Medical Case Management Training Series Module 1. Anissa Ray & Vadim Kogan

Transcription

1 Medical Case Management Training Series Module 1 Anissa Ray & Vadim Kogan 6/9/2016

2 The Goal of This Training: Give you the HIV Knowledge you need to support your clients Help you Understand what these facts mean Provide you Resources for more information 6/9/2016 2

3 Today We Will Discuss: The science of HIV, including: HIV Life Cycle HIV Transmission Stages & Symptoms of Untreated HIV Treatment & Medications HIV Case Numbers HIV Disparities Prevention Tips 6/9/2016 3

4 What is HIV and AIDS? HIV (Human Immunodeficiency Virus) A virus that attacks the immune system, what the body uses to fight infection AIDS (Acquired Immunodeficiency Syndrome) The final stage of HIV, when the immune system is so damaged that it can t protect a person from disease AIDS is a classification of HIV infection Typically diagnosed by a CD4 count below 200 and/or presence of opportunistic infections, cancers, or other conditions 6/9/2016 4

5 HIV: 5 Source: AIDS Vaccine Initiative & VisualScience.com (2011)

6 HIV is Spread Through Body Fluids BLOOD PRE-EJACULATE /SEMEN VAGINAL FLUIDS BREAST MILK That someone may be exposed to during: Sexual Contact (Unprotected anal, vaginal, oral) Mother to Child Transmission (pregnancy, labor, breastfeeding) Drug Use (Sharing needles, works, snorting drugs) 6/9/2016 6

7 HIV is NOT Spread By: Saliva Touching Toilet Seats Tears Kissing Water Fountains Sweat Sharing Utensils Mosquitoes Urine 6/9/2016 7

8 How Does HIV Infect the Body? Source: Terrence Higgins Trust: The Immune System (2014) 6/9/2016 8

9 How Does HIV Progress to AIDS? If Left Untreated, there are three different stages of HIV infection: Acute Infection Latency Period AIDS Source: Pantaleo, G et al. New concepts in the immunopathogenesis of HIV 6/9/2016 9

10 The First Stage: Acute Infection Occurs in the first 2-4 weeks The virus is multiplying and spreading throughout the body The chance of spreading HIV is high at this stage Flu-like illness for some (fever, muscle aches, rash, joint pain) Few people recognize they are infected 6/9/

11 Second Stage: Latency (Chronic Infection) Virus is slowly destroying CD4 immune cells People can spread HIV at this stage No/few symptoms Diagnosis/treatment is important to prevent transmission and for longterm health 6/9/

12 The Final Stage of HIV Infection: AIDS Occurs after latency, when symptoms develop Immune system is so damaged it can t protect a person from some infections/cancers HIV levels rise, increasing transmission risk Defined by how damaged the immune system is. Measured by a CD4 count AIDS if CD4 count is below 200 And/or presence of opportunistic infections, specific cancers, or other AIDS-defining illness 6/9/

13 Opportunistic Infections are Signs Häggström, Mikael. DOI: /wjm/ (2014) Someone May Have AIDS Opportunistic Infection A disease that only affects people with weakened immune systems Since HIV damages the immune system, opportunistic infections are a way to help diagnose AIDS Ex: Tuberculosis Some types of pneumonia Ex: Pneumocystis Inflammation of the brain Toxoplasmosis 6/9/

14 There is No Cure for HIV, But Treatment Can Lead to Long-Term Survival Antiretroviral medication (ARV) helps fight the HIV virus Combination Therapy: includes at least 3 ARVs May also include medicine for opportunistic infections Can decrease the amount of HIV in the body to an undetectable level Gives the immune system a chance to recover Early treatment helps PLWH live longer ARVs reduce the chance of infecting others so, Treatment is Part of Prevention! 6/9/

15 ARV Treatment Only Works if PLWH Take Their Medicines Regularly Because there is no cure yet, ARVs must be taken for life When people don t take their medicine they are more contagious This contributes to: More people passing HIV to others More AIDS diagnoses and hospitalizations Higher health care costs Increased number of deaths HIV resistance: ARVs stop working 6/9/

16 Taking All ARVs as Prescribed Without Missing Doses Helps Prevent HIV Resistance HIV that is resistant cannot be killed by an ARV Resistant HIV can be transmitted to others Most PLWH are on several medicines Missing doses, or not taking the all the medicines can cause the HIV to become resistant If resistance develops, the drug that doesn t work must be replaced There are many medicines to treat HIV and more are being developed 6/9/

17 Reasons Why PLWH Don t Engage in Care Barriers to Care Motivators to Care Needed Services Substance / Alcohol Abuse Homelessness Mental Health Issues Problems with Medication Discrimination Denial/Not wanting to Deal with HIV Transportation Disclosure and Stigma Childcare Positive experience with a provider / program Getting clean from substances Conversation with a provider Access to basic needs Incarceration Support System HIV education Transportation Housing Mental Health Services Consumer Participation Cultural Competency Food Peer Support 6/9/2016 (Planning Council Unmet Need Report 17 Out of Care Consumer Focus Group 2015)

18 Side Effects Could Discourage PLWH from Taking Their Medicine Some examples of side effects are: Nausea/vomiting Dizziness Fatigue/drowsiness Vivid dreams Diabetes Bone loss Cardiovascular diseases If a client tells you they ve experienced any unusual health effects during treatment, including the ones above, assist them in contacting their health care provider 6/9/

19 HIV Rates Vary By Location in the Boston EMA In 2014: 19,196 people living with HIV Of these: 16,739 were diagnosed 2,457 unaware of HIV status (13%) 553 new HIV cases 75% men 63% between years old Source: Massachusetts Department Of Public Health (2016), New Hampshire Department of Health & Human Services (2016) 19

20 HIV Rates are Unequal Between Populations in the Boston EMA Black (non-hispanic) residents: Rate of HIV infection is 9x higher than in Whites 6% of Boston EMA, but 35% of new cases (2014) Latino residents: Rate of HIV infection is 4x higher than in Whites 9% of Boston EMA population, but 27% of new cases HIV Burden on Boston Populations by Race/Ethnicity Latino 655 Black 1487 White /9/ Cases per 100,000 Members of Each Population (2014)

21 Populations At the Highest Risk in the Boston EMA: Men who have sex with men (MSM): 48% of new infections Injection drug users (IDU): 5% of new infections Immigrant Groups 39% of new HIV cases Note: over 75% of people infected in 2014 via heterosexual sex were Black and Latina women New Cases of HIV in 2014 By Transmission Category Unknown 30% Heterosexual Sex 17% Other 1% MSM 47% 6/9/ IDU 5%

22 In Order to Reduce the Risk of Spreading HIV to Others, Encourage Your Clients to: Take all of their HIV medication as prescribed Always use a latex/polyurethane condom or dental dam when having sex (vaginal, oral, or anal) Limit their number of sex partners Limit drug use: sex while under the influence of drugs and/or alcohol can increase likelihood of unprotected sex 6/9/

23 In Order to Reduce the Risk of Spreading HIV to Others, Encourage Your Clients to: Adhere to their medical treatment plan Use clean needles available at Needle Exchange (NEP) programs if injecting or snorting drugs 6/9/

24 One Last Thing One of your roles as an MCM is to Help your clients live a longer, healthier life by taking all their medicines and attending all medical appointments Be the coach and cheerleader for your clients! 6/9/