Building Capacity of Community Nurses to Strengthen the Management of Uncomplicated Hypertension in Persons Living with HIV in Low- and Middle-Income Countries

Objectives

Poor training of non-physician healthcare workers (especially community nurses) could hinder the successful integration of cardiovascular disease (CVD) management into HIV chronic care in primary healthcare facilities in low- and middle-income countries. To address this limitation, we included a holistic training programme with a robust module for both practice facilitators and community nurses as part of the formative stages of the managing hypertension among people living with HIV: an integrated model (MAP-IT), which is a study that is evaluating the effectiveness of practice facilitation on the integration of a task-strengthening strategy for hypertension control (TASSH) into primary healthcare centres in Akwa Ibom State of Nigeria.

Methods

Between June and November 2021, 3 didactic training workshops were conducted using a training module which is based on the simplified Nigerian Hypertension Protocol for primary care and the World Health Organization (WHO) heart package. Knowledge acquired by the participants was assessed using anonymized pre- and post-training assessments in the first two workshops. Participants' view of the training was assessed using a comprehensive course evaluation questionnaire.

Results

A total of 92 community nurses and six practice facilitators were trained in the workshops on managing hypertension in persons living with HIV. Mean pre- and post-test scores improved from 11.9(3.4) to 15.9(2.9); p < 0.001 in the first workshop, and from 15.4(0.9) to 16.4 (1.4); p < 0.001 in the second workshop. The methodology used in the training, understanding of the MAP-IT study programme, and the level of engagement was highly rated by the participants with LIKERT scores of 3.2/4.0, 3.2/4.0, and 3.1/4.0 respectively.

Conclusion

Our training methodology, which involved the train-the-trainer model to deliver simplified HIV and HTN care guidelines, showed improvement in the knowledge of managing hypertension in persons living with HIV and was highly rated by participants.

Annonaceae) on candida species isolated from stage II HIV patients

BACKGROUND

Candida species (sp) is implicated in causing opportunistic disseminated mycotic complications in stage II HIV patients. Cleistopholis patens is a West African medicinal tree reported to have significant antifungal activity against C. albicans.

OBJECTIVES

This study aimed to determine the anti-candidal activity of methanolic leaf extract of Cleistopholis patens against Candida species isolated from stage II HIV patients.

METHODS

The minimum inhibitory concentration (MIC) of the extract and Nystatin®® was determined by agar dilution method. The killing rate studies of the plant extract and Nystatin® were also determined.

RESULTS

The extract had activity against all Candida isolates, with the MIC against the five isolates ranging from 6.0 - 9.8 mg/ml. Nystatin® also demonstrated plausible activity against the isolates with MICs ranging from 0.3125 - 25 mg/ml. Candida albicans strain 2 was the most sensitive to both extract and Nystatin® with MIC values of 6 and 0.3125 mg/ml respectively. Candida krusei was the least sensitive with MIC values of 9.8 and 25 mg/ml for the extract and Nystatin® respectively. The killing rate values for the extract ranged from -0.029 to -0.091 min(-1) and that of Nystatin® ranged from -0.076 to -0.11216 min(-1).

CONCLUSIONS

The results indicate that the methanolic extract of Cleistopholis patens is a promising clinical alternative besides Nystatin® in the treatment of infections caused by Candida species in stage II HIV patients.