monitoring disease-specific service provision. On the basis of a systematic review of descriptive and comparative studies and previous reviews of health information technologies, demonstrated the efficacy of information gathered using health information technologies, such as electronic health records, to improve both quality and efficiency of health care. Sound data are especially vital for the success of large-scale public sector health programs in developing countries where limited human and financial resources require their optimal use ().

Validation of the World Health Organization Quality of Life HIV Instrument in a Zambian Sample - Corrected Proof

Prudencia Mweemba, Richard Zeller, Ruth Ludwick, Davina Gosnell, Charles Michelo — 2010-07-09

Given the longevity achievable with the current treatment for people living with HIV, quality of life (QOL) has emerged as a significant health outcome measure. The purpose of this study was to test the QOL factor structure in a Zambian sample using the World Health Organization Quality of Life-HIV (WHOQOL-HIV) instrument. A cross-sectional 2 × 2 factorial design was conducted with 160 people living with HIV. Factor analysis yielded 3 new scales: Zambian WHOQOL-HIV, Zambian WHOHIV Medication Dependence, and Zambian WHOHIV spirituality religion personal beliefs (SRPB), and validated the Overall Quality of Life and General Health Perceptions Scale. The study tested the WHOQOL-HIV instrument, validated a scale that can be used for regular assessment, and yielded three comprehensive QOL assessment scales to monitor disease progression and response to care. The assessments will lead to the development of holistic nursing interventions based on perception of QOL.

Understanding Low-Income, Minority Older Adult Self-Perceptions of HIV Risk - Corrected Proof

Elijah G. Ward, William B. Disch, Jean J. Schensul, Judith A. Levy — 2010-06-28

The number of people ages 50 or older living with HIV in the United States is increasing. Yet, few older adults see themselves at risk of infection. This study examines the heuristic reasoning that low income, minority adults, ages 50 or older use in calculating the likelihood of infection. The data are drawn from face-to-face interviews with a sample of 134 African American and Latino residents, ages 50 to 86, living in low-income housing in Chicago, Illinois, and Hartford, Connecticut. Results show that nearly half of the study's participants thought themselves to be at some level of risk for HIV. In self-assessing their risk, they relied on seven heuristic categories: self-imperilment, social imperilment, fate, incidental contact, situational safety, medical iatrogenesis, and self-protection. These findings extend our understanding of how individuals make sense of their likelihood of experiencing a major health threat and provide insight into more effective HIV prevention programming for older adults.

Potential Impact of Vaginal Microbicides on HIV Risk Among Women With Primary Heterosexual Partners - Corrected Proof

2010-06-21

This article explores the potential public health consequences of anti-HIV microbicide adoption among women in high-risk communities, using data from an exploratory study to illustrate key points. A brief quantitative survey was administered to 71 drug-using women with primary heterosexual partners in New York City. Only 37% of women reported recent condom use with a primary male partner. A total of 86% expressed willingness to use a microbicide with a primary partner. Among women using condoms, 50% believed they would decrease condom use if they started using a vaginal microbicide. Although overall condom use and intended condom migration was low among women with HIV-infected partners, universal promotion of microbicides could nonetheless lead to an increase in HIV risk among specific subgroups of women, indicating the importance of promoting continued condom use. Further research is needed to inform public policy decisions before the availability of the first commercial microbicide.

Adapting Positive Prevention Interventions for International Settings: Applying U.S. Evidence to Epidemics in Developing Countries - Corrected Proof

Carol Dawson Rose, Sarah A. Gutin, Michael Reyes — 2010-06-11

HIV prevention efforts with people living with HIV are critical, and Positive Prevention (PP) interventions have expanded globally to address this growing need. This article provides an overview of U.S. PP literature addressing evidence-based interventions. It continues by looking at the prevention needs and care issues of people living with HIV in Mozambique and the larger African context, and then discusses which U.S. PP models may be best suited for adaptation and use in Mozambique. The research suggests that the lessons learned from these U.S.-developed interventions can be modified to develop theoretically sound interventions. These interventions must be culturally specific and include a collaborative approach for best results.

Transition of Adolescents With HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions - Corrected Proof

2010-06-11

The transition process from pediatric to adult health care for adolescents with chronic diseases is always challenging and can be even more so for adolescents with HIV disease. The purpose of this study was to describe characteristics and current practices surrounding the transition of adolescents from the clinics of the Adolescent Trials Network for HIV/AIDS Interventions to adult medical care. This report focuses on the processes of transition, perceived barriers and facilitators, and anecdotal reports of successes and failures. Practice models used to assist adolescents during transition to adult medical care are described. Interviews were conducted with 19 key informants from 14 Adolescent Trials Network clinics. Findings revealed no consistent definition of “successful” transition, little consensus among the sites regarding specific elements of a transition program, and a lack of mechanisms to assess outcomes. Sites that viewed transition as a process rather than an event consistently described more structured program elements.

Aging With HIV: A Cross-Sectional Study of Comorbidity Prevalence and Clinical Characteristics Across Decades of Life - Corrected Proof

David E. Vance, Michael Mugavero, James Willig, James L. Raper, Michael S. Saag — 2010-05-17

Nurses and nurse practitioners require information on the health problems faced by aging HIV-infected adults. In this descriptive, cross-sectional study, we reviewed the electronic medical records of 1,478 adult patients seen in an HIV clinic between May 2006 and August 2007 to examine patterns of comorbidities, and immunological and clinical characteristics across each decade of life. With increasing age, patients were found to have lower HIV viral loads, more prescribed medications, and a higher prevalence of comorbid conditions, including coronary artery disease, hypertension, hypercholesterolemia, hypogonadism, erectile dysfunction, diabetes, peripheral neuropathy, hepatitis C, esophageal gastric reflux disease, and renal disease. Fortunately, with increasing age, patients were also more likely to have public or private health insurance and tended to be more compliant to medical appointments. With growing interest in aging with HIV, this study highlights the vastly different comorbidity profiles across decades of life, calling into question what constitutes “older” with HIV.

Assessing Medication Adherence of Perinatally HIV-Infected Children Using Caregiver Interviews - Corrected Proof

2010-05-10

Medication adherence is critical for children's HIV treatment success, but obtaining accurate assessments is challenging when complex measurement technologies are not feasible. Our goal was to evaluate a multidimensional adherence interview designed to improve on existing adherence measures. Data from caregivers (N = 126) of perinatally infected children were analyzed to determine the ability of the revised interview guide to detect potential treatment nonadherence. Questions related to viral load (VL) on a bivariate level included proportion of doses taken in the previous days 3 and 6 months, caregivers' knowledge of prescribed dosing frequencies, and caregivers' reports of problems associated with medication administration. VL was not associated with 3-day recall of missed doses. In multivariate analyses, only caregiver knowledge of prescribed dosing frequencies was uniquely associated with VL. Our modified interview appears to successfully identify family struggles with adherence and to have the capacity to help clinicians address medication adherence challenges.

Strategies to Promote Adherence to Antiretroviral Therapy Applied by Dutch HIV Nurse Consultants: A Descriptive Qualitative Study - Corrected Proof

2010-04-30

This study describes strategies used by Dutch HIV nurse consultants to promote adherence to antiretroviral therapy (ART) and the assumptions on which these strategies were based. The study used a descriptive qualitative design with individual and focus group interviews. Individual semi-structured interviews (n = 23) focusing on adherence-supporting procedures and case-based focus groups (3 groups with 5-7 participants each) focusing on adherence strategies were held with HIV nurse consultants (n = 19). The strategies described were mainly based on experience. Theoretical principles were rarely discussed and participants seldom referred to the literature. Adherence-promoting strategies were identified for two phases: (a) before beginning ART and (b) during follow-up care while on ART. Strategies that were not used in one specific phase were categorized under “all phases.” Data yielded useful ideas for the care of HIV-infected patients, and findings can be applied to the development and use of adherence-promoting strategies.

Perceived Barriers to HIV Care Among HIV-Infected Women in the Deep South - Corrected Proof

2010-04-30

Despite the wide availability of effective treatments for HIV disease, many HIV-infected individuals are not in care, and HIV-infected women, particularly those residing in resource-poor areas, may have greater difficulty accessing HIV care than men. The purpose of this research was to explore perceived barriers to care experienced by HIV-infected women living in the Deep South region of the United States. Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care. Participants (N = 40) were recruited from 4 community-based HIV service organizations to participate in focus groups. Sessions lasted approximately 2 hours and were audio recorded. Verbatim transcripts, demographic data, and observational notes were subjected to content analysis strategies that coded the data into categories. Five categories of barriers to HIV care were identified as follows: personal, social, financial, geographic/transportation, and health system barriers. Implications of the findings for future research and practice are discussed in this study.

Essential Core Competencies Related to HIV and AIDS Are Critically Needed in Nursing - Corrected Proof

2010-04-23

HIV and AIDS have had a profound effect on human life across the globe. In 2007, an estimated 33 million people were living with HIV or AIDS, 96% of whom were living in resource-limited settings (). In the countries shouldering the greatest burden of the epidemic, “HIV has reduced life expectancy by more than 20 years, slowed economic growth, and deepened household poverty” (UNAIDS, 2008, p. 13). In 2007, the 15 countries of the Southern Africa Development Community (SADC) comprised two thirds of the global HIV population and accounted for nearly three fourths of those who had died from AIDS (UNAIDS, 2008).

Piloting an HIV Prevention Intervention for Cameroonian Girls - Corrected Proof

Comfort Enah, Marilyn Sommers, Linda Moneyham, Carrie Ann Long, Gwendolyn Childs — 2010-04-23

In this report, the authors describe the pilot test of a school-based culturally tailored HIV prevention intervention for 10- to 12-year-old Cameroonian females. The aims of this research were to determine the feasibility of recruiting and enrolling Cameroonian girls in HIV prevention research studies, estimate the efficacy of the intervention, and assess cultural sensitivity of the intervention and study protocols. Sixty participants completed the study. A pre-/posttest design was used to evaluate the intervention. Findings include 100% participation of all eligible participants with a majority (78%) of participants reporting positive perceptions of the intervention. The intervention was estimated to be potentially effective with significant increases in immediate postintervention sexual-abstinence behavior skills (t = 4.51; p < .05) and intentions to postpone sexual activity (t = 3.40; p < .05). Findings can inform more rigorously designed studies of the intervention. This line of research can contribute to decreasing new infections among adolescents.

The New Nurse Investigator - Corrected Proof

Veronica P.S. Njie-Carr, Nancy E. Glass — 2010-04-23

The new investigator is defined by the National Institutes of Health (NIH) as an individual with a doctoral degree who has “not previously competed successfully for an NIH-supported research project other than small or early stage research awards” (, Definition of New Investigator Section, para. 1). Other research funding organizations and foundations such as the American Nurses Foundation and the Robert Wood Johnson Foundation suggest that the new investigator should have completed a research doctorate in the previous 5 years, which often includes nurse researchers at the postdoctoral and junior faculty levels. The purpose of the “new investigator” initiative was to increase the pipeline of scientists by providing access to training, research resources, and opportunities to help this cadre of investigators, including nurse investigators, progress to independent and productive research careers.

Factors Influencing Utilization of Voluntary Counseling and Testing Service in Kasenyi Fishing Community in Uganda - Corrected Proof

Emmanuel Mugisha, Gisela Hildegard van Rensburg, Eugine Potgieter — 2010-04-12

This article reports on part of a study that described models of voluntary counseling and testing (VCT) service delivery and analyzed how a model influenced uptake of VCT services in a Ugandan community. A quantitative, exploratory, and descriptive design was used. Respondents (N = 127, 52% male, 48% female) provided data during structured interviews. Although knowledge about HIV transmission and prevention was high, only 47.2% of respondents had been tested for HIV. Married people were less likely to have been tested than unmarried people. The most common reasons for testing included risky lifestyle, signs and symptoms related to HIV, sex partners' risky lifestyles, and a sex partner's death. The most common barriers to testing were fear of results, belief that it was not necessary, and lack of time. VCT use was low. Sensitization to testing, mobilization of the community, and improving the quality and volume of VCT services are needed.