Noncompliance in people living with HIV: accuracy of defining characteristics of the nursing diagnosis

ABSTRACT Objective: to evaluate the accuracy of the defining characteristics of the NANDA International nursing diagnosis, noncompliance, in people with HIV. Method: study of diagnostic accuracy, performed in two stages. In the first stage, 113 people with HIV from a hospital of infectious diseases in the Northeast of Brazil were assessed for identification of clinical indicators of noncompliance. In the second, the defining characteristics were evaluated by six specialist nurses, analyzing the presence or absence of the diagnosis. For accuracy of the clinical indicators, the specificity, sensitivity, predictive values and likelihood ratios were measured. Results: the presence of the noncompliance diagnosis was shown in 69% (n=78) of people with HIV. The most sensitive indicator was, missing of appointments (OR: 28.93, 95% CI: 1.112-2.126, p = 0.002). On the other hand, nonadherence behavior (OR: 15.00, 95% CI: 1.829-3.981, p = 0.001) and failure to meet outcomes (OR: 13.41; 95% CI: 1.272-2.508; P = 0.003) achieved higher specificity. Conclusion: the most accurate defining characteristics were nonadherence behavior, missing of appointments, and failure to meet outcomes. Thus, in the presence of these, the nurse can identify, with greater security, the diagnosis studied.

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Accuracy of risk factors for nursing diagnosis risk of infection in people with AIDS

Revista da Escola de Enfermagem da USP ◽

10.1590/1980-220x-reeusp-2020-0309 ◽

2021 ◽

Vol 55 ◽

Author(s):

Cristiane da Câmara Marques ◽

Bárbara Coeli Oliveira da Silva ◽

Vanessa Pinheiro Barreto ◽

Aline Rodrigues Feitoza ◽

Ana Luísa Brandão de Carvalho Lira ◽

...

Keyword(s):

Risk Factors ◽

Secondary Data ◽

Invasive Procedure ◽

Nursing Intervention ◽

People Living With Hiv ◽

Risk Of Infection ◽

Predictive Values ◽

Nursing Diagnosis ◽

Data Collection Instrument ◽

Method Accuracy

ABSTRACT Objective: To evaluate the accuracy of risk factors for infection that add up to the nursing diagnosis risk of infection in people with AIDS who are hospitalized. Method: Accuracy study with case-control design carried out with a total of 208 people living with AIDS and hospitalized between 2010 and 2016. The cases comprised people living with HIV, hospitalized and who developed infection related to health care and controls to those who did not develop it. Secondary data from medical records and research forms were used to respond to the data collection instrument for sociodemographic, clinical evaluation and investigation of the presence or absence of risk factors. The accuracy of clinical diagnostic indicators was measured through specificity, sensitivity and predictive values. Results: The risk factor that showed the greatest sensitivity and specificity was chronic illness, while the invasive procedure and the change in the integrity of the skin had the highest positive predictive value. Conclusion: Accurate diagnoses allow nurses to build a nursing intervention plan aimed at the needs of this population.

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Patterns of Co-occurring Comorbidities in People Living With HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy272 ◽

2018 ◽

Vol 5 (11) ◽

Cited By ~ 14

Author(s):

Davide De Francesco ◽

Sebastiaan O Verboeket ◽

Jonathan Underwood ◽

Emmanouil Bagkeris ◽

Ferdinand W Wit ◽

...

Keyword(s):

Mental Health ◽

General Health ◽

Mental Health Problems ◽

Principal Component ◽

The Other ◽

People Living With Hiv ◽

Wide Range ◽

Living With Hiv ◽

Shared Risk ◽

Hiv Aids

Abstract Background The aims of this study were to identify common patterns of comorbidities observed in people living with HIV (PLWH), using a data-driven approach, and evaluate associations between patterns identified. Methods A wide range of comorbidities were assessed in PLWH participating in 2 independent cohorts (POPPY: UK/Ireland; AGEhIV: Netherlands). The presence/absence of each comorbidity was determined using a mix of self-reported medical history, concomitant medications, health care resource use, and laboratory parameters. Principal component analysis (PCA) based on Somers’ D statistic was applied to identify patterns of comorbidities. Results PCA identified 6 patterns among the 1073 POPPY PLWH (85.2% male; median age [interquartile range {IQR}], 52 [47–59] years): cardiovascular diseases (CVDs), sexually transmitted diseases (STDs), mental health problems, cancers, metabolic disorders, chest/other infections. The CVDs pattern was positively associated with cancer (r = .32), metabolic disorder (r = .38), mental health (r = .16), and chest/other infection (r = .17) patterns (all P < .001). The mental health pattern was correlated with all the other patterns (in particular cancers: r = .20; chest/other infections: r = .27; both P < .001). In the 598 AGEhIV PLWH (87.6% male; median age [IQR], 53 [48–59] years), 6 patterns were identified: CVDs, chest/liver, HIV/AIDS events, mental health/neurological problems, STDs, and general health. The general health pattern was correlated with all the other patterns (in particular CVDs: r = .14; chest/liver: r = .15; HIV/AIDS events: r = .31; all P < .001), except STDs (r = –.02; P = .64). Conclusions Comorbidities in PLWH tend to occur in nonrandom patterns, reflecting known pathological mechanisms and shared risk factors, but also suggesting potential previously unknown mechanisms. Their identification may assist in adequately addressing the pathophysiology of increasingly prevalent multimorbidity in PLWH.

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P1668SIMULTANEOUS LIVER-KIDNEY TRANSPLANTATION IN PEOPLE LIVING WITH HIV: A CASE-SERIES WITH LONG TERM FOLLOW-UP

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1668 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Giovanni Dolci ◽

Giovanni Guaraldi ◽

Franceschi Erica ◽

Gaetano Alfano ◽

Francesco Fontana ◽

...

Keyword(s):

Kidney Transplantation ◽

Bile Duct ◽

Case Series ◽

The Other ◽

People Living With Hiv ◽

Long Term Follow Up ◽

End Stage ◽

Living With Hiv

Abstract Background and Aims The number of simultaneous liver-kidney transplants (SLKT) has been constantly increasing in the past two decades. In the US, the relative proportion of liver transplants performed as part of SLKT augmented from 2.7% in 2000 to 9.3% in 2016. In this rapidly evolving scenario, people living with HIV (PLWH) have been substantially excluded from SLKT. The poor prognosis of SLKT in people living with HIV (PLWH) has refrained transplant centers to perform this procedure. Method We retrospectively describe indications, clinical characteristics and survival of HIV-infected patients who underwent SLKT at the Transplant Centre of Modena, Italy. Results Since 2001 five SLKTs were performed in HIV-affected subjects. With regards to medical eligibility criteria for SLKT all the patients were on hemodialysis and had liver end-stage disease or HCC at time of transplantation (Table 1A). Mean age at transplantation was 47.8± 5.93 years and all patients were Caucasian males. Mean duration of HIV was 25 years and all patients had undetectable HIV-viral load at SLKT. The causes of end-stage renal disease were different in all recipients and only one had biopsy-proven kidney disease. Dialysis vintage was 15.8±10.2 months. Four patients had HCV-related cirrhosis and one had hepato-carcinoma (HCC). Mean HCV-RNA at SOT was 464,327 copies/ml; in three HCV patients, the sustained virologic response to HCV therapy was obtained after transplant with peg-INF in one case (pre-direct antiviral agent era) and with a combination of sofosbuvir, daclatasvir and rifampicin in the other two. Only one patient had HBV-HDV-related cirrhosis and did not experience HBV or HDV relapse during the follow-up. At the end of a mean follow up of 7.6±4.71 years, four out of five patients are still alive One patient died on post-transplant day 41 for disseminated candidiasis with cerebral involvement (Table1 b). During the follow-up period, HIV-VL remained undetectable over nearly 10 years. Clinical outcome was characterized by the reverse of frailty in all the patients. All of them are conducting an independent living with quality of life exceeding 90% using the EUQoL 5D-5L questionnaire. The liver function was normal and remained stable during theobservation period. Bile duct stricture and bile duct calculi were the main surgical complications. Regarding renal function, mean serum creatinine was 1.7±0.4mg/dl corresponding to a mean estimated GFR of 47.7±5.9 ml/min. Only one patient had proteinuria (0.8 gr/daily) after 10 years of transplantation. Contrary to our expectations, no cases of graft rejections occurred during this long-term follow-up despite mean HLA mismatches of 5.75 and underexposure to the immunosuppressive agents. Withdrawn of steroids occurred after 1.8±2.5 years from SLKT. Thereafter, immunosuppressive therapy continued with monotherapy: calcineurin inhibitor in three recipients and inhibitors of the mammalian target of rapamycin in the other one. Conclusion Contrary to the previously published data, this case series describes a favorable clinical outcome in PLWH who received SLKT. The absence of graft rejection despite the reduced immunosuppressive therapy highlights the concept that the liver is able to induce tolerance in kidney transplantation. These results could lead other transplant programs to consider SLKT as a reliable clinical option in PLWH with liver and kidney failure.

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Depression And HIV/TB In Southern Africa: A Mixed Method Evaluation of An Integrated Primary Care Mental Health Programme In Eswatini

10.21203/rs.3.rs-1153206/v1 ◽

2021 ◽

Author(s):

Nina Putnis ◽

Nick Riches ◽

Archibald Nyamayaro ◽

Darah Boucher ◽

Rebecca King ◽

...

Keyword(s):

Primary Care ◽

Southern Africa ◽

Healthcare Services ◽

People Living With Hiv ◽

Mixed Methods Evaluation ◽

Activity Program ◽

Major Treatment ◽

Specialist Nurses ◽

Healthy Activity ◽

Living With Hiv

Abstract Background: Depression and comorbidity with chronic illnesses is common in Southern Africa, yet there are major treatment gaps. This study evaluates the intervention ‘Healthy Activity Program’ to bridge this gap, which involves training non-specialist nurses in depression: including identification, counselling based on behavioural activation theory and structured referral. This intervention aims to be integrated into routine primary healthcare services for HIV/TB. The patient cohort were people living with HIV and/or tuberculosis (TB) (PLHIV/TB) in rural Eswatini. Aims: To assess the feasibility and acceptability of this intervention and concepts of depression in this setting.Methods: This is a pragmatic mixed methods evaluation of a pilot integrated service.Results: 324 PLHIV/TB were screened for depression, with 19% (62/324) screening positive. Attendance to counselling declined over time, with 16/62 attending the minimum 5 sessions. Qualitative results indicated acceptability, yet concerns around feasibility. Conclusions: The ‘Healthy Activity Program’ represents a promising option to manage the treatment gap for depression in PLHIV/TB. However, task-shifting onto non-specialist healthcare professionals with the aim to integrate care for these conditions in primary care, without increasing staff capacity, is a barrier to implementation. Realistic and pragmatic assessments of capacity and workforce are essential.

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User satisfaction with pharmacy services in the Brazilian National STD/AIDS Program: validity and reliability issues

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2009000700018 ◽

2009 ◽

Vol 25 (7) ◽

pp. 1597-1609 ◽

Cited By ~ 2

Author(s):

Thiago Botelho Azeredo ◽

Maria Auxiliadora Oliveira ◽

Vera Lucia Luiza ◽

Ângela Esher ◽

Mônica Rodrigues Campos

Keyword(s):

Internal Consistency ◽

User Satisfaction ◽

Demographic Variables ◽

People Living With Hiv ◽

Validity And Reliability ◽

Satisfaction Scale ◽

Aids Program ◽

Two Stages ◽

Living With Hiv

The objective of this study is to evaluate the psychometric properties of a user satisfaction scale regarding the Brazilian National STD/AIDS Program, specifically related to dispensing AIDS medicines. The scale was developed and applied in a study covering 10 Brazilian States that evaluated the quality of medicine dispensing. The questionnaire was answered by 1,412 people living with HIV and undergoing antiretroviral therapy. Construct validation involved two stages of factor analysis. The item-total correlation matrix was analyzed, and tests for associations between the target variable, socio-demographic variables, and related constructs were performed. Reliability was studied by means of the sub-scales' internal consistency, estimated by Cronbach's alpha. Five relevant satisfaction dimensions were identified. A moderate level of internal consistency was found for these dimensions, suggesting they were adequate. The results of the association tests agreed with other studies reported in the literature. We conclude that the instrument is appropriate for application in similar populations with adequate psychometric characteristics and serves to measure users' assessments of the pharmaceutical services received and helps to orient improvements in such services.

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Clinical validation of the nursing diagnosis labor pain

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692013000700012 ◽

2013 ◽

Vol 21 (spe) ◽

pp. 88-96 ◽

Cited By ~ 2

Author(s):

Simone Roque Mazoni ◽

Emilia Campos de Carvalho ◽

Cláudia Benedita dos Santos

Keyword(s):

Facial Expression ◽

Pain Intensity ◽

Muscle Tension ◽

Labor Pain ◽

Active Stage ◽

Clinical Indicators ◽

Uterine Contractions ◽

Nursing Diagnosis ◽

Positive Linear Correlation ◽

Two Stages

OBJECTIVE: The study intends to identify the presence of clinical indicators of pain during labor and to correlate the verbal reference of pain intensity with uterine contractions as a proposal to validate the clinical nursing diagnosis Labor Pain. METHOD: Observational study of the 22 clinical indicators that represented the defining characteristics for the diagnosis. RESULTS: There were 55 participants in labor (18 in the initial active stage, 6 in the final active stage and 31 in both stages), over 18 years old, in their first pregnancy, with effective contractions and cervical dilation of 4cm or more. Among the 22 defining characteristics tested, 6 were present in most participants during the two stages: verbal or codified report, noted evidence of uterine contraction, altered muscle tension, noted evidence of pain, expressive behavior and facial expression of pain. There were differences between the stages in relation to perspiration, facial expression of pain, protective gestures, anodyne position, distractive behavior, self-focus and perineum pressure feeling. CONCLUSIONS: A positive linear correlation was noted between pain intensity scores and the extent of intra-uterine pressure in the initial stage. Labor pain was proven to be compatible with a nursing diagnosis.

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