ABSTRACT
[This corrects the article DOI: 10.1186/s40814-016-0087-6.].
ABSTRACT
As people living with HIV (PLHIV) age, knowledge of HIV and the associated care of those aging with HIV will become an increasingly important component of education for long-term care (LTC) providers. This descriptive study piloted two different approaches to distribute narrative-based HIV educational videos. Four LTC facilities were assigned to receive the videos to implement 'as usual' or to receive the videos in addition to blended learning sessions where the videos were shown with facilitated discussion with a nurse educator and a PLHIV. In LTC facilities where external educators were provided, a larger proportion of staff watched the videos. However, increases in staff comfort level providing care to PLHIV were comparable between both groups. Narratives of PLHIV, administrator engagement and coordination of online education were identified as facilitators to improving HIV knowledge and compassion in LTC, while fear of HIV transmission and limited time for education, especially when not mandated or identified as immediately applicable, were identified as barriers. From our findings, HIV-related stigma still exists in LTC and these videos may be a strategy for disseminating basic knowledge about HIV transmission and sensitizing staff to the experience of living with HIV.
Subject(s)
HIV Infections/therapy , Health Personnel/education , Long-Term Care , Videotape Recording/methods , Empathy , HIV Infections/transmission , Humans , Social StigmaABSTRACT
BACKGROUND: In Canada, the majority of HIV-positive pregnant women receive combination antiretroviral therapy that includes a ritonavir-boosted protease inhibitor to prevent mother-to-child HIV transmission. However, protease inhibitor-based combination antiretroviral therapy has been associated with increased rates of preterm, low birth weight, and small for gestational age births. Our previous experimental findings demonstrate that protease inhibitor use during pregnancy is associated with decreased progesterone levels that correlate with fetal growth, and that progesterone supplementation can improve protease inhibitor-induced fetal growth restriction. We hypothesize that HIV-positive pregnant women who receive protease inhibitor-based combination therapy may also benefit from progesterone supplementation during pregnancy. METHODS/DESIGN: In order to test this hypothesis, we have designed an open-label, multi-centre, randomized controlled (parallel group) pilot trial. The initial goal of this trial is to test feasibility and acceptability of our intervention. Forty HIV-positive pregnant women who are either on, or intending to start or switch to a boosted protease inhibitor-based combination antiretroviral regimen will be enrolled from six sites across Ontario, Canada. Twenty-five women will be randomized to self-administer natural progesterone (Prometrium, 200 mg) vaginally every night starting between gestational week 16 and 24 until week 36, and 15 women will be randomized to no intervention. While the participants and treating physicians will not be blinded, the laboratory personnel performing the biochemical and morphological evaluations will be blinded to ensure unbiased evaluation. The primary outcome of the pilot study is the feasibility of enrolment as measured by the recruitment rate and patient-reported reasons to decline participation. Secondary outcomes in participants include safety, acceptability, and adherence to progesterone supplementation. DISCUSSION: Given the safety of intravaginal progesterone and its current use in the general obstetrical population to prevent recurrent preterm delivery, this pilot study will provide data to determine the feasibility of a larger randomized controlled trial to assess the impact of this intervention on improving neonatal health in the context of HIV-positive pregnancies. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02400021.
