Hospitalization and Emergency Room Visits: The Opportunity for Re-Engagement for People Living with HIV/AIDS (PLWHA)

Abstract Background Persons living with HIV/AIDS (PLWHA) who are not engaged in HIV medical care are at greater risk for adverse individual health outcomes, as well as potential transmission to others. Thus, detecting and re-engaging PLWHA who are not in care is a public health priority. Unplanned hospitalizations or Emergency Department (ED) visits provide a potential opportunity to re-engage PLWHA who are out of care. Our Data-to-Care (D2C) pilot project was launched in July 2016 to identify PLWHA in the ED and inpatient settings and subsequently, establish re-engagement in HIV care (RIC) among those out of care. Methods Our D2C program leverages electronic health records (EHR) as a mechanism to identify PLWHA and support RIC. An Infectious Diseases social worker (SW) generates an EHR-based report daily to identify PLWHA in the hospital in near real-time, then determines whether a patient currently receives HIV care. If not, the SW meets with the patient to determine needs, insurance status, schedules an HIV care appointment, and provides referrals for wraparound services. SW subsequently confirmed attendance at HIV care appointment. RIC was defined as attending an HIV clinical appointment, and X2 analyses were used to compare differences between RIC and not RIC. Results Over a 10-month period, we identified 237 PLWHA seen in the ED or hospitalized. The majority of patients were African-American (AA) (92.7%), male (66.1%) and mean age 44.6 ± 14.6 years old. Of the 237 patients identified, 172 (72.6%) confirmed already in care, 7 (3.0%) deceased, and 2 (0.8%) incarcerated. Among patients eligible for RIC, 44 (73.3%) were contacted by staff, 39 (65.0%) were referred to care, and 32 (53.3%) were RIC. Patients not RIC were all AA, 69.2% male, and mean age 38.5 ± 14.2 years old. Patients identified in the inpatient setting were more likely to be RIC vs. those identified in the ED (81.3% vs. 18.8%, P < 0.01). Interestingly, insurance type was not associated with RIC vs. not RIC (P = 0.17). Conclusion Our pilot program demonstrates the potential for using the EHR to identify PLWHA who are in need of RIC during unplanned hospitalizations and ED visits. Inpatients were more likely to be RIC than ED patients, likely due to the ability to make in-person contact during hospitalization compared with ED visit by SW staff. Disclosures D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient

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Role of Nurses in the Treatment and Care of HIV/AIDS patients - based on the dimensions of health care.

International Journal for Innovation Education and Research ◽

10.31686/ijier.vol6.iss1.935 ◽

2018 ◽

Vol 6 (1) ◽

pp. 199-212

Author(s):

Glodiana Sinanaj ◽

Arjan Harxhi ◽

Brunilda Subashi

Keyword(s):

Health Care ◽

Nursing Care ◽

People Living With Hiv ◽

Positive Trend ◽

Aids Patients ◽

Cross Sectional ◽

Old Patients ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

There is a lack of nursing studies that are specifically focused on assessing and caring for people living with HIV / AIDS to improve their quality of life. Little is known about the current situation regarding the care of persons living with HIV / AIDS.This cross-sectional, descriptive and analytical study will try to identify the assessment of nursing care in order to promote a better understanding of nursing care. A structured self-administered questionnaire administered from April 30 to June 15, 2014, was used for data collection.The participants were 55 patients, whose average age was 33.3 ±7.98 years, ranging from 20 to 55 years of age, out of which 24 (43.6%) of patients were female, while 31 (56.4% of them were males). They had different socioeconomic and educational levels. Regarding the biological dimension of nursing care, despite a positive trend in patient care estimation, differences between individual patient groups are observed based on the educational level.So patients with secondary and higher education are more likely to positively assess nursing care by the biological dimension versus 8-year-old patients. While with the psychological dimension and with other dimensions such as spiritual, social, stigmatization and discrimination there is no statistically significant relation between the socio-demographic characteristics of patients.Among the 5 dimensions, it is noticed that patients have evaluated less positively stigma, discrimination, compared to other dimensions. So patients are noticed a dissatisfaction with the fact that they are treated by nurses at the time of health care. The Nursing School to increase the development and implementation of quality research should identify the feelings, experiences, experiences and meanings of HIV/AIDS patients on nursing care. HIV / AIDS is a growing risk of modern times, requiring long-lasting research and research.

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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Improving Adherence to Anti-retroviral Therapy among Persons Living with HIV/AIDS in Enugu State, South East Nigeria

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2019/v39i130199 ◽

2019 ◽

pp. 1-9

Author(s):

C. P. Igweagu ◽

O. H. Chime ◽

C. N. Onwasigwe

Keyword(s):

Health Education ◽

Poor Adherence ◽

Public Health Issue ◽

People Living With Hiv ◽

Study Group ◽

Control Groups ◽

Persons Living With Hiv ◽

Enugu State ◽

Living With Hiv ◽

Hiv Aids

HIV/AIDS continues to be a major global public health issue, having claimed more than 32 million lives so far. There were approximately 37.9 million people living with HIV/AIDS (PLHIV) at the end of 2018. Anti-retroviral therapy (ART) has significantly reduced morbidity and mortality and improved quality of life among people with HIV infection. Aims: The study was conducted to improve the knowledge and adherence to anti-retroviral therapy among PLHIV in Enugu state, southeast Nigeria. Study Design: Interventional study. Place and Duration of Study: Anti-retroviral Therapy clinics within Enugu metropolis in Enugu state Nigeria between June to December 2018. Methodology: A health education intervention was carried out among 312 PLHIV receiving ART in Enugu metropolis to improve their perception and adherence to antiretroviral therapy. A structured questionnaire was used to collect data from 312 PLHIV (156 each in the study and control groups), who were selected by multistage sampling. Subsequently, health education was conducted among the study group. Three months after this intervention its effects were assessed through a survey using the same structured questionnaires employed in the baseline survey. Results: The most frequently occurring reason given by the respondents for poor adherence to ART was forgetfulness (65.4% for study and 69.9% for control groups). Knowledge of the factors and consequences of poor adherence to treatment was significantly higher among the study group than the controls post-interventions p<0.001. Adherence to ART improved from 42.3% pre-intervention to 81.4% post-intervention. Conclusion: Intensive health education effectively improved adherence to ART among persons living with HIV/AIDS and this should be carried out regularly.

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1309. Effects of a Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Service in Persons Living with HIV/AIDS

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1172 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S471-S472

Author(s):

Marisa B Brizzi ◽

Rodrigo M Burgos ◽

Thomas D Chiampas ◽

Sarah M Michienzi ◽

Renata Smith ◽

...

Keyword(s):

Care Service ◽

Transitions Of Care ◽

Hiv Care ◽

Outpatient Clinics ◽

Readmission Rates ◽

Implementation Phase ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

Abstract Background Historical data demonstrate that PLWHA experience higher rates of medication-related errors when admitted to the inpatient setting. Prior to initiation of this program, rapid-start initiation of antiretroviral therapy (ART) was not implemented prior to discharge. The purpose of this study was to evaluate the impact of a pharmacist-driven antiretroviral stewardship and transitions of care service in persons living with HIV/AIDS (PLWHA). Methods This was a retrospective pre- and post-analysis of PLWHA hospitalized at University of Illinois Hospital (UIH). Patients included were adults following at UIH outpatient clinics for HIV care admitted to UIH for acute care. Data were collected between April 19, 2017 and October 19, 2017 for the pre-implementation phase, and between July 1, 2018 and December 31, 2018 for the post-implementation phase. The post-implementation phase included an HIV-trained clinical pharmacist (Figure 1). Primary and secondary endpoints included follow-up rates at UIH outpatient HIV clinics, 30-day readmission rates, and access to medications at hospital discharge. Statistical analysis included descriptive statistics and Fisher’s Exact test. Results A total of 119 patients were included in the analysis, 66 in the pre-implementation phase and 53 in the post-implementation phase. Patients included were mostly black males with median age of 48. In the pre-implementation phase 50 out of 65 (77%) patients attended follow-up visits for HIV care at UIH outpatient clinics, vs. 42 out of 47 (89%) patients in the post-implementation phase (P = 0.1329). Thirty-day readmission occurred in 17 of 62 (27%) patients in the pre-implementation phase vs. 5 of 52 (10%) of patients in the post-implementation phase (P = 0.0183). During the post-implementation phase, the HIV pharmacist secured access of ART and opportunistic infection medications prior to discharge for 22 patients (42%), 2 of which were new diagnoses. Conclusion A pharmacist-led antiretroviral stewardship and TOC program led to a decrease in 30-day readmission rates in PLWHA. Although not significant, the HIV-pharmacist led to higher rates of clinic follow-up. Finally, the HIV-pharmacist helped secure access to ART and initiate rapid-start therapy in newly diagnosed patients prior to leaving the hospital. Disclosures All authors: No reported disclosures.

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An Afro-Christian ministry to people living with HIV/Aids in South Africa

HTS Teologiese Studies / Theological Studies ◽

10.4102/hts.v61i3.466 ◽

2005 ◽

Vol 61 (3) ◽

Cited By ~ 1

Author(s):

Matsobane J. Manala

Keyword(s):

South Africa ◽

World View ◽

People Living With Hiv ◽

Raising Awareness ◽

Aids Pandemic ◽

Persons Living With Hiv ◽

Pain And Suffering ◽

Living With Hiv ◽

The Church ◽

Hiv Aids

The HIV/Aids pandemic is cause for great frustration to the developing countries in their attempts to improve the quality of life of their citizens. HIV/Aids in South Africa demands a specific approach to the Christian ministry in which the African world-view is acknowledged. In order for the church to play a relevant and meaningful role in combating the HIV/Aids pandemic, it is necessary that the church should be informed of the existential situation of persons living with HIV/Aids. This information is vital for raising awareness and engendering sensitivity among Christians. In the context of such awareness of and sensitivity to human pain and suffering, the community of the faithful should be moved to heed Christ’s call to show neighbourly love. The possible role of the church in caring for those who are already infected with HIV is defined.

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The Validity of the Substance Abuse and Mental Illness Symptom Screener (SAMISS) in People Living with HIV/AIDS in Primary HIV Care in Cape Town, South Africa

AIDS and Behavior ◽

10.1007/s10461-014-0698-y ◽

2014 ◽

Vol 18 (6) ◽

pp. 1133-1141 ◽

Cited By ~ 16

Author(s):

Erica Breuer ◽

Kevin Stoloff ◽

Landon Myer ◽

Soraya Seedat ◽

Dan J. Stein ◽

...

Keyword(s):

South Africa ◽

Substance Abuse ◽

Mental Illness ◽

Cape Town ◽

Hiv Care ◽

People Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

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Sociocultural Factors Influencing The Transmission of HIV/AIDS in The United States

10.1093/med/9780199392742.003.0009 ◽

2017 ◽

Author(s):

Robert E Fullilove

Keyword(s):

United States ◽

Criminal Justice ◽

Correctional Facility ◽

The United States ◽

Hiv Care ◽

Sociocultural Factors ◽

Effective Interventions ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

This chapter discusses the unique impact that social disadvantage in general and the criminal justice systems in the United States in particular have on the conditions that drive the HIV/AIDS epidemic in this country. HIV/AIDS is classified as an important racial/ethnic health disparity because residents of marginalized black and Hispanic communities are overrepresented among persons living with HIV/AIDS in the United States. Members of black and Hispanic communities are also overrepresented in the criminal justice; in terms of the epidemic, approximately one out of seven persons living with HIV/AIDS will pass through a U.S. correctional facility in any given year. A history of incarceration is associated with poor treatment outcomes for HIV illness. Improving the quality of HIV care in correctional facilities and in the communities to which incarcerated persons will return is imperative, as is effective interventions in incarcerated populations and communities. Having AIDS activists, scientists, and healthcare workers join in efforts to reform incarceration policies and practices will improve efforts to prevent and treat HIV/AIDS, particularly in communities that confront high rates of HIV/AIDS and incarceration.

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Burden of Suicidal Ideation and Attempt among Persons Living with HIV and AIDS in Semiurban Uganda

AIDS Research and Treatment ◽

10.1155/2016/3015468 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Godfrey Zari Rukundo ◽

Brian Leslie Mishara ◽

Eugene Kinyanda

Keyword(s):

Suicidal Ideation ◽

Hiv And Aids ◽

Hiv Care ◽

State Anger ◽

Increased Risk ◽

Persons Living With Hiv ◽

Considerable Morbidity ◽

Living With Hiv ◽

The Impact ◽

Hiv Aids

Although the impact of HIV/AIDS has changed globally, it still causes considerable morbidity and mortality, including suicidality, in countries like Uganda. This paper describes the burden and risk factors for suicidal ideation and attempt among 543 HIV-positive attending two HIV specialized clinics in Mbarara municipality, Uganda. The rate of suicidal ideation was 8.8% (n=48; 95% CI: 6.70–11.50) and suicidal attempt was 3.1% (17, 95% CI 2.00–5.00). The factors associated with increased risk for suicidal ideation and attempts were state anger (OR = 1.06, 95% CI: 1.03–1.09;p=0.001); trait anger (OR 1.10, 95% CI 1.04–1.16,p=0.002); depression (OR 1.13, 95% CI 1.07–1.20,p=0.001); hopelessness (OR 1.12, 95% CI 1.02–1.23,p=0.024); anxiety (OR 1.06, 95% CI 1.03–1.09); low social support (OR 0.19, 95% CI 0.07–0.47,p=0.001); inability to provide for others (OR 0.19, 95% CI 0.07–0.47,p=0.001); and stigma (OR 2.48, 95% CI 1.11–5.54,p=0.027). At multivariate analysis, only state anger remained statistically significant. HIV/AIDS is associated with several clinical, psychological, and social factors which increase vulnerability to suicidal ideation and attempts. Making suicide risk assessment and management an integral part of HIV care is warranted.

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