HIV is a current global health issue associated with unprecedented losses both economically and in terms of human life. The virus is associated with over 32 deaths globally. As of 2018, about 37 million people were living with HIV across the globe with 62 percent adults and 54 percent children being from low and middle income countries (“HIV/AIDS. Who.int.,” 2019). In USA, over one million people are living with the infection with approximately14% not being aware of their condition (“U.S. Statistics. HIV.gov” 2019). Due to the dangers posed by the virus, intervention measures should be proactive rather than reactionary when it progresses to AIDS.
Contributing Factors
The virus is spread through exchange of bodily fluids between an infected person and one who is HIV negative. The involved bodily fluids include semen, blood, breast milk, vaginal and rectal fluids. Having unprotected sex with an infected person is the most rampant form of contracting the virus with others being sharing body piercing objects, an infected mother breastfeeding their infants, and transfusing infected blood into a health person (“HIV/AIDS. Who.int.,” 2019). One thus acknowledges that human behaviors are at the center of HIV global health problem.
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Prevention strategies
Human caution is the central pillar that define HIV prevention strategies. People can reduce HIV infections by limiting exposure to contributing factors. Correct and consistent use of protection during sexual intercourse is crucial in checking the spread of the virus (“HIV/AIDS. Who.int.,” 2019). There are condoms for both men and women which should be used during vaginal and anal penetration. Second, conducting testing and counselling sessions for HIV and other STIs (“HIV/AIDS. Who.int.,” 2019). Anybody at a high risk of HIV is always advised to seek testing and counseling services subsequently more people know their HIV status and access the essential prevention and management services. Medical male circumcision helps reduce the risk of heterosexually acquired HIV in men by about 60 percent (“HIV/AIDS. Who.int.,” 2019). Hence, men should undergo voluntary medical male circumcision (VMMC). Antiretroviral treatment (ART) is the other approach that has been proven to reduce the risk of infection. Research has confirmed that if an infected person strictly adheres to ART, the risk of transmission reduces approximately by 96 percent (“HIV/AIDS. Who.int.,” 2019). Breastfeeding mothers strictly following medical guidelines on breastfeeding and medical practitioners testing blood for HIV before transfusion. Also, people should avoid sharing piercing objects with others.
Signs and symptoms
HIV symptoms are dependent of the phase of infection with the first few weeks after one contracts the virus being lethal infection stage. During this time, the virus reproduces rapidly while the immune system produces antibodies to fight the infection. During this phase, many people do not show any signs with the first signs exhibiting themselves in the first two months. Some of the indicators include fever, chills, sore throat, inflamed lymph nodes, and nausea among others. During the clinical phase which lasts for a few years, one may have nonspecific symptoms like headaches, recurrent fever, night sweats, fatigue, nausea, diarrhea, and weight loss. Without treatment and testing these symptoms can escalate to severe diseases such as TB and cancers such as lymphomas, Kaposi’s sarcoma in the later virus stages (“HIV/AIDS. Who.int.,” 2019).
Diagnostic Tests
Testing for HIV should be done on a voluntary basis and a person the right to decline a test should be respected. Blood tests are the most common methods used in ascertaining HIV status in individuals and they are designed to look for antibodies that fight the virus. If an individual becomes exposed to HIV, they should get tested immediately (“HIV Diagnosis”). There are several diagnostic tests that can be performed on a person but the most common ones include:
Enzyme-Linked Immunosorbent Assay (ELISA)
ELISA is commonly used to measure antibodies, antigens, and proteins in biological samples. Hence, it has been used to test for HIV fighting antibodies in people exposed to the virus. A person who tests negative from an ELISA but feels that they may have HIV should be tested again after three months. A positive ELISA tests should be followed by a Western blot test for confirmation purposes (“HIV Diagnosis”).
Viral Load Test
This test is used to measures the amount of HIV viruses in the blood. The test is based on three technologies that include RT-PCR, Bdna, and, NASBA which are all based on the same principle of binding of DNA sequence.
Western Blot
Western Blot confirms the results of a positive ELISA test. The test is administered by taking a samples of blood to detect HIV antibodies by separating the blood proteins thus detecting specific HIV antibodies. A combination of a Western Blot and ELISA is always 99.9% accurate (“Western blot test”).
Advanced Practice Nursing Role and Management Strategies
Clinical Practice
Clinical is the most prominent aspect of HIV advanced practice role for nurses. As an experienced practitioner, a nurse must determine expert problem solving and refined clinical decision making skills while collaborating with a wider multidisciplinary team. At an advanced level, nurses must acknowledge the diversity of HIV patients while working from diagnosis through to medication and treatment and care management (“ National HIV Nurses Association” 2016 ).
Service Assessment, Enhancement, and Research
A nurse must be able to extend the boundaries of their professional practice by searching for better service delivery approaches. Therefore, they must learn to evaluate their service delivery to support further care development, audit the evidence to understand quality and safety of care, and conduct high quality research. All these should be guided by the need to improve patient experience. with the value of patient experience in mind (“ National HIV Nurses Association” 2016 ).
Headship, Consultancy, and Development for Future Nursing Practice
At an advanced level, a nurse should continually work at redefining the limits of their career to include better care for HIV patients. For one to actualize this, they must always question their scope of practice and assess outcomes while striving to create new nursing knowledge within the realm of HIV (“ National HIV Nurses Association” 2016 ).
Medical Management
Up to now, there is no cure for HIV/AIDS but there are several medications that are used to control the virus thus preventing opportunistic diseases. Such medications are called antiretroviral therapy (ART). A HIV positive person should be started on ART at the earliest time possible. ART is composed of a three drug or more combination and its major goal is to reduce a patient’s viral load to undetectable levels. A person with undetectable viral load has effectively no risk of infecting HIV to their HIV negative partners through sexual intercourse. ART works by preventing the multiplication of HIV viruses in the blood thus reducing the amount of HIV in the body (“HIV Treatment”, 2020). Having less HIV virus count in the body boost the immune system by allowing it to produce more CD4 cells.
Follow-up Care
Care for people with HIV does not end after testing or treatment. Since HIV viruses cannot be eradicated in the body, patients need uninterrupted treatment with ART by physicians. Follow-up care include regular physical examinations and medical tests. Nurses and doctors must keep track of the patients’ recovery trajectory in the months and years after testing positive (“Follow-Up Actions for Patients with Confirmed HIV-Positive Test Results”, 2013). Follow up plan will be dictated by the nature of opportunistic diseases.
Conclusion
Though HIV has no cure, it is highly manageable through the use of ART. A person who suspects that they may have been exposed to HIV should get tested immediately. There are several tests that are available and once one is confirmed as positive they should embark on medication. Strict adherence to ART is key to maintaining undetectable viral load.
References
Follow-Up Actions for Patients with Confirmed HIV-Positive Test Results . Health.ny.gov. (2013). Retrieved 19 June 2020, from www.health.ny.gov/diseases/aids/providers/testing/followup_confirmed_positive.htm.
HIV Diagnosis . ucsfhealth.org. Retrieved 19 June 2020, from www.ucsfhealth.org/conditions/hiv/diagnosis#:~:text=Tests%20for%20HIV%20and%20AIDS,administered%20to%20confirm%20the%20diagnosis.
HIV Treatment: The Basics Understanding HIV/AIDS . AIDSinfo. (2020). Retrieved 19 June 2020, from aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/51/hiv-treatment--the-basics.
HIV/AIDS . Who.int. (2019). Retrieved 19 June 2020, from www.who.int/news-room/fact-sheets/detail/hiv-aids .
National HIV Nurses Association. (2016). Advanced Nursing Practice in HIV Care: Guidelines for nurses, doctors, service providers and commissioners [Ebook] (1st ed.). Retrieved 19 June 2020, from www.nhivna.org/file/cXYDBwZTSnKNV/Advanced-Nursing-practice-in-HIV-care-2016.pdf .
U.S. Statistics . HIV.gov. (2019). Retrieved 19 June 2020, from www.hiv.gov/hiv-basics/overview/data-and-trends/statistics#:~:text=Fast%20Facts,and%20gay%20and%20bisexual%20men .
Western blot test . Stanfordhealthcare.org. Retrieved 19 June 2020, from stanfordhealthcare.org/medical-conditions/sexual-and-reproductive-health/hiv-aids/diagnosis/western-blot-test.html#:~:text=The%20Western%20blot%20test%20separates,combined%20tests%20are%2099.9%25%20accurate .
