NURSING CARE FOR PLWHIV

Transcription

1 NURSING CARE FOR PLWHIV Eva Mureithi, RN ACRN Sheka Jones, BSN, MPH, ACRN Bay Area and North Coast AIDS Education and Training Center May 11th

2 Learning Objectives After attending this session, you will be able to: Identify testing / treatment barriers within the United States Describe biomedical interventions currently available for HIV treatment / prevention Explain the nurses role in the care for a person living with HIV in the community health care setting 2

3 Topics We Will Cover Overview of Prevalence and Incidence Testing Prevention Measures HIV Management and Treatment Nursing Considerations

4 Related Terms CD4 Cells: T-cells or T-helper cells Type of white blood cells that play a major role in protecting the body from infection. Normal range is about 500-1,500 HIV Viral Load Measurement of HIV virus particles or copies in a milliliter of blood. Treatment success = Undetectable VL (<20-200) 4

5 HIV Incidence: Number of new HIV infections in a population during a certain time period. Incidence HIV Prevalence: Proportion of a population who have a diagnosis of HIV/AIDS in a given time period. Prevalence

6 What is HIV? HIV: Human Immunodeficiency Virus Chronic Disease with highly effective treatment but no cure Virus that is spread through certain bodily fluids that attacks the body s immune system (CD4 cells) Over time, HIV can destroy so many CD4 cells that the body cannot fight off infections and disease HIV-1 and HIV-2 are the main two types 6

7 What is AIDS? AIDS: Acquired Immunodeficiency Syndrome Advanced stage of HIV (CD4<200) Harder for the body to fight off infections Opportunistic infections or cancers take advantage of a very weak immune system 7

8 Global Perspective

9 World Health Organization 2020 Goals

10 Global Perspective 36.7 million people were living with HIV 19.4 million people in Sub-Saharan Africa 1.8 million new HIV infections 2016 Approx. 30% of all people living with HIV do not know that they have the virus 20.9 million receiving antiretroviral treatment (ART) 1 0

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13 Our Nation's Perspective

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15 2016 New HIV Diagnoses for the Most-Affected Subpopulations

16 The South: 50% of the HIV epidemic in the USA 16

17 HIV in Southern United States The South now experiences the greatest burden of HIV infection, illness, and deaths of any U.S. region, and lags far behind in providing quality HIV prevention and care to its citizens. The Southern States: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and the District of Columbia.

18 Social and Structural Determinants Lack of medicare expansion HIV related Stigma HIV Surveillance data reporting Poverty Access / quality healthcare Shortage of HIV healthcare providers Healthcare infrastructure Anti-immigration policies High impact prevention strategies: 1. Increasing diagnosis / testing 2. Rapid linkage to care and treatment 3. Condoms 4. PrEP 5. Supporting behavior change

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20 Let s Talk About Testing

21 HIV Screening and Testing Guidelines Consenting of HIV Test: Patients informed verbally or in writing Opt-Out Screening: Testing will be performed unless patient declines *If a patient declines an HIV test, this decision should be documented in the medical record 21

22 Who Should Get Tested? People aged years People identifying as high risk or identified as high risk People seeking screening or treatment for STI s All pregnant women Post an occupational exposure for a healthcare provider All patients with signs or symptoms consistent with HIV

23 Results are in... Negative Toolkit Harm Reduction Syringe Service Programs Expanded testing PEP: Post-Exposure Prophylaxis PrEP: Pre-Exposure Prophylaxis Condoms Serosorting Abstinence Medications Harm Reduction HIV Negative Test Safer sex

24 SSP s: Syringe Service Programs Indiana HIV Cluster Rural area, high prevalence of poverty and PWID, Population: new infections from DEC 2014 April San Francisco 2.7 million syringes per year. Washington DC SSP s were prohibited in 1998 but then allowed again in new infections estimated prevented over next two years (predicted by mathematical modeling). 24 (Indiana State Department of Health, Duwve, 2015)

25 PEP: Post-Exposure Prophylaxis STARTED AS A TREATMENT FOR OCCUPATIONAL EXPOSURE (NEEDLESTICKS) Meds used to lower the risk of a seroconversion AFTER a possible exposure to HIV. Access PEP via ER, Urgent Care, or an HIV Clinic within 72 hours of a possible exposure the sooner the better! It is a complete 3-drug regimen, to be taken for 28 days. ALWAYS consider client for a seamless transition from PEP to PrEP! 25

26 Pre-Exposure Prophylaxis Disparities PrEP Recipients /2015: 74% White 12% Hispanic 4% Asian 10% African American Marketing has been to WHITE gay men; not to those groups with the greatest need: Men of color Youth Transgendered Women

27 Results are in... TasP Rapid ART Positive Toolkit Universal ART (Antiretroviral Therapy) Rapid ART TasP: Treatment as Prevention Linkage to Care HIV Positive Test

28 Natural Progression of HIV 28

29 Acute HIV Infection Can be asymptomatic: EASY TO MISS! Symptoms occur between 2-6 weeks after infection (window period) Flu-like symptoms (e.g fever, lymphadenopathy, pharyngitis, skin rash, body aches, muscle pain) 29

30 Late Phase Symptoms Weight loss Chronic diarrhea Fever and Night sweats Persistent cough Mouth and Skin problems e.g abscesses Altered mental status Regular Infections e.g yeast infections in women 30

31 CD4 Cell Count Any PNA Flu TB Salmonella Syphilis HSV/VZV HPV KS PCP Fungal -Candida -Histo -Cocci Toxo Crypto PML MAC CMV Toxo Prevent: TMP-SMX DS Dapsone + pyrim. + leuco Atovaquone

32 TasP: Treatment as Prevention Theory: undetectable viral load = little or no sexual transmission of HIV virus. RAPID ART 21 st Int l AIDS Conference PARTNER Study: ZERO transmissions in 58,000 condomless acts in serodifferent couples (where one partner was HIV+ and virally-suppressed). (UNAIDS 2016) 32

33 Single Tablet Regimens

34 HIV Specialty Pharmacy Adherence Tools 34

35 Health Care Maintenance Considerations Psychosocial Needs: Social Workers are a Key Part of the Team Immunizations Cancer Screenings Age Appropriate Considerations: Comorbidities, Medications, etc. Safety Considerations

36 Summary Testing, Treatment and Biomedical interventions WHO 2020 Goals Most affected subpopulations Testing guidelines Treatment disparities in southern states Single tablet regimens Nurses role in caring for PLWHIV Medication adherence and teaching are key to ensure success! Provide proper teaching: be mindful of food requirements. Acute phase/chronic phase of HIV infection Healthcare maintenance 36

37 Resources PrEP provider locator: HIV treatment guidelines and research: Harm reduction programs in SF (San Francisco AIDS Foundation):

38 THANK YOU! Amanda Newstetter, AETC Jessica Price, AETC Jon Oskarsson, Ward 86 Ward 86 Nurses Our families!!!!

39 Myths About HIV Transmission

40 Immunization Influenza Vaccine Pneumococcal Vaccine 23 (PPSV 23) Pneumococcal Vaccine 13 Hepatitis A Vaccine Hepatitis B Vaccine Tdap (Tetanus, Diphtheria, acellular Pertussis) Td (Tetanus, Diphtheria) MCV (Meningococcal /Menactra) Gardasil/ HPV Years Old Schedule Once Every Flu Season (September-April) Administer once, ideally after PCV 13. Repeat Dose #2 after 5 Years and no need for subsequent doses. A single dose should be given after age 65, assuming at least 5 years have elapsed since the last dose Administer one dose *If PPSV 23 given first, wait at least 1 year to administer PCV 13. *If PCV 13 given first, wait at least 2 months to administer first dose of PPSV 23. Dosing Schedule: 0, and 6 months (2 dose series) If not immune (e.g. HAV Total Abnegative) Dosing Schedule: 0, 1 and 4-6 months (3 dose series) If not immune (e.g. HepBsAb negative) Once if no previous Tdap (only indication for repeat is with every pregnancy) 9 years after Tdap or Td (repeat Td every 10 years) 2 doses given 8-12 weeks apart. A booster dose should be given every 5 years Dosing Schedule: 0, 2 and 6 months (3 dose series) *Screen women to ensure they did not receive the vaccine when they were younger