Comorbid HIV Infection and Opioid Use Disorder Simulation for Nurse Practitioner Students.

BACKGROUND: Human immunodeficiency virus (HIV) infection and opioid use disorder (OUD) often occur as comorbid conditions. Many nurse practitioners are treating these conditions in their practice. PROBLEM: Most advanced practice registered nursing (APRN) students do not encounter a medically complex patient with both HIV infection and OUD during their clinical experiences. APPROACH: We present an unfolding simulated standardized patient scenario involving both HIV infection and OUD for APRN students. During each of 3 semesters, the students encounter the patient as he presents for a sexually transmitted infection, an OUD relapse, and, finally, new-onset HIV infection. The scenarios become increasingly complex as the students progress in their clinical experiences. CONCLUSION: This innovative series of scenarios introduces APRN students to complex comorbid patient situations, with many issues to consider.

Understanding patient motivations for HIV pre-exposure prophylaxis initiation and adherence.

Consistent dosing of tenofovir/emtricitabine-based HIV pre-exposure prophylaxis (PrEP) can reduce HIV infection risk by up to 92%. However, clinical trials have shown low PrEP adherence (34-71%), resulting in reduced effectiveness. To improve PrEP's effectiveness, adherence to a daily PrEP regimen is essential. This report explores patients' patterns of PrEP initiation and use and their PrEP-related perceptions to provide greater understanding of patient motivations for beginning and adhering to PrEP. At two urban primary care clinics, individual coaching sessions that included semistructured interviews were offered to 10 PrEP patients. Regarding PrEP initiation, 30% of patients were advised to use PrEP by their nurse practitioners (NPs), while the remaining patients requested PrEP themselves. Before they initiated PrEP, all patients were familiar with it through social contacts or internet-based research. Patients' PrEP-related perceptions were identified, including perceived pros and cons of PrEP use, and degrees of PrEP knowledge, uncertainty, and fear. Primary care NPs should take detailed sexual histories to avoid overlooking PrEP candidates. In addition, primary care NPs should introduce easy-to-access, Internet-based resources to reinforce patient education. Last, PrEP promotional campaigns should be focused at the community level in gay, bisexual, transgender and queer populations.