Using the Lifeworld Approach to Improve HIV Testing

Major guidelines for HIV recommend that testing should be provided in a way that is adapted to the lifeworld of groups at risk. However, precise definitions as to what adaption to the lifeworld means are missing. Therefore, this research project evaluated how the lifeworld approach can be operationalized in regard to HIV testing and how voluntary counseling and testing services can use this approach to improve efficacy. A survey for VCT providers in Germany showed a limited number of factors influencing the adaption to the lifeworld of groups at risk. The opening hours, the number of languages used in public relations, and the comfort of the waiting zone are important for all clients. For men who have sex with men, information material for use in social networks and peer volunteers are relevant. Intravenous drug users are concerned with participation, (low) costs, and counseling. For migrants, continuing staff training and anonymity are important.

Optimizing Community-Based HIV Testing and Linkage to Care for Young Persons in Metropolitan Atlanta

HIV continuum of care analyses in Georgia during 2013 revealed that 82% of adolescents and adults living with HIV knew their diagnosis and that 75% were linked to care. However, of all persons in Georgia living with HIV in 2014, only 60% had at least one HIV care visit, and just 48% were retained in care. Understanding barriers for HIV testing, linkage, and retention in youth may strengthen HIV-related encounters and improve patient outcomes. We conducted 17 qualitative focus groups with HIV-positive and -negative youth, ages 18-24 years, from the Atlanta Metropolitan Statistical Area. Using computer-assisted thematic analyses, we examined focus group responses on ways to approach youth for community-based HIV testing and how service providers should discuss a new positive HIV diagnosis with youth. Of 68 participants, 85% were male, 90% were African American, 68% were HIV positive, and 50% had high school education or less. Mean age was 21.5 years (standard deviation: 1.8 years). Thematic analyses identified the following three key themes for approaching someone for HIV testing: (1) discretion, (2) being candid about testing, and (3) incentivizing testing. When service providers discuss an HIV positive test, participants recommended enhanced emotional support and reassurance of a potential healthy life span despite an HIV diagnosis. Community-based testing may be a viable option for increasing HIV screening of at-risk youth. Structuring an empathetic new diagnosis disclosure that addresses potential misconceptions and describes successful HIV treatment is essential to improving linkage to care among youth.

The role of nurses in HIV screening in health care facilities: A systematic review

OBJECTIVE

To examine nurse-driven HIV screening in various health care settings in terms of its impact on test offering, acceptance and delivery rates, nursing responsibilities, staff perceptions and long-term implementation.

DESIGN

Systematic review.

REVIEW METHODS

The systematic review conducted in September 2014 adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two independent reviewers extracted and summarised the eligible studies using a standardised form.

STUDY ELIGIBILITY CRITERIA

All studies published from 2004 to 2014 that explored nurse-driven HIV screening practice in health care facilities in countries with comparable concentrated HIV epidemics were included.

DATA SOURCES

MEDLINE, EBSCO CINAHL.

RESULTS

Overall, 30 quantitative, qualitative and mixed methods studies fulfilled the eligibility criteria. The studies showed a trend in higher test offering, better acceptance and higher delivery rates with the implementation of nurse-driven HIV screening. However, among the 23 studies (77%) that evaluated these aims, only 13 studies (56%) had a control group, and 4 studies (17%) were randomised controlled trials (RCT) in few centres (i.e., 1 or 2). In 2 studies that compared nurse-driven HIV test offering to physician intervention, the participation of nurses was higher than that of physicians (85% vs. 54%, p<0.001; 47% vs. 28%, p<0.05). In a third study, the intervention of a dedicated nurse increased the test offering from 96.5% to 99.5% (OR=7.27, 95% CI=1.02-316.9). Acceptance rates increased with the nurse intervention in 2 RCTs (75% vs. 71%, p=0.025; 45% vs. 19%, p<0.05) and in a cohort study (74.8% vs. 84.3%, OR=1.82, 95% CI=1.14-2.88), whereas it decreased in 2 other studies. The testing rates increased in 7 out of 10 studies, with a maximum absolute increase of 65.9%. Nurse-driven HIV screening was evaluated at the time of routine HIV screening implementation in 27 studies (90%) and provided nurses with new responsibilities in 9 studies (30%). The few studies (23%) that explored how health care professionals, including nurses, perceived the strategy showed that this approach was well received. However, several operational barriers, such as lack of time, prevented its long-term implementation.

CONCLUSION

The review supports the implementation of nurse-driven HIV screening. However, the evaluation of the impact of the nurse approach by RCTs was scarce, calling for additional research to better evaluate the impact of the nursing profession's contribution to HIV screening. Moreover, the perceptions of nurses and health care staff were seldom evaluated and require further exploration to improve nurse-driven HIV screening implementation.