HIV is Now a Manageable Long-Term Condition, But What Makes it Unique? A Qualitative Study Exploring Views About Distinguishing Features from Multi-Professional HIV Specialists in North West England

Baltimore oral epidemiology, disease effects, and HIV evaluation study (BEEHIVE) study protocol: a prospective cohort study

BACKGROUND

As antiretroviral therapy has become widely available and highly effective, HIV has evolved to a manageable, chronic disease. Despite this health advancement, people living with HIV (PLWH) are at an increased risk for age-related non-communicable diseases (NCDs) compared to HIV-uninfected individuals. Similarly, PLWH are at an increased risk for selected oral diseases. PLWH with a history of injecting drugs experience an even greater burden of disease than their counterparts. The overall objective of the Baltimore Oral Epidemiology, Disease Effects, and HIV Evaluation (BEEHIVE) study is to determine the combined effects of HIV infection and NCDs on oral health status. The specific aims of the study are to: (1) determine to what extent HIV status influences access to and utilization of oral health care services; (2) determine to what extent HIV status affects self-reported and clinical oral health status; (3) determine to what extent HIV status influences the progression of periodontitis; and (4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature.

METHODS

The BEEHIVE study uses a prospective cohort study design to collect data from participants at baseline and at a 24-month follow-up visit. Data are collected through questionnaire assessments, clinical examinations, and evaluation of oral microbiological samples to determine the drivers of oral disease among a high-risk population of PLWH with a history of injection drug use and prevalent comorbid NCDs. The established AIDS Linked to the Intravenous Experience (ALIVE) cohort serves as the source of participants for the BEEHIVE Study.

DISCUSSION

Upon completion of the BEEHIVE study, the knowledge gained will be important in informing future clinical and preventive interventions that can be implemented into medical and dental practice to ultimately help eliminate long-standing oral health inequities that PLWH experience.

Intentional non-adherence in the context of antiretroviral therapy

Adherence to antiretroviral therapy (ART) is a crucial determinant of treatment success in HIV. This article seeks to look closely at intentional non-adherence and why some patients choose to opt out of life-sustaining treatment. There is a range of reasons why patients intentionally stop taking their ART and the author take a more detailed look at some of those reasons, specifically religion, the need for control and social isolation. Case studies are included throughout the discussion to give more depth and increase understanding. The author goes to explore strategies that can be employed to help nurses in their response, as health professionals, to support patients and deliver high-quality and non-judgemental care.

Developing therapeutic relationships with people living with HIV: exploring the nurse-patient relationship

BACKGROUND

The care paradigm for HIV has changed from one of an infectious, life-limiting disease to that of a chronic manageable condition. This shift poses challenges for practitioners working in this area when providing care that is both person centred and reflective of the demands placed on an evolving disease area.

OBJECTIVES

The overall aim of this study was to explore how therapeutic relationships are developed and their subsequent use within person-centred care.

DESIGN

An interpretative phenomenological analysis research design was used to collect data from 10 purposively recruited HIV specialist nurses in the north-west region of the UK. In-depth, semistructured interviews were used to collect the data.

RESULTS

Data analysis revealed three themes that captured person-centredness in HIV care. These were: ways of being; the nurse-patient relationship; and the influence of stigma.

CONCLUSION

The research illuminates key features that are important when developing therapeutic relationships and offers a framework to explain how these features were also key elements of person-centred care.

Forgetting to take HIV antiretroviral therapy: a qualitative exploration of medication adherence in the third decade of the HIV epidemic in the United States

Optimal adherence to HIV antiretroviral therapy (ART) is challenging, and racial/ethnic disparities in adherence rates are substantial. The most common reason persons living with HIV (PLWH) give for missed ART doses is forgetting. We took a qualitative exploratory approach to describe, from the perspectives of African American/Black and Hispanic/Latino PLWH, what it means to forget to take ART and factors that influence forgetting. Participants (N = 18) were purposively sampled for maximum variability and engaged in semi-structured/in-depth interviews on HIV/ART management. The analysis took a directed content analysis approach. Participants were mostly male (56%) and African American/Black (79%), between 50 and 69 years old, and had lived with HIV for an average of 21 years. Findings were organised into six inter-related themes: (1) forgetting to take ART was a shorthand description of a complex phenomenon, but rarely a simple lapse of memory; (2) ‘forgetting’ was means of managing negative emotions associated with HIV; (3) life events triggered mental health distress/substance use which disrupted adherence; (4) historical traumatic events (including AZT monotherapy) and recent trauma/loss contributed to forgetting; (5) patient-provider interactions could support or impede adherence; and (6) intrinsic motivation was fundamental. Implications for HIV social service and health care settings are described.

Representations and care practices of health professionals for people with HIV

OBJECTIVE

To analyze the social representations of health professionals regarding the care of people living with HIV.

METHOD

A descriptive and exploratory study with a qualitative approach in light of the Theory of Social Representations, carried out with health professionals. The semi-structured interview technique was used, which was analyzed using the lexical content analysis technique.

RESULTS

Forty-six (46) professionals participated. The analyzed results reveal that the representations and care practices referred to by health professionals are technical, relational and organizational, ensuring the confidentiality of the diagnosis and taking care to develop embracement actions, provide guidance, clarification and emotional and psychological support, as well as being based on confidentiality, multi-professional care practice and addressing structural difficulties.

CONCLUSION

It is important to encourage multiprofessional care for people living with HIV, so that professionals engage, develop critical thinking and are able to act in improving healthcare services.

Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance

INTRODUCTION

This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV.

METHODS

This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method.

RESULTS

Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance.

CONCLUSION

Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.