Home-based care for reducing morbidity and mortality in people infected with HIV/AIDS

BACKGROUND

Home-based care (HBC), to promote quality-of-life and limit hospital care, is used in many countries, especially where public health services are overburdened.

OBJECTIVES

This review assessed the effects of HBC on morbidity and mortality in those with HIV/AIDS.

SEARCH STRATEGY

Randomised and controlled clinical trials of HBC including all forms of treatment, care and support offered in the home were included. A highly sensitive search strategy was used to search CENTRAL, MEDLINE, EMBASE, AIDSearch, CINAHL, PsycINFO/LIT. Risk of bias of all trials was assessed.

SELECTION CRITERIA

All randomised and controlled clinical trials were included of HIV/AIDS positive individuals, adults and children, of any gender, and from any setting. Home-based care, provided by family, lay and/or professional people, including all forms of treatment, care and support offered in the HIV/AIDS positive person's home as compared to hospital or institutional based care

DATA COLLECTION AND ANALYSIS

Titles, abstracts and descriptor terms of the electronic search results were screened independently by two authors for relevance based on the types of participants, interventions, and study design. Full text articles were obtained of all selected abstracts and an eligibility form was used to determine final study selection. Data extraction and assessment of risk of bias were done independently. Narrative synthesis of results were done. Relevant effect measures and the 95% confidence intervals were reported.

MAIN RESULTS

Ten studies randomised individuals and trial sizes varied from n=31 to n=549. One study randomised 392 households and enrolled a total of 509 persons with HIV and 1,521 HIV-negative household members. Two ongoing studies were identified. Intensive home-based nursing significantly improved self-reported knowledge of HIV and medications, self-reported adherence and difference in pharmacy drug refill (1 study). Another study, comparing proportion of participants with greater than 90% adherence, found statistically significant differences over time but no significant change in CD4 counts and viral loads. A third study found significant differences in HIV stigma, worry and physical functioning but no differences in depressive symptoms, mood, general health, and overall functioning. Comprehensive case management by trans-professional teams compared to usual care by primary care nurses had no significant difference in quality-of-life after 6-months of follow-up (n=57) and average length of time on service (n=549). Home total parenteral nutrition had no significant impact on overall survival and rate of re-hospitalisation. Two trials comparing computers with brochures/nothing/standard medical care found no significant effect on health status, and decision-making confidence and skill, but a reduction in social isolation after controlling for depression. Two trials evaluating home exercise programmes found opposing results. Home-based safe water systems reduced diarrhea frequency and severity among persons with HIV in Africa.

AUTHORS' CONCLUSIONS

Studies were generally small and very few studies were done in developing countries. There was a lack of studies truly looking at the effect of home based care itself or looking at significant end points (death and progression to AIDS). However, the range of interventions and HBC models evaluated can assist in making evidence-based decisions about HIV care and support.

Impact of intervention programs on nurses' knowledge, attitudes, and willingness to take care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome: a descriptive review

OBJECTIVE

This paper reviews the current literature on intervention programs designed to improve nurses' knowledge and attitudes to human immunodeficiency virus/acquired immunodeficiency syndrome and their willingness to take care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome. It also explores the impact of these intervention programs.

MATERIALS AND METHODS

The MEDLINE and Pubmed, Science Direct, Cochrane Library, EbscoHost, ERIC databases were searched for relevant English-language citations between 1997 and 2007 using the following search terms: human immunodeficiency virus/acquired immunodeficiency syndrome, nurse, intervention, teaching, education, knowledge, attitude, and willingness. Relevant articles were retrieved, reviewed, and assessed. A total of 16 articles were considered appropriate and selected for content analysis.

RESULTS

We identified articles that reported on intervention programs to improve nurses' knowledge and attitudes and their willingness to take care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome. Eight of the intervention studies included lectures among their methods of educational intervention. The nurse sample sizes (n) ranged from 12 to 552. Many of the studies involved one experimental/intervention group and one control group. The intervention programs varied in terms of their methodological rigor. Almost all reported one or more statistically significant effects.

CONCLUSIONS

The review highlights the need for well-designed, methodologically sound research on outcomes of nursing education. Future studies should examine not only the short-term effectiveness of intervention programs in terms of changing attitudes and increasing willingness to care, but also their impact in the longer term.

The effectiveness of web-based and face-to-face continuing education methods on nurses' knowledge about AIDS: a comparative study

BACKGROUND

Information about web-based education outcomes in comparison with a face-to-face format can help researchers and tutors prepare and deliver future web-based or face-to-face courses more efficiently. The aim of this study was to compare the effectiveness of web-based and face-to-face continuing education methods in improving nurses' knowledge about AIDS.

METHODS

A quasi-experimental method was used with a pre-test and post-test design. In this study 140 nurses with BSc degrees were chosen through a random sampling method and divided into a web-based and a face-to-face group by random allocation. For the former group the intervention consisted of a web-based course on AIDS; the latter received a 3-hour lecture course on the same subject. At the beginning and end of the course in both groups, the nurses' knowledge was measured by a questionnaire. Pre- and post-test scores were compared within and between the groups.

RESULTS

The results show that there was no significant difference between the groups in either the pre-test (t(138) = -1.7, p = 0.096) nor the post-test (t(138) = -1.4, p = 0.163) scores in the knowledge test. However, there was a significant difference in the pre-test and post-test scores within each group (web-based, t(69) = 26, p < .001; face-to-face, t(69) = 24.3, p < .001).

CONCLUSION

The web-based method seems to be as effective as the face-to-face method in the continuing education of nurses. Therefore, the web-based method is recommended, as complementary to the face-to-face method, for designing and delivering some topics of continuing education programs for nurses.

Vulnerabilities and caregiving in an ethnically diverse HIV-infected population

The current study aimed to identify the primary informal caregivers of a group of urban HIV+ adults (n = 250) and to determine relationships between demographic, medical, and substance use characteristics and caregivers types. Reported caregiver types included 36.8% familial, 22.4% significant other, and 22.8% institutional or other caregiver relationships. The remaining 18% of the sample reported having no individual that rendered informal care. Factors associated with the absence of an informal caregiver included African American race and low education. Hispanic participants reported the highest frequency of family caregivers while participants with a history of substance disorder were less likely to identify a significant other as a caregiver. This study demonstrates the evolving nature of informal caregiving in HIV, race- and education-related disparities in the absence of primary caregivers, and the importance of sociocultural and demographic factors in the study of HIV caregiving.

[HIV/AIDS children living in shelters under the perspective of humanistic nursing]

This article views the life of HIV/AIDS children in shelters under the perspective of the Humanistic Nursing Theory. This is a qualitative study with an existential-phenomenological-humanistic approach based on the Nursology of Paterson and Zderad. The scenario was a shelter for HIV/AIDS children located in the state of Rio Grande do Sul, Brazil. Information was collected using phenomenological interview carried out with three children with AIDS. This article presents part of the interpretation of the obtained information centered in two meaning units. The results provided an understanding of the child's play as way of feeling better in the environment of the shelter because the child perceives himself/herself as part of that environment with others. It also gives visibility to children with HIV/AIDS in shelters, and highlights the importance of including this theme in undergraduate courses, training health professionals in humanistic care, and managers to develop specific public policies for this population.

[Applying the family adjustment and adaptation response model to care of an AIDS patient's family]

Discrimination against AIDS patients occurs in our society, not only influencing the patients but also restricting their usage of social resources. We report on a 31-year-old AIDS patient facing a family crisis because of an imbalance between the meanings, demands, and capabilities of his family. In this paper, we have applied the family adjustment and adaptation response (FAAR) model to assess this family, and identified three health problems, including (1) poor communication among family members, (2) deficiency in disease-related knowledge and skill, and (3) dysfunctional processing among the family. Throughout the care, we adopted a family-centered belief to communicate with the family to resolve their misunderstandings. We provided the family with information related to the disease to reduce their stress arising from caring for the patient. We also helped the family to utilize social resources by coordinating multi-disciplinary care. The family successfully restored a balance between meanings, demands, and capabilities. If we can apply this model clinically to understand the capabilities, demands and meanings of family existence as well as to help family members to develop their capabilities, reduce demands and recognize the positive meanings of family, we can help AIDS patients and their families to achieve positive adaptation.

Disclosure of HIV status: experiences and perceptions of persons living with HIV/AIDS and nurses involved in their care in Africa

Most people with HIV have disclosed their status to someone, often with mixed results. Most health literature seems to favor disclosure by persons living with acquired immunodeficiency syndrome (AIDS), but it could be that to disclose is not always a good thing. We used a descriptive, qualitative research design to explore the experience of human immunodeficiency virus (HIV) and AIDS stigma of people living with HIV or AIDS and nurses involved in their care in Africa. Focus group discussions were held with respondents. We asked them to relate incidents that they themselves observed, and those that they themselves experienced in the community and in families. Thirty-nine focus groups were conducted in five countries in both urban and rural settings. This article is limited to a discussion of data related to the theme of disclosure only. The sub-themes of disclosure were experiences before the disclosure, the process of disclosure, and responses during and after disclosure.

[The experience of parents caring for adult children with HIV/AIDS]

Antiretroviral treatment dramatically reduces mortality and prolongs the life expectancy of HIV/AIDS patients in Taiwan. The stigma attached to AIDS, and conflicts within the family result in family stress and emotional distress. Consequently, parents of adult children with HIV/AIDS endure perpetual distress while caring for their adult children. The purpose of this study is to elucidate the experiences of seven parents caring for children over 18 years of age with HIV/AIDS. Hermeneutic phenomenological methodology was applied to reveal the trajectory of parents' caring experiences and to discover the hidden meanings of the phenomena. Data were collected using semi-structured in-depth interviews lasting from 1.5 to three hours. Interviews were tape-recorded and transcribed verbatim. Data were analyzed using thematic analysis with the concept of the hermeneutic circle. Four essential themes emerged, and were identified and clarified. The parents' caring experiences were: (1) We didn't expect our children's controversial illness, so we pretend to ignore the taboo; (2) We are suffering from shame, and our daily lives and interaction with others have changed; (3) We provide advice frequently to protect our children from pain, and try our best to take care of them in order to bring them better fortune; and (4) We feel helpless in the face of predestined causality, and wish we could bear the burden of sin for our children. Unconditional love and endless responsibility, furthermore, were the essential experiences of these parents. Our findings highlight the importance of patient-center nursing care for HIV/AIDS patients and for healthcare professionals to assist HIV affected families on related family stress throughout the illness trajectory.

[Casa Siloé: the history of an NGO for children with HIV/AIDS]

Casa Siloé (Siloam House) is a Catholic support house that shelters children with human immunodeficiency virus or acquired immunodeficiency syndrome. The article presents a history of the institution and discusses its work. A qualitative approach was used, relying on oral history techniques and documental analysis. Eight key informants were interviewed: the president of the institution, two coordinators who worked at the home, a member of the supporting foundation, a volunteer social worker, a member of the state NGO/AIDS forum, a physician, and a psychologist from the state public service. Topics addressed include the Catholic Church and AIDS, community mobilization, the Casa Siloé, the State and civil society, and project evaluation and outlook.

HIV-related traumatic stress symptoms in AIDS caregiving family dyads

This study assesses HIV-related traumatic stress symptoms in 135 AIDS caregiving family dyads in which the caregiver is a midlife or older mother or wife, and the care-recipient is her HIV-infected adult son or husband. Symptoms of HIV-related traumatic stress can be reliably measured in these dyads, with both caregivers and care-recipients reporting avoidant and intrusive thoughts. Among care-recipients, high symptoms are associated with high daily living assistance requirements, low dyadic adjustment, and high constriction of social activities. Among caregivers, high symptoms of traumatic stress are associated with being HIV positive, feeling overloaded by caregiving demands, and perceiving high levels of HIV stigma. Caregiving mothers and wives may feel traumatized 'courtesy' of their loved one's HIV infection, the caregiving scenario, or the resultant caregiving stress.

Knowledge and attitudes of nursing students toward patients living with HIV/AIDS (PLHIV): A Turkish perspective

The aim of this study was to assess the knowledge and attitudes towards HIV/AIDS of nursing students in Turkey. HIV/AIDS has become one of the most serious health problems in the world. It is important to understand nursing students' knowledge and attitudes towards people living with HIV (PLHIV) because the educational preparation of nurses has been known to affect the attitudes of the nurse and the effectiveness of the care provided to PLHIV. The study was conducted with 227 nursing students from the School of Health in Antalya, Turkey during the calendar year 2005/2006. Qualitative and quantitative methods were both used to collect data for the study. Analysis of variance, t-test, Mann-Whitney U-test, Kruskal-Wallis and inductive methods were used in data analysis. The majority of nursing students in this study had a moderate level of HIV/AIDS knowledge. Students correctly answered 64.4% of HIV/AIDS-related questions in the questionnaire (Mean 28.99; SD 7.03 out of 45 points). Scores increased parallel with student grade (F=26.925; p=0.000) and age (chi2 (K-W)=35.117; p=0.000). Fear of being infected and feelings of pity and empathy were the feelings most commonly indicated by the students. Students who had previous experience in caring for an AIDS patient and had known someone with HIV/AIDS were willing to care for PLHIV. Results underline the need to strengthen education on all aspects of HIV/AIDS. To improve nursing students willingness to care for PLHIV, particular emphasis should be placed on the training of nursing students as skilled nursing staff with humane attitudes towards PLHIV.

Factors associated with the self-reported health status of female caregivers of AIDS patients

A cross-sectional study was conducted on women who were family caregivers of spouses with AIDS, living in the Bumbu Zone, Kinshasa, Democratic Republic of Congo. Eighty caregivers were randomly selected from a client visitation list of the home-based care program for AIDS patients. A semistructured questionnaire was used in face-to-face interviews. A self-reported health status score was calculated using five items from the questionnaire. The self-reported health of female caregivers indicates poor health. Lower caregiver health is associated with lower income, rented accommodation, little support, and stigmatization of the caregiver by relatives.

The processes by which persons with HIV-related peripheral neuropathy manage their symptoms: a qualitative study

A variety of peripheral neuropathies occur throughout the course of HIV infection, with the most common peripheral nerve disorder of late HIV infection being distal symmetrical peripheral neuropathy (DSPN). Current management strategies often fail to achieve satisfactory pain relief. This study was designed to explore the everyday life experiences related to DSPN in persons with AIDS (PWAs) and the behaviors they initiate to alleviate the symptoms. A qualitative study using a grounded theory approach was used to better understand the impact DSPN has on PWAs. Many interventions were attempted and were ineffective; the effective ones were highly individualized. Emerging themes in the delimiting debilitation continuum included isolating the symptom cluster, inventing and testing interventions, and assimilating the annoyance. Results indicated a need for better DSPN assessment by nurses and teaching strategy development to manage the symptoms, and development of strategies to combat functional DSPN disabilities.

Developing a nursing database system in Kenya

OBJECTIVE

To describe the development, initial findings, and implications of a national nursing workforce database system in Kenya.

PRINCIPAL FINDINGS

Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified.

CONCLUSIONS

The Kenya nursing database is a first step toward facilitating evidence-based decision making in HRH. This database is unique to developing countries in sub-Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders.

The behavioral assessment scale: a measure of community living skills

This study reports the development of a community living skills measure of long-term care AIDS residents. Community living skills impact numbers and types of care providers needed. The Behavioral Assessment Scale (BAS) used multiple sources of validity evidence to ensure community living skills construct representation. The BAS was piloted in four diverse long-term care facilities. Nurses rated residents using the BAS and the Nurse Perception Scale (NPS)-another community living skills measure. Researchers rated residents' community living skills through medical record notations (Interdisciplinary Notation Scale [INS]). Reliability coefficients over .6 (p < .001) were reported for the BAS in both the total sample and the individual samples. Evidence-based validity of the BAS was obtained via coefficients from the total sample (.422 [BAS and INS] and .526 [BAS and NPS], with p < .001 for both relationships), Cronbach's alpha (.851 for all community living skills tools), analysis of variance, and regression results. The BAS was substantiated for long-term care practice with AIDS residents.