Engaging nonHIV specialist general practitioners with new priorities in HIV prevention and treatment: qualitative insights from those working in the field

Sexual Health ◽  
2013 ◽  
Vol 10 (3) ◽  
pp. 193 ◽  
Author(s):  
Christy E. Newman ◽  
Michael R. Kidd ◽  
Susan C. Kippax ◽  
Robert H. Reynolds ◽  
Peter G. Canavan ◽  
...  
Keyword(s):  
General Practice ◽  
Hiv Prevention ◽  
Hiv Testing ◽  
General Practitioners ◽  
Hiv Transmission ◽  
Hiv Care ◽  
Timely Initiation ◽  
Practice Nurses ◽  
Societal Issues ◽  
Prevention And Treatment

Background The science of HIV prevention and treatment is evolving rapidly, resulting in renewed calls to increase rates of HIV testing and, in particular, facilitate the timely and possibly earlier initiation of treatment, as this has the potential to dramatically reduce new infections. Little is known about how to engage nonHIV specialist Australian general practitioners (GPs) with these new priorities. Methods: Content related to the engagement of nonHIV specialist GPs in the HIV response was identified within the transcripts of in-depth interviews with policy key informants (n = 24) and general practice clinicians (n = 47) engaged with HIV medicine. A qualitative analysis of the semantic meaning of this content identified three categories of ‘issues’ described by participants. Results: Educational issues referred to a lack of attention to HIV in medical curricula, a perception that HIV care is only provided by HIV-specialist GPs, a need to make HIV testing more ‘routine’ in GP education and a need to strengthen GP awareness of referral options. Organisational issues encompassed time pressures in general practice, and a need for general practice nurses and for rapid testing to become available, as well as formalised peer mentoring and comanagement opportunities. Societal issues included the changing dynamics of HIV transmission and a need to reconnect GPs with the Australian HIV response. Conclusions: To successfully engage nonHIV specialist GPs in the promotion of regular HIV testing and timely initiation of treatment, challenging issues affecting their capacity and willingness must be urgently addressed.

Shifting the Paradigm in HIV Prevention and Treatment Service Delivery Toward Differentiated Care for Youth

2019 ◽  
Author(s):  
Vincent Guilamo-Ramos ◽  
Marco Thimm-Kaiser ◽  
Adam Benzekri ◽  
Donna Futterman
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Service Delivery ◽  
The United States ◽  
Hiv Care ◽  
Health Concern ◽  
Service Needs ◽  
Minority Adolescents ◽  
Prevention And Treatment ◽  
Differentiated Care

Despite significant progress in the fight against HIV/AIDS in the United States, HIV prevention and treatment disparities among key populations remain a national public health concern. While new HIV diagnoses are increasing among people under age 30—in particular among racial, ethnic, and sexual minority adolescents and young adults (AYA)—dominant prevention and treatment paradigms too often inadequately consider the unique HIV service needs of AYA. To address this gap, we characterize persistent and largely overlooked AYA disparities across the HIV prevention and treatment continuum, identify AYA-specific limitations in extant resources for improving HIV service delivery in the United States, and propose a novel AYA-centered differentiated care framework adapted to the unique ecological and developmental factors shaping engagement, adherence, and retention in HIV services among AYA. Shifting the paradigm for AYA to differentiated HIV care is a promising approach that warrants implementation and evaluation as part of reinforced national efforts to end the HIV epidemic in the United States by 2030.

scholarly journals High levels of mild to moderate depression among men who have sex with men and transgender women in Lima, Peru: implications for integrated depression and HIV care

2020 ◽  
Author(s):  
Jerome T. Galea ◽  
Stephanie Marhefka ◽  
Segundo R. León ◽  
Guitele Rahill ◽  
Elena Cyrus ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Transgender Women ◽  
Hiv Care ◽  
Depression Care ◽  
Care Services ◽  
Treatment Services ◽  
Moderate Depression ◽  
Prevention And Treatment ◽  
Patient Health ◽  
Sex With Men

ABSTRACTDepression disproportionally affects people at risk of acquiring or living with HIV and is associated with worse health outcomes; however, depression care is not routinely integrated with HIV prevention and treatment services. Selection of the best depression intervention(s) for integration depends both on the prevalence and severity of depression among potential users. To inform depression care integration in a community-based setting in Lima, Peru, we retrospectively analyzed routinely collected depression screening data from men who have sex with men and transgender women seeking HIV prevention and care services (N=185). Depression was screened for using the Patient Health Questionnaire-9. Prevalence of any depression (PHQ-9 ≥5) was 42% and was significantly associated with the last sexual partner being “casual” (p=0.01). Most (81%) depressive symptoms were mild to moderate (≥5 PHQ-9 ≤14). Integrating depression care with HIV prevention and treatment services in Peru should begin by implementing interventions targeting mild to moderate depression.

scholarly journals Symbiotic relationships in patients' engagements with practice nurses

2021 ◽  
Author(s):  
◽  
Elsa Lally
Keyword(s):  
General Practice ◽  
Narrative Inquiry ◽  
General Practitioners ◽  
Professional Education ◽  
Well Being ◽  
Original Research ◽  
Practice Nurses ◽  
Symbiotic Relationships ◽  
Primary Health ◽  
Health And Well Being

<p>Practice nurses engaging with patients is a daily activity in general practice. However, there is little research to assess these relationships from a primary health care, general practice standpoint. The purpose of this new and original research was to explore from patients' perspectives what occurs in general practice, and to establish how the engagements patients have with practice nurses influences patients' health and well-being. The conceptualisation of symbiotic relationships between practice nurses, general practitioners receptionists and patients described in this study, shows how these relationships work in practice, and how they shaped patients' perspectives of their engagements in the general practice setting. Although each person’s role was independent and capable of existing without the other, a mutually beneficial close association was developed.  From the experiences of 15 patients from seven rural and urban general practices in New Zealand, using Narrative Inquiry methodology informed by life course theory and White’s (2010) dimensions of well-being, the co-constructed stories gathered from the participants were analysed applying a modification of McCormack’s (2001) multiple lens model. Findings from the individual participant stories revealed three major themes – general practice activity, health focused practice, and professional comforting. Each of these themes described aspects of the participants' relationships and engagements with practice nurses that contributed to their health and well-being. The co-constructed stories described participants' relationships and engagements, not only with practice nurses but also with general practitioners and receptionists. The presence of the (often unseen) overarching doctor and of practice nurses filling the gap in patients' care was evident. Patients described practice nurses as both support for the doctor and as autonomous practitioners. Ease of access to practice nurses significantly contributed to patients obtaining competent health promoting care. Particularly cogent were the findings that practice nurses directly contributed to patients' health and well-being through nurses' skilled compassion and skilled companionship. Nurses actively listened to patients' concerns, suggesting strategies to move patients forward, while at the same time, providing space for them to move at their own pace. Receptionists were viewed as the 'fronts people' of the practice who triaged patients' health concerns, making decisions relating to whom the patient consulted, the doctor or the nurse.  By building on existing theories in Narrative Inquiry methodology, data collection and analysis, this research makes an important contribution to nursing knowledge. It provides new perspectives about nurse-patient relationships, as well as other relationships within general practice. The research also demonstrates that while there has been a significant increase in collaboration between nurses and general practitioners over time, this collaboration is distinct from the symbiotic relationships described. The findings have implications for health professionals' everyday practice, and for Primary Health Organisations and District Health Boards when undertaking health professional education and funding reviews. Future research into patients' relationships with practice nurses, doctors and receptionists, and how these relationships contribute to patients' health and well-being is necessary.</p>

scholarly journals Mental health in 2020 for men who have sex with men in the United States

Sexual Health ◽  
2017 ◽  
Vol 14 (1) ◽  
pp. 59 ◽  
Author(s):  
Abigail W. Batchelder ◽  
Steven Safren ◽  
Avery D. Mitchell ◽  
Ivan Ivardic ◽  
Conall O'Cleirigh
Keyword(s):  
Mental Health ◽  
Hiv Prevention ◽  
The United States ◽  
Hiv Care ◽  
Hiv Care Cascade ◽  
Age Related ◽  
The Us ◽  
Prevention And Treatment ◽  
Sex With Men ◽  
Hiv Aids

Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.

Nutrition advice in general practice: the role of general practitioners and practice nurses

2011 ◽  
Vol 17 (2) ◽  
pp. 202 ◽  
Author(s):  
Lana J. Mitchell ◽  
Lesley MacDonald-Wicks ◽  
Sandra Capra
Keyword(s):  
General Practice ◽  
Nutrition Education ◽  
General Practitioners ◽  
Private Practice ◽  
Best Practice ◽  
Online Survey ◽  
Efficient Manner ◽  
Practice Nurses ◽  
Best Practice Guidelines

General practice is an ideal setting to be providing nutrition advice; however, it is important that the role of general practitioners (GPs) and practice nurses in providing nutrition advice is acknowledged and defined. This article aims to discuss the role of GPs and practice nurses in the delivery of nutrition advice. Ten general practitioners and 12 practice nurses from a NSW urban Division of General Practice participated in questionnaires and a Lifescripts© implementation study, as well as their consenting patients receiving Lifescripts© (n = 13). An online survey was conducted with 90 Australian private practice dietitians. Semi-structured telephone interviews were conducted with 52 Australian private practice dietitians. The provision of basic nutrition advice is acknowledged to be part of the role of GPs and practice nurses, as they are the first point of contact for patients, allowing them to raise nutrition awareness. However, it is important that this advice is evidence based and able to be delivered in a time-efficient manner. Increased nutrition education and the availability of appropriate resources and nutrition-related best practice guidelines will assist in this process.

scholarly journals Modeling an Integrated HIV Prevention and Care Continuum to Achieve the Ending the HIV Epidemic Goals

2020 ◽  
Author(s):  
Samuel M. Jenness ◽  
Jordan A. Johnson ◽  
Karen W. Hoover ◽  
Dawn K. Smith ◽  
Kevin P. Delaney
Keyword(s):  
Hiv Prevention ◽  
Hiv Transmission ◽  
Relative Increase ◽  
Retention Rates ◽  
Hiv Care ◽  
Transmission Model ◽  
Hiv Screening ◽  
Substantial Impact ◽  
Hiv Epidemic ◽  
Sex With Men

ABSTRACTObjectiveWe sought to evaluate which combinations of HIV prevention and care activities would have the greatest impact towards reaching the US Ending the HIV Epidemic (EHE) plan goals of reducing HIV incidence at least 75% by 2025 and 90% by 2030.DesignA stochastic HIV transmission model for men who have sex with men (MSM), calibrated to local surveillance estimates in the Atlanta area, a focal EHE target jurisdiction.MethodsModel scenarios varied HIV screening rates relative to current levels, under different assumptions of how HIV-negative MSM would be linked to PrEP initiation, and also considered improvements to HIV care linkage and retention for those screening positive.ResultsA 10-fold relative increase in HIV screening rates (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 43% of infections averted if integrated with PrEP initiation. Improvements to HIV care retention would avert 41% of infections if retention rates were improved 10-fold. If both screening and retention were jointly improved 10-fold, up to 74% of cumulative infections would be averted. Under this scenario, it would take 4 years to meet the 75% EHE goal and 12 years to meet the 90% goal for MSM in Atlanta.ConclusionsInterventions to improve HIV screening linked with PrEP for those screening negative, and HIV care retention would have a substantial impact on HIV prevention. However, additional interventions may be necessary to reach the EHE goal of a 90% reduction in incidence for Atlanta MSM by 2030.

scholarly journals Role Identification: an Impediment to Effective Core Primary Health Care Teamwork?

2021 ◽  
Author(s):  
◽  
Jean Ross
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
General Practitioners ◽  
Team Work ◽  
Role Clarity ◽  
Practice Nurses ◽  
Attitudinal Differences ◽  
Primary Health ◽  
The Future

<p>This study, which is methodologically grounded in qualitative research and philosophically informed by critical social science, explores important aspects of the socio-political context in which practice nurses and general practitioners (core primary health care team) work within a team environment. It is indicated in the literature that there are benefits for improved health care through the development of collaborative teamwork. However, there have been many barriers identified which prevent collaborative teamwork. Amongst the many barriers, is the lack of role clarity and attitudinal differences. Role clarity and attitudinal differences are the topic of this thesis. This thesis explored and highlighted whether the lack of role clarity and attitudinal differences do indeed impede the team's success, and are barriers to teamwork. The views and opinions of practice nurses and general practitioners understanding of their own and each other's current roles within the general practice setting were explored. The participants had the opportunity to discuss together, in focus group meetings, their thoughts on the topic. This raised their awareness of their taken for granted ideas on role and teamwork. Focus groups offered the participants the added opportunity to question each other which allowed for a deeper and more fulfilling understanding of role. New understandings that emerged could lead to alternative models of health care and influence the future delivery and planning of general practice. The thesis concludes by offering a potentially suitable model/framework which has been developed to further the understanding of teamwork in the future.</p>

scholarly journals Client perspectives on an outreach approach for HIV prevention targeting Indonesian MSM and transwomen

2019 ◽  
Vol 35 (5) ◽  
pp. 916-924 ◽  
Author(s):  
Adi Nugroho ◽  
Vicki Erasmus ◽  
Sarah E Krier ◽  
Kusnindyah P Reviagana ◽  
Pipiet A Laksmono ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Hiv Testing ◽  
Qualitative Interviews ◽  
Hiv Care ◽  
Face To Face ◽  
Outreach Workers ◽  
The Face ◽  
Positive Experiences ◽  
Sex With Men ◽  
Prevention Approach

Abstract This study explored clients’ perspective on an outreach approach to promote HIV testing in Indonesia targeting men who have sex with men (MSM) and transgender women (transwomen or waria). Semi-structured qualitative interviews were conducted with 32 individuals (21 MSM and 11 waria) who had received services from outreach workers (OWs) in five cities in Indonesia. Participants in this study reported positive experiences with the outreach approach and perceived OWs as their motivators in accessing HIV testing as well as HIV care and treatment. OWs provided easy-to-understand HIV information. Clients expected OWs to be well-trained and more creative in performing outreach. They perceived that the Internet and social media have helped them considerably to stay in touch with OWs. Yet, they expressed that such virtual contacts could not simply replace the face-to-face contact, especially for waria. Furthermore, clients suggested outreach to be delivered in a more appealing manner, for example through activities that may facilitate clients learning professional or life skills. They also asserted that as an HIV prevention approach, outreach needs to use more positive framing and go beyond HIV and health contents, chiefly for the youth. Future outreach programmes should facilitate OWs in providing tailored services based on the level and type of support that the clients need, and in applying varied proportion and levels of sophistication in the use of online and virtual platforms for outreach.

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