Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes

Expert Consensus on an Exercise Prescription Framework for Older People Living With HIV in a South African Setting-A Delphi Study

ABSTRACT

Well-established, regular exercise interventions for older people living with HIV (OPLWH) are beneficial. However, the fundamental principles of exercise prescription for this population have not been sufficiently explored. An expert panel of health care professionals engaged in a modified Delphi technique to explore their perceptions of, and gain their consensus on, an exercise prescription framework for OPLWH in a resource-poor South African setting. A high level of agreement among participants was determined using a priori threshold of 80% agreement and an interquartile range of ≤ 1. Expert consensus was reached on a structured, multifaceted exercise prescription and also fundamental principles, such as multidisciplinary engagement and team collaboration, pre-exercise health screening, and exercise supervision. These were viewed as necessary components of a framework to improve the integration of exercise rehabilitation in the treatment, care, and support for OPLWH.

Exploring the Perspectives of Older Adults Living With HIV on Virtual Care: Qualitative Study

Background

As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV.

Objective

This study aimed to understand the perceptions of older adults living with HIV regarding virtual care.

Methods

Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes.

Results

The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access.

Conclusions

By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities.

Definition, Measurement, Precursors, and Outcomes of Trust Within Health Care Teams: A Scoping Review

PURPOSE

This scoping review aims to map the breadth of the literature examining how trust is defined in health care teams, describe what measurements of trust are used, and investigate the precursors and outcomes of trust.

METHOD

Five electronic databases (Ovid MEDLINE, CINAHL, PsycInfo, Embase, and ASSIA [Applied Social Sciences Index and Abstracts]) were searched alongside sources of gray literature in February 2021. To be included, studies needed to discuss a health care team directly involved in managing patient care and one aspect of trust as a relational concept. A content count of the definitions of trust and tools used to measure trust and a deductive thematic analysis of the precursors and outcomes of trust in health care teams were conducted.

RESULTS

Ultimately, 157 studies were included after full-text review. Trust was the main focus of 18 (11%) studies and was not routinely defined (38, 24%). Ability appeared to be key to the definition. Trust was measured in 34 (22%) studies, often using a bespoke measure (8/34, 24%). The precursors of trust within health care teams occur at the individual, team, and organizational levels. The outcomes of trust occur at the individual, team, and patient levels. Communication was a broad overarching theme that was present at all levels, both as a precursor and outcome of trust. Respect, as a precursor, influenced trust at the individual, team, and organizational levels, while trust influenced learning, an outcome, across the patient, individual, and team levels.

CONCLUSIONS

Trust is a complex, multilevel construct. This scoping review has highlighted gaps in the literature, including exploration of the swift trust model, which may be applicable to health care teams. Furthermore, knowledge from this review may be integrated into future training and health care practices to optimize team processes and teamworking.

Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature

ABSTRACT

The field of HIV research has grown over the past 40 years, but there remains an urgent need to address challenges that cisgender women living in the United States experience in the HIV neutral status care continuum, particularly among women such as Black women, who continue to be disproportionately burdened by HIV due to multiple levels of systemic oppression. We used a social ecological framework to provide a detailed review of the risk factors that drive the women's HIV epidemic. By presenting examples of effective approaches, best clinical practices, and identifying existing research gaps in three major categories (behavioral, biomedical, and structural), we provide an overview of the current state of research on HIV prevention among women. To illustrate a nursing viewpoint and take into account the diverse life experiences of women, we provide guidance to strengthen current HIV prevention programs. Future research should examine combined approaches for HIV prevention, and policies should be tailored to ensure that women receive effective services that are evidence-based and which they perceive as important to their lives.

Primary Care and Public Health Collaboration Reports: A Qualitative Review of Integration Aims, Participants, and Success Determinants

This qualitative review of 57 published case reports aimed to analyze primary care and public health integration efforts in 45 states to summarize collaboration aims, participants, and systemic, organizational, and interactional success determinants. Chronic disease management, maternal and child health, and wellness and health promotion were the most commonly reported aims of collaboration between primary care and public health entities in the United States. Typical participants were government public health structures, health delivery systems, communities, academia, state professional medical associations, and employers and businesses. Systemic, organizational, and interactional determinants included adequate funding, multiple stakeholder engagement, leadership, data and information sharing, capitalization on collaborator resources, community engagement, steering committees, effective communication, regular meetings, shared mission, vision, and goals, previous positive relationships, collaborations, and partnerships. The present study contributes to the body of knowledge of when, where, and under what contextual circumstances collaboration and integration have been perceived as effective. Future research could extrapolate which determinants are more essential than others and focus on how systemic, organizational, and interactional factors are interrelated. To advance the practice of successful integration between primary care and public health entities, longitudinal research is needed to examine the degree of integration and sustainability.

Exploring Risk Factors Affecting the Mental Health of Refugee Women Living with HIV

Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting the mental health of refugee women living with HIV. A total of eight refugee women living with HIV took part in the study; they were individually interviewed, and their transcripts were thematically analyzed. The overall findings indicated that participants’ mental health was impaired by multiple stressors associated with their conditions, such as racial discrimination, HIV-related stigma, including from health professionals, loneliness, and resettlement adversities. These all represent threats to public health, as they discourage individuals from engaging with adequate health/mental health services. Despite their situation, participants had not received psychological interventions and their healthcare was reduced to managing the physical symptoms of HIV. Participants indicated their need to take part in group interventions that could promote their mental health and social recovery. These findings are relevant to raising awareness about the specific risk factors affecting refugee women living with HIV and to provide evidence for public health interventions based on this specific population’s need.