NRS 493 Grand Canyon University Wk 3 HIV and AIDS Pandemic Capstone Project PICOT Question Paper Review your problem or issue and the study materials to

NRS 493 Grand Canyon University Wk 3 HIV and AIDS Pandemic Capstone Project PICOT Question Paper

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

Evidence-based solution
Nursing intervention
Patient care
Health care agency
Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide

*PICOT: IN HIV positive high risk patients would in-depth counseling/education sessions with the nurse practitioner regarding u=u (Undetectable=Untransmittable) result in increased self reported status disclosure and medication adherence when compared to patients who receive written information only over a 3 month period? Running head: BENCHMARK CAPSTONE CHANGE PROJECT OBJECTIVE
Benchmark Capstone Change Project Objective
Khatriena Johnson
Grand Canyon University
Professional Capstone and Practicum
NRS-493-0507
Chris Bartholomew
July 1, 2020
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BENCHMARK CAPSTONE CHANGE PROJECT OBJECTIVE
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Benchmark Capstone Change Project Objective
Objectives:
1. To increase Medication Compliance-Medication compliance keeps the viral load
low; this prevents the patient from converting to AIDS, which opens them up to
opportunistic infections.
2. Increase awareness- Awareness gives insight into how the disease works, who it
affects, possible outcomes, morbidity, and mortality.
3. Prevent and or decrease transmission/New Cases of HIV: U=U
(Undetectable=Untransmitable) educates on the effects of having an undetectable
viral load preventing the ability to transmit HIV/AIDS to others.
4. Increase status disclosure: Having a clear understanding of U=U helps to educate
sex partners, family, and friends without fear, given the inability to transmit the
disease because of undetectable status.
5. Decrease and or prevent discrimination and the stigma associated with
HIV/AIDS: Educating the public on U=U. The effects and outcomes of
medication compliance, such as being undetectable, make it impossible to pass
the virus can change how HIV/AIDS is viewed. It will no longer be associated
with death, illness, and uncleanness. But it will be recognized as another chronic
illness that can be treated and managed. Patients can live normal healthy lives and
conceive children without the threat of infecting others.
Living with HIV/AIDS is often a challenge. Many face discrimination, depression, low
self-esteem, fear, and poverty due to the stigma associated with having a diagnosis of
HIV/AIDS. Lack of education, misinformation, understanding, and cultural bias prevents
status disclosure. Fear and embarrassment cause noncompliance with treatment and
BENCHMARK CAPSTONE CHANGE PROJECT OBJECTIVE
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follow through on doctors’ appointments. Patients that go undiagnosed and untreated and
are not only predisposed to death and opportunistic infections but have a higher level of
the virus in their system, which makes them highly infectious and put others at a much
higher risk of contracting the disease. Implementing Undetectable =
Untransmittable (U=U) into the education plan for both HIV positive and HIV negative
patients will serve to decrease the overall social impact of this disease but also help to
prevent new transmissions, increase medication compliance, help to fight & address the
stigma associated with HIV/AIDS as well as bring an overall awareness to the
modernization and advancements in HIV treatment that enables those infected to be
functionally cured from the effects of the disease. It also helps to educate the community
on the nature of the disease, positive outcomes related to treatment, and compliance while
providing hope and giving evidence of living a healthy normal life.
BENCHMARK CAPSTONE CHANGE PROJECT OBJECTIVE
4
References
HIV Undetectable=Untransmittable (U=U), or Treatment as Prevention. (2019). Retrieved from
https://www.niaid.nih.gov/diseases-conditions/treatment-prevention
Turan, B., Budhwani, H., Fazeli, P. L., Browning, W. R., Raper, J. L., Mugavero, M. J., &
Turan, J. M. (2017, January 21). How Does Stigma Affect People Living with HIV? The
Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived
Community Stigma on Health and Psychosocial Outcomes. AIDS and Behavior.
https://doi.org/10.1007/s10461-016-1451-5
Why Is U=U a Game Changer? Undetectable = Untransmittable (U=U) campaign. (2020).
Retrieved from https://www.oar.nih.gov/about/directors-corner/why-is-u-equals-u-gamechanger
AIDS Behav (2016) 20:126–136
DOI 10.1007/s10461-015-1022-1
ORIGINAL PAPER
The ‘Fears’ of Disclosing HIV Status to Sexual Partners: A Mixed
Methods Study in a Counseling Setting in Ghana
D. Obiri-Yeboah • D. Amoako-Sakyi •
I. Baidoo • A. Adu-Oppong • T. Rheinla?nder
Published online: 26 February 2015
Springer Science+Business Media New York 2015
Abstract Encouraging disclosure within a trusting and
supportive environment is imperative in dealing with HIV/
AIDS related stigma. However, disclosure rates and the
factors that influence it are vaguely understood in African
societies. This study aimed at determining the disclosure
rate and factors that influence disclosure in Cape Coast,
Ghana. In-depth interviews of 15 peer educators and a
survey of 510 PLHIV were used in a mixed methods study
design. Majority of the study participants (78.6 %) had
disclosed their HIV positive status to their sexual partners.
Although peer educators in this study portrayed the overall
outcome of disclosure to be negative, 84.0 % of disclosers
were accepted by their partners without negative consequences after disclosure. This study suggests that the
This article is about the issues of disclosure of positive HIV status to
sexual partners. This is discussed in the context of the Ghanaian
socio-cultural setting and the issues of navigating intimate
relationships by people living with HIV. The discussion helps reveal
possible strategies to help made disclosure of HIV positive status to
sexual partners more likely to occur in a safe manner and thus lead to
the potential benefits stated in literature.
D. Obiri-Yeboah (&) D. Amoako-Sakyi
Department of Microbiology, School of Medical Sciences,
University of Cape Coast, PMB, Cape Coast, Ghana
e-mail: d.obiri-yeboah@uccsms.edu.gh
I. Baidoo
ART Center, Cape Coast Teaching Hospital,
P.O. Box CT 1363, Cape Coast, Ghana
A. Adu-Oppong
Department of Community Medicine, School of Medical
Sciences, University of Cape Coast, Cape Coast, Ghana
T. Rheinla?nder
Department of Public Health, University of Copenhagen,
Copenhagen, Denmark
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existing support services ill prepares newly diagnosed HIV
positive clients and hampers disclosure initiatives. Providing comprehensive support services and re-training peer
educators may be crucial in creating a safe disclosure environment in Ghana.
Keywords
HIV Disclosure Sexual partners Ghana
Introduction
While the overall global incidence of HIV seem to have
stabilized in recent years, the incidence of HIV among
married or cohabiting heterosexual couples has remained
high in many parts of Africa [1–3]. The estimated adult
national HIV prevalence in Ghana was 1.37 % in 2012
with an estimated 235,982 persons living with HIV and
AIDS. Among adults, 7,139 new infections are estimated to
have occurred in Ghana in 2012 [4]. A central factor influencing the incidence of HIV among married and cohabiting couples mentioned in studies in the African setting
is HIV disclosure status, defined as the readiness of people
living with HIV (PLHIV) to inform their sexual partners of
their HIV positive status.
A study in Ghana showed that the issue of disclosure
within a trusting and supportive environment may be an
important strategy in dealing with AIDS related stigma [5].
In another study in Ghana, the sexual risk behavior of
adults living with HIV was found to be affected by whether
they had disclosed to their sexual partners or not [6]. Increasingly, disclosure of HIV status to sexual partners by
PLHIV is being recognized as a crucial part of HIV prevention. The benefits of disclosure are several. First, the
infected partner will be able to adhere to schedules given
for clinical care and antiretroviral therapy (ART) with
AIDS Behav (2016) 20:126–136
support from the partner as shown in studies in Uganda,
Zambia and China [7–9]. Also, the infected partner can
better deal with the initial confusion and despair with the
emotional and practical support received from the partner
as demonstrated in studies from San Francisco, and Uganda
[10, 11]. In situations where discordant couples decide to
have a child, they can be supported to achieve a pregnancy
with reduced risk to the uninfected partner if disclosure of
the positive status has occurred [12]. In addition, if found
to be infected, the partner can know his or her HIV status in
the early asymptomatic phase, which is a strong correlate
for slow disease progression and better prognosis compared
with people diagnosed in the symptomatic phase. This has
been shown in studies across diverse settings such as
Nigeria, South Korea and Georgia [13–15]. Finally, prevention of mother to child transmission (PMTCT) of HIV
also has a better chance of succeeding when partners disclose their HIV status. Many studies in developing African
countries including Ghana have indicated that when men
are aware of the status of their HIV positive pregnant
women, they are often supportive and encourage adherence
to ART and other PMTCT interventions [16–19]. However
disclosing HIV status to an intimate partner, presents with
many moral, emotional and relational challenges. Fear of
domestic violence, economic and emotional repercussions
from partners etc. have been documented in studies in
various settings including South Africa and Nigeria [20–
22].
The policy on disclosure in Ghana requires that all
newly diagnosed clients receive counseling on disclosure
and partner notification. The clients are encouraged and
allowed to disclose either by themselves at home or in the
presence of the counselor to their sexual partners. The
policy does not allow counselors to disclose a client’s
HIV status to partner(s) without consent from the positive
client. Hence, counselors need to be better informed on
the factors that influence client’s willingness to disclose
their HIV status. However, literature on the rate of disclosure to sexual partners, disclosure outcomes and factors influencing disclosure in the Ghanaian socio-cultural
context are scarce. An important first-step in encouraging
disclosure is to establish the disclosure rate in a Ghanaian
setting and adequately understand what informs the decision to disclose or not and the implications this can have
on disclosure support initiatives in Ghana. This study
therefore aimed at determining the disclosure rate and
factors that influence disclosure in Cape Coast, Ghana.
This is done in order to suggest ways to help HIV positive
clients to disclose their HIV status in safe ways to ultimately improve their social, reproductive and health
prospects. Findings from this study may provide fresh
insights on how HIV positive clients can be counseled to
increase disclosure rates in Ghana. Increased disclosure
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rates may in turn improve their prognosis, social and reproductive health.
Methods
This study was a mixed method study among HIV positive
clients receiving care in the Cape Coast Teaching Hospital
(CCTH) in the Cape Coast Metropolis of Ghana. This facility
has a well-established HIV clinic with about 3,000 registered
clients. In 2011 the Central region recorded the highest HIV
prevalence of 4.7 % and the Cape Coast metropolis had the
highest HIV prevalence across the country of 9.6 %. This
was a significant rise from the 2010 regional prevalence of
1.7 and 2.2 % for Cape Coast Metropolis and these influenced the choice of this as an important study site.
The proposal for this study was first reviewed by the
ethical review committee of the School of Medical Sciences of the University of Cape Coast, Ghana. Final ethical
approval was obtained from the institutional review board
of the University of Cape Coast, Ghana. Semi- structured
in-depth interviews were conducted with 15 purposively
selected key-informants (Ten females, five males, aged
between 28 and 48 years). Initially five peer educators at
the ART center who are themselves leaders in various associations supporting PLHIV in the region were recruited
and interviewed. Through snowball sampling [23] ten additional leaders were identified and recruited from the
various associations of PLHIV across the region. These
participants, by their positions had in-depth knowledge of
the situation of a larger number of PLHIV and hence could
offer an insider perspective on the challenges of disclosure
to sexual partners. The interviews were of a narrative nature [24, 25] with clients allowed to respond to four open
ended questions and sharing their stories and experiences:
1.
2.
3.
4.
From your own experience and that of members of
your association, what can you tell me about the issue
of disclosure of HIV positive status to sexual partners?
Tell me some of the stories you hear about the experiences
of people when they disclose their HIV status
Do you think it is good to tell your sexual partner about
your HIV status?
What do you think could be done to make it possible
for people to disclose to their sexual partners?
Each interview lasted between 45 and 60 min and was
conducted in the mother tongue of Fante, or English as preferred by the informants. Written informed consent was obtained from all respondents before the interviews were
conducted. The responses were transcribed ad verbatim into
English and analyzed using a thematic approach [24, 26] in
which text was thoroughly read through several times, coded
and organized into main themes. The themes which are
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128
presented in this paper include the perceptions of real or
imagined ‘fears’ associated with disclosure strategies, experiences with managing intimate relationships when disclosing
and health care implications of disclosure and non-disclosure.
All the interviews were conducted by the first author, a
female doctor who has an extensive knowledge in supporting
PLHIV and has been actively engaged in diagnosis and
treatment of HIV clients in the region and the specific clinic
since 2006. The author knew all 15 key-informants prior to the
interviews and could therefore relate to their experiences and
build rapport for the interviewees to express themselves
freely. Based on the findings from interviews, a structured
questionnaire in English was developed and used to gather
information from a total of 510 respondents on factors influencing disclosure. The maximum sample size required at
95 % confidence interval and 50 % response distribution and
a population size of 20,000 was 377. Adjusting for non-response or incomplete responses a total of 510 clients were
surveyed. Respondents were systematically recruited among
PLHIV visiting the clinic for their routine management on
each clinic day between November 2012 and March 2013.
Inclusion criteria were: being HIV positive, being 18 years or
above and being sexually active. After obtaining written informed consent, respondents who spoke English answered the
questionnaire themselves. Those who could not read English
were assisted by three research assistants, who had all received
training by the first author in confidentially, explaining and
obtaining written informed consent, administering the questionnaire in the local language of Fante and managing the data
collected. The themes of the questionnaire included: sociodemographic characteristics, how and why they disclosed or
not disclose their HIV status to sexual partner(s), the effect
disclosure or lack of it on their lives and their intimate relationships, and their views on the current disclosure policy in
Ghana and suggestions to help PLHIV disclosure.
Questionnaire data was entered into STATA statistical
software without patient identifiers and analyzed (Release10;
Stata Corporation, College Station, TX, USA). Descriptive
analyses were conducted to generate frequencies and percentages. Person Chi square test was done for some categorical data to determine statistical significance among groups.
A p value of B0.05 was deemed significant. Univariate and
multivariate analysis were conducted to test for associations
between demographic characteristics and disclosure.
Results
Demographic Characteristic of Study Participants
and Disclosure Status
Table 1 shows the demographic characteristics of the participants, the circumstance of HIV diagnosis and partners’
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AIDS Behav (2016) 20:126–136
HIV status. The mean age of the 510 total participants from
the quantitative data was 41.26 years with majority being
women (82.5 %), and the majority belonging to the
Christian faith (92.1 %). Most participants were either
living together with a partner in a legal marriage (49.8 %)
or cohabiting with a sexual partner without being legally
married (30.2 %). The rest lived alone and reported having
occasional sexual partners.
Most respondents reported being diagnosed with HIV as
part of a health provider initiated testing at a health facility
due to symptoms suggestive of HIV/AIDS (n = 383,
75.1 %). This was followed by women who were tested at
antenatal clinics as part of routine HIV testing for pregnant
women (n = 65, 12.7 %).
Whiles 78.6 % (n = 401) of respondents had disclosed
their HIV positive status to their sexual partners, only 48.2 %
(n = 246) of them knew of the HIV status of their sexual
partners. Twenty-three percent of respondents did not know
if their partners had tested for HIV and 22.4 % reported that
their partners had out rightly refused to be tested.
Factors Associated with Disclosure and Disclosure
Process
Out of 510 respondents, 78.6 % (n = 401) had disclosed their
HIV status to partners at the time of the survey, while 21.4 %
(n = 109) had still not disclosed. Table 2 shows the associations between demographic and socio-economic factors
with the odds of disclosing HIV status to partners. The results
shows that those who conceal their HIV status from partners
are significantly younger (median age = 38.11 years.) than
those who disclose (median age = 42.11 years)
(p 0.0001). Those living alone with occasional sexual
partners were less likely to disclose their HIV status compared
to those who are married (p 0.05; OR = 0.52; CI
(0.30–0.92)). Interestingly, cohabiting individuals were more
likely to disclose their HIV status to partners compared to
married (p 0.0001; OR 2.39 (1.34–4.35)).
The results also revealed some important challenges
relating to disclosure and relationships: those who had not
disclosed their own HIV status to their partners had a
higher likelihood of having partners who refused to test
(p 0.0001 OR = 0.01 CI (0.00–0.05)). In addition, the
odds of having their partners disclose their HIV status was
greatly reduced for those who had not disclosed themselves
(p 0.0001 OR = 0.01 CI (0.00–0.05)). These findings
point towards some crucial barriers for disclosure related to
relationship dynamics, which will be further investigated in
the qualitative data.
Next stage of the analysis concentrated on investigating
the process of disclosure including the motivating factors
leading to a decision to disclose and the responses of sexual
partners (See Table 3). In total, 84.0 % (n = 337) of
AIDS Behav (2016) 20:126–136
Table 1 General characteristics
of study population
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Characteristics
N = 510 (%) [range]
Mean age (years)
40 (20–75)
Sex
Male
89 (17.5)
Female
421 (82.5)
Disclosure status
Disclosed
401 (78.6)
Undisclosed
109 (21.4)
Level of education
No education
143 (28.0)
Primary school
79 (15.5)
Junior secondary school
228 (44.7)
Secondary and above
60 (11.8)
Religion
Christian
470 (92.1)
Moslem
Traditional
32 (6.3)
8 (1.6)
Relationship type
Single (with occasional sexual partners)
16 (3.1)
Married
254 (49.8)
Cohabiting (lives with a partner but not legally married)
154 (30.2)
Divorced (with occasional sexual partners)
47 (9.2)
Widowed (with occasional sexual partners)
39 (7.6)
Employment status
Employed
424 (83.1)
Unemployed
86 (16.9)
HIV diagnosis
Health provider initiated test
383 (75.1)
Client initiated walk-in test in a health facility
44 (8.6)
During a community testing and counseling campaign
18 (3.5)
Routine testing and counseling at antenatal clinic
65 (12.7)
Partner’s HIV status
Positive
115 (22.5)
Negative
131 (25.7)
I do not know if my partner tested
119 (23.3)
Partne…
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