The Social, Mental, and Physical Health Impacts of the COVID-19 Pandemic on People With HIV: Protocol of an Observational International Multisite Study.

ABSTRACT: As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; HIV continuum of care indicators; mental and social health; COVID-19 and vaccination knowledge, attitudes, behaviors, and fears; and overall outcomes. Results of this study will contribute to knowledge that can inform responses to future public health crises to minimize their impacts on vulnerable populations such as PWH.

Experiences of rural nurses with emergency patient transport in a resource limited setting.

BACKGROUND: Registered nurses are primary care providers during most patient transfers from rural areas. Various local conditions and circumstances impact the provision of nursing care prior to and during transportation. These include clinic staffing, uneven access to functioning equipment and other necessary infrastructure across settings, the wide-ranging clinical need for specialty care, and complex social and interpersonal circumstances that play a role in care-seeking and transport decision-making. This study explored the experiences of nurses with emergency patient transport in rural health facilities in Botswana. METHOD: A qualitative descriptive approach was used using a semi structured interview. Twenty-six registered nurses from four remote, isolated rural health districts in Botswana participated in this study. Purposive convenience sampling technique was employed. RESULTS: The ten main themes under transporter were infringement of scope of practice, inadequate knowledge and skills, distressful practice, restriction from making decisions, challenges with staffing, Ineffective facilities clustering, lack of support from the managers, shortage of technology and tools, non-enabling infrastructure, and transport related tasks. DISCUSSION AND CONCLUSION: The perceived ineffective emergency transfer of patients was associated with work system shortfalls. The work system needs to be balanced and consider the requirements of the various stakeholders involved in the processes for optimal performance of patient transport.

Just4Us: Development of a Counselor-Navigator and Text Message Intervention to Promote PrEP Uptake Among Cisgender Women at Elevated Risk for HIV.

ABSTRACT: In the United States, pre-exposure prophylaxis (PrEP) uptake among eligible cisgender women has been slow, despite the availability of oral PrEP since 2012. Although women make up nearly 20% of those living with HIV, there are currently few PrEP uptake interventions for cisgender women at elevated risk for acquiring HIV. Here we describe the process used to design and pre-pilot test Just4Us, a theory-based behavioral intervention to promote PrEP initiation and adherence among PrEP-eligible cisgender women. This work was part of a multiphase study conducted in New York City and Philadelphia, two locations with HIV rates higher than the national average. The counselor-navigator component of the intervention was designed to be delivered in a 60- to 90-min in-person session in the community, followed by several phone calls to support linkage to care. An automated text messaging program was also designed for adherence support. Just4Us addressed personal and structural barriers to PrEP uptake using an empowerment framework by building on women's insights and resources to overcome barriers along the PrEP cascade. Usability pre-pilot testing results were favorable and provided valuable feedback used to refine the intervention.

"They do not see us as one of them": a qualitative exploration of mentor mothers' working relationships with healthcare workers in rural North-Central Nigeria.

BACKGROUND: In HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT). Nigeria has significant PMTCT program gaps, and in this resource-constrained setting, lay health workers such as MMs serve as task shifting resources for formal healthcare workers and facility-community liaisons for their clients. However, challenging work conditions including tenuous working relationships with healthcare workers can reduce MMs' impact on PMTCT outcomes. This study explores the experiences and opinions of MMs with respect to their work conditions and relationships with healthcare workers. METHODS: This study was nested in the prospective two-arm Mother Mentor (MoMent) study, which evaluated structured peer support in PMTCT. Thirty-six out of the 38 MMs who were ever engaged in the MoMent study were interviewed in seven focus group discussions, which focused on MM workload and stipends, scope of work, and relationships with healthcare workers. English and English-translated Hausa-language transcripts were manually analyzed by theme and content in a grounded theory approach. RESULTS: Both intervention and control-arm MMs reported positive and negative relationships with healthcare workers, modulated by individual healthcare worker and structural factors. Issues with facility-level scope of work, workplace hierarchy, exclusivism and stigma/discrimination from healthcare workers were discussed. MMs identified clarification, formalization, and health system integration of their roles and services as potential mitigations to tenuous relationships with healthcare workers and challenging working conditions. CONCLUSIONS: MMs function in multiple roles, as task shifting resources, lay community health workers, and peer counselors. MMs need a more formalized, well-defined niche that is fully integrated into the health system and is responsive to their needs. Additionally, the definition and formalization of MM roles have to take healthcare worker orientation, sensitization, and acceptability into consideration. TRIAL REGISTRATION: Clinicaltrials.gov number NCT01936753 , registered September 3, 2013.

HIV Task Sharing Between Nurses and Physicians in Nigeria: Examining the Correlates of Nurse Self-Efficacy and Job Satisfaction.

A global shortfall of 12.9 million health care workers has been predicted to occur in the next two decades. Task sharing between physicians and nurses, a method used to help compensate for provider shortages, was shown to improve access to antiretroviral therapy in Africa, but led to nurses performing beyond their scopes of practice. We surveyed 508 nurses in task-shifted roles in Nigeria. Respondents (n = 399) provided information on age, years in practice, gender, registration status, employment site, and access to task-sharing training and mentoring. Years in practice negatively influenced task-sharing self-efficacy. Positive correlates of job satisfaction were years in practice, older age, male gender, single licensure, employment at a tertiary hospital, mentoring, and duration of training. System challenges and employment in faith-based and nontertiary hospitals increased likelihood of job dissatisfaction. Supportive practice and policy interventions are needed to minimize negative effects of disparities in job satisfaction across facilities.

Task shifting of HIV management from doctors to nurses in Africa: clinical outcomes and evidence on nurse self-efficacy and job satisfaction.

With 24% global disease burden and 3% global health workforce, the World Health Organization (WHO) designates the African region a critical workforce shortage area. Task shifting is a WHO-recommended strategy for countries with severe health worker shortages. It involves redistribution of healthcare tasks to make efficient use of available workers. Severe physician shortages, increasing HIV disease burden, and the need for improved access to antiretroviral treatment (ART) posed serious challenges for Africa. Shifting ART management from physicians to nurses was adopted by many countries to increase access to treatment. Growing evidence from Africa supports this model of care but little is known about its impact on African nurses. A PubMed literature search was conducted for most recent task-shifting studies in Africa between January 2009 and August 2012. Thirty-four studies were identified but 11 met criteria for "task shifting from physicians to nurses in HIV settings." The methodologies and findings related to patient outcome, nurses' perceived self-efficacy, and job satisfaction were summarized. Patient outcomes were measured in 10 of the studies and all demonstrated comparable results. Seven of eight studies showed no difference in mortality while five found better retention and lower client loss to follow-up in nurse-managed groups. Four studies showed that nurses built on existing nursing and HIV knowledge; improved HIV and other disease management skills; and had increased comfort levels with using treatment guidelines. Results of job satisfaction from three studies showed that nurses expressed "feelings of emotional rewards, accomplishment, prestige, and improved morale." In six studies, nurse-managed care was acceptable to patients in five studies, nurses in two studies, and majority of physicians and program managers in one study. Nurse-managed care had comparable outcomes and retained more patients but only two studies "directly" assessed nurses' perceptions. Research exploring nurses' response, self-efficacy, and job satisfaction are critically to sustainability.

Organizational learning and the development of global health educational capabilities: critical reflections on a decade of practice.

This paper describes the process of organizational global health capability development at the University of Maryland Baltimore over the past decade. Theories of organizational learning and of organizational capabilities are applied in this retrospective analysis of organizational innovations in global health education within UMB as well as in the University of Maryland School of Nursing.

Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors.

BACKGROUND: Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria. METHODS AND FINDINGS: We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100-200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent. CONCLUSIONS: These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.