Nurses Tackle Tough Topics That Keep People in HIV Care

Heather Boerner

November 03, 2016

ATLANTA — Now that HIV treatment is highly effective, nurses can shift their focus from explaining drugs and side effects to patients to making sure that people living with HIV get on therapy and stay on it.

That continuum of HIV care will be the focus here at the Association of Nurses in AIDS Care (ANAC) 2016, said Carole Treston, RN, MPH, chief nursing officer of the association.

"The idea is that no one is left behind in care and no one is left behind in cure," Treston told Medscape Medical News. "The way that happens is to get people engaged in care, on meds, and staying on meds."

But that is a challenge. Right now, only 86% of people living with HIV know they have it, and only 40% of those are in care. And the virus is fully suppressed in only 30% of patients.

In addition to continuum of care, psychosocial and structural barriers to help will be featured at the meeting. There will be sessions on access to health services, HIV stigma, and the internalized homophobia and racism that often underlie stigma.

As nurses, "we develop clinical expertise in the framework of human rights and social justice," Treston said.

We develop clinical expertise in the framework of human rights and social justice. Carole Treston

At the meeting, members will be able to tour the only public health pre-exposure prophylaxis (PrEP) clinic in Georgia, which is housed at the Fulton County Department of Health's sexual health clinic. They can also attend a panel on Magnet, the nurse-led PrEP program in San Francisco, California.

Nurse-Led PrEP Rollout

These presentations are part of the larger ANAC PrEP implementation program. Last year, ANAC created a learning module to help members create and find funding for HIV prevention services in their clinics. This year, the focus is on expanding those services outside of HIV clinics and into sexual health clinics like the one in Fulton County.

This approach is important, Treston said, "because if your clinic is Ryan White Care–funded, the law requires your patients to be HIV positive."

The keynote address will be delivered by Carl Dieffenbach, PhD, director of the Division of AIDS at the National Institute of Allergies and Infectious Diseases, National Institutes of Health.

"He'll be talking about the cure agenda and the role of science in moving cure forward," said Jeffrey Kwong, DNP, MPH, from Columbia University in New York City, who is cochair of the conference. "I don't think we've ever been able to sit down and have a session on this."

But HIV is not the only disease state that will be discussed in terms of cure. Advances in direct-acting antivirals against hepatitis C will be reported during a plenary session by Michael Saag, MD, from the University of Alabama at Birmingham.

Because as many as one in three people living with HIV is coinfected with hepatitis C virus, it is important that nurses and other professionals at the bedside understand how the two diseases — and treatments for each — interact.

"What happens after the cure?" Kwong asked. "I hope we'll hear about monitoring and the role nurses play in terms of preventing reinfections and staying healthy."

Retention in Care

"Nurses play a pivotal role in helping patients remain in care," said Kwong. "We're the front-line people to notice any changes and to alert the care team to issues that could affect retention and linkage to care."

During the meeting there will be panels on the roles nurses play in getting patients into care and keeping them there.

A panel on linkage to care will include Carlos del Rio, MD, from Emory University in Atlanta. "He's a big proponent of the role of nurses," said Treston. "And his experience in the South [where the majority of the need is], in Atlanta, will be of great interest to our members."

There will also be sessions on intimate-partner violence and trauma, and on mental healthcare and HIV. And during a session on the way the criminalization of HIV affects retention in care, which will be led by Treston, a rack card with clinical guidance on HIV criminalization and patients will be distributed.

There will also be sessions that will help nurses ramp up their skills to improve patient retention in care. A morning-and-afternoon session on motivational interviewing is designed to help patients understand the medications they're being prescribed and to understand the social and cultural aspects of being on a medication for, in some cases, the next 50 years.

"This is one of the ways that the nursing approach is different than the medicine approach," Treston explained. "It's a holistic view. You're not just treating the illness, but also the patient's response to the illness. How do we support the patient's response to their illness, and how do we help them navigate that response?"

Another skill-building session will explore ways to work with transgender patients. Although transgender women have extremely high rates of HIV, many ANAC members are not well acquainted with this population, Treston pointed out.

"It's the same as anything else: how do you build skills? What's your comfort level? How do you address people? What matters most to them?" she said.

Congressman John Lewis, a longtime supporter of HIV funding, will deliver the closing night plenary and will receive the association's public service award.

Kwong said he expects the congressman's talk will address all the overlapping social and structural issues that affect the lives of people with HIV.

"When you think about human rights and social justice issues, especially with HIV, we think about marginalized populations," Kwong noted. "Congressman Lewis has been a true advocate for underserved populations and for people with HIV."

Ms Treston has disclosed no relevant financial relationships. Mr Kwong is a member of the speakers bureau for Gilead Sciences.

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